Intest Res.  2016 Apr;14(2):111-119. 10.5217/ir.2016.14.2.111.

Changing epidemiological trends of inflammatory bowel disease in Asia

• Ng WK
• Wong SH
• Ng SC

• KMID: 2425283
• DOI: http://doi.org/10.5217/ir.2016.14.2.111

Abstract

Inflammatory bowel disease (IBD) has become more common in Asia over the past few decades. The rate of increase in prevalence of the disease varies greatly in Asia, with several countries in East Asia experiencing a more than doubled increase in IBD prevalence over the past decade. Historically, ulcerative colitis (UC) is more common than Crohn's disease (CD) in Asia. However, a reverse trend is beginning to appear in more developed countries in Asia such as Japan, Korea, and Hong Kong. While Asian IBD patients share many similarities with their Western counterparts, there are important differences with significant clinical implications. In Asia, there are more men with CD, more ileo-colonic involvement in CD, less familial aggregation, fewer extra-intestinal manifestations and worse clinical outcomes for older-onset patients with UC. These differences are likely related to the different genetic makeup and environmental exposures in different regions. Evaluation of the differences and rates in epidemiologic trends may help researchers and clinicians estimate disease burden and understand the reasons behind these differences, which may hold the key to unravel the etiology of IBD.

Keyword

Inflammatory bowel diseases; Colitis, ulcerative; Crohn disease; Asia; Epidemiology

MeSH Terms

Asia*
Asian Continental Ancestry Group
Colitis, Ulcerative
Crohn Disease
Developed Countries
Environmental Exposure
Epidemiology
Far East
Hong Kong
Humans
Inflammatory Bowel Diseases*
Japan
Korea
Male
Prevalence

Reference

1. Danese S, Fiocchi C. Etiopathogenesis of inflammatory bowel diseases. World J Gastroenterol. 2006; 12:4807–4812. PMID: 16937461.

2. Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012; 142:46–54.e42. PMID: 22001864.

3. Thia KT, Loftus EV Jr, Sandborn WJ, Yang SK. An update on the epidemiology of inflammatory bowel disease in Asia. Am J Gastroenterol. 2008; 103:3167–3182. PMID: 19086963.

4. Ng SC, Tang W, Ching JY, et al. Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn's and colitis epidemiology study. Gastroenterology. 2013; 145:158–165.e2. PMID: 23583432.

5. Cosnes J, Gower-Rousseau C, Seksik P, Cortot A. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011; 140:1785–1794. PMID: 21530745.

6. Zhao J, Ng SC, Lei Y, et al. First prospective, population-based inflammatory bowel disease incidence study in mainland of China: the emergence of "western" disease. Inflamm Bowel Dis. 2013; 19:1839–1845. PMID: 23669403.

7. Yang H, Li Y, Wu W, et al. The incidence of inflammatory bowel disease in Northern China: a prospective population-based study. PLoS One. 2014; 9:e101296. DOI: 10.1371/journal.pone.0101296. PMID: 25029440.

8. Hilmi I, Jaya F, Chua A, Heng WC, Singh H, Goh KL. A first study on the incidence and prevalence of IBD in Malaysia–results from the Kinta Valley IBD Epidemiology Study. J Crohns Colitis. 2015; 9:404–409. PMID: 25744112.

9. Sood A, Midha V, Sood N, Bhatia AS, Avasthi G. Incidence and prevalence of ulcerative colitis in Punjab, North India. Gut. 2003; 52:1587–1590. PMID: 14570727.

10. Lee EJ, Kim TO, Song GA, et al. Clinical features of Crohn's disease in Korean patients residing in Busan and Gyeongnam. Intest Res. 2016; 14:30–36. PMID: 26884732.

11. Kaplan GG. The global burden of IBD: from 2015 to 2025. Nat Rev Gastroenterol Hepatol. 2015; 12:720–727. PMID: 26323879.

12. Morita N, Toki S, Hirohashi T, et al. Incidence and prevalence of inflammatory bowel disease in Japan: nationwide epidemiological survey during the year 1991. J Gastroenterol. 1995; 30(Suppl 8):1–4. PMID: 8563866.

13. Asakura K, Nishiwaki Y, Inoue N, Hibi T, Watanabe M, Takebayashi T. Prevalence of ulcerative colitis and Crohn's disease in Japan. J Gastroenterol. 2009; 44:659–665. PMID: 19424654.

14. Japanese Ministry of Health, Labour and Welfare. Handbook of Health and Welfare Statistics 2014 Contents. Table 2-22 Number of persons with specific (intractable) disease healthcare certificate by disease and sex. http://www.mhlw.go.jp/english/database/db-hh/2-1.html.

15. Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology. 2004; 126:1504–1517. PMID: 15168363.

16. Kappelman MD, Rifas-Shiman SL, Kleinman K, et al. The prevalence and geographic distribution of Crohn's disease and ulcerative colitis in the United States. Clin Gastroenterol Hepatol. 2007; 5:1424–1429. PMID: 17904915.

17. Yang SK, Yun S, Kim JH, et al. Epidemiology of inflammatory bowel disease in the Songpa-Kangdong district, Seoul, Korea, 1986-2005: a KASID study. Inflamm Bowel Dis. 2008; 14:542–549. PMID: 17941073.

18. Kim HJ, Hann HJ, Hong SN, et al. Incidence and natural course of inflammatory bowel disease in Korea, 2006-2012: a nationwide population-based study. Inflamm Bowel Dis. 2015; 21:623–630. PMID: 25647154.

19. Yoshida Y, Murata Y. Inflammatory bowel disease in Japan: studies of epidemiology and etiopathogenesis. Med Clin North Am. 1990; 74:67–90. PMID: 2404182.

20. Leong RW, Lau JY, Sung JJ. The epidemiology and phenotype of Crohn's disease in the Chinese population. Inflamm Bowel Dis. 2004; 10:646–651. PMID: 15472528.

21. Kuo CJ, Yu KH, See LC, et al. The trend of inflammatory bowel diseases in Taiwan: a population-based study. Dig Dis Sci. 2015; 60:2454–2462. PMID: 25837597.

22. Ng SC, Tsoi KK, Kamm MA, et al. Genetics of inflammatory bowel disease in Asia: systematic review and meta-analysis. Inflamm Bowel Dis. 2012; 18:1164–1176. PMID: 21887729.

23. Chua KH, Hilmi I, Ng CC, et al. Identification of NOD2/CARD15 mutations in Malaysian patients with Crohn's disease. J Dig Dis. 2009; 10:124–130. PMID: 19426395.

24. Liu JZ, van Sommeren S, Huang H, et al. Association analyses identify 38 susceptibility loci for inflammatory bowel disease and highlight shared genetic risk across populations. Nat Genet. 2015; 47:979–986. PMID: 26192919.

25. Halfvarson J, Jess T, Magnuson A, et al. Environmental factors in inflammatory bowel disease: a co-twin control study of a Swedish-Danish twin population. Inflamm Bowel Dis. 2006; 12:925–933. PMID: 17012962.

26. Orholm M, Binder V, Sørensen TI, Rasmussen LP, Kyvik KO. Concordance of inflammatory bowel disease among Danish twins. Results of a nationwide study. Scand J Gastroenterol. 2000; 35:1075–1081. PMID: 11099061.

27. Thompson NP, Driscoll R, Pounder RE, Wakefield AJ. Genetics versus environment in inflammatory bowel disease: results of a British twin study. BMJ. 1996; 312:95–96. PMID: 8555939.

28. Carr I, Mayberry JF. The effects of migration on ulcerative colitis: a three-year prospective study among Europeans and first- and second- generation South Asians in Leicester (1991-1994). Am J Gastroenterol. 1999; 94:2918–2922. PMID: 10520845.

29. Jayanthi V, Probert CS, Pinder D, Wicks AC, Mayberry JF. Epidemiology of Crohn's disease in Indian migrants and the indigenous population in Leicestershire. Q J Med. 1992; 82:125–138. PMID: 1620813.

30. Probert CS, Jayanthi V, Pinder D, Wicks AC, Mayberry JF. Epidemiological study of ulcerative proctocolitis in Indian migrants and the indigenous population of Leicestershire. Gut. 1992; 33:687–693. PMID: 1307684.

31. Benchimol EI, Mack DR, Guttmann A, et al. Inflammatory bowel disease in immigrants to Canada and their children: a population-based cohort study. Am J Gastroenterol. 2015; 110:553–563. PMID: 25756238.

32. Benchimol EI, Manuel DG, To T, et al. Asthma, type 1 and type 2 diabetes mellitus, and inflammatory bowel disease amongst South Asian immigrants to Canada and their children: a population-based cohort study. PLoS One. 2015; 10:e0123599. DOI: 10.1371/journal.pone.0123599. PMID: 25849480.

33. van der Heide F, Dijkstra A, Weersma RK, et al. Effects of active and passive smoking on disease course of Crohn's disease and ulcerative colitis. Inflamm Bowel Dis. 2009; 15:1199–1207. PMID: 19170191.

34. Calkins BM. A meta-analysis of the role of smoking in inflammatory bowel disease. Dig Dis Sci. 1989; 34:1841–1854. PMID: 2598752.

35. Boyko EJ, Koepsell TD, Perera DR, Inui TS. Risk of ulcerative colitis among former and current cigarette smokers. N Engl J Med. 1987; 316:707–710. PMID: 3821808.

36. Sutherland LR, Ramcharan S, Bryant H, Fick G. Effect of cigarette smoking on recurrence of Crohn's disease. Gastroenterology. 1990; 98:1123–1128. PMID: 2323505.

37. Cosnes J, Beaugerie L, Carbonnel F, Gendre JP. Smoking cessation and the course of Crohn's disease: an intervention study. Gastroenterology. 2001; 120:1093–1099. PMID: 11266373.

38. Prideaux L, Kamm MA, De Cruz P, et al. Comparison of clinical characteristics and management of inflammatory bowel disease in Hong Kong versus Melbourne. J Gastroenterol Hepatol. 2012; 27:919–927. PMID: 22098103.

39. Naganuma M, Iizuka B, Torii A, et al. Appendectomy protects against the development of ulcerative colitis and reduces its recurrence: results of a multicenter case-controlled study in Japan. Am J Gastroenterol. 2001; 96:1123–1126. PMID: 11316158.

40. Jiang L, Xia B, Li J, et al. Risk factors for ulcerative colitis in a Chinese population: an age-matched and sex-matched case-control study. J Clin Gastroenterol. 2007; 41:280–284. PMID: 17426467.

41. Koutroubakis IE, Vlachonikolis IG, Kouroumalis EA. Role of appendicitis and appendectomy in the pathogenesis of ulcerative colitis: a critical review. Inflamm Bowel Dis. 2002; 8:277–286. PMID: 12131612.

42. Frisch M, Pedersen BV, Andersson RE. Appendicitis, mesenteric lymphadenitis, and subsequent risk of ulcerative colitis: cohort studies in Sweden and Denmark. BMJ. 2009; 338:b716. DOI: 10.1136/bmj.b716. PMID: 19273506.

43. Beaugerie L, Sokol H. Appendicitis, not appendectomy, is protective against ulcerative colitis, both in the general population and first-degree relatives of patients with IBD. Inflamm Bowel Dis. 2010; 16:356–357. PMID: 19685454.

44. IBD in EPIC Study Investigators. Tjonneland A, Overvad K, et al. Linoleic acid, a dietary n-6 polyunsaturated fatty acid, and the aetiology of ulcerative colitis: a nested case-control study within a European prospective cohort study. Gut. 2009; 58:1606–1611. PMID: 19628674.

45. Jantchou P, Morois S, Clavel-Chapelon F, Boutron-Ruault MC, Carbonnel F. Animal protein intake and risk of inflammatory bowel disease: The E3N prospective study. Am J Gastroenterol. 2010; 105:2195–2201. PMID: 20461067.

46. Jowett SL, Seal CJ, Pearce MS, et al. Influence of dietary factors on the clinical course of ulcerative colitis: a prospective cohort study. Gut. 2004; 53:1479–1484. PMID: 15361498.

47. Riordan AM, Ruxton CH, Hunter JO. A review of associations between Crohn's disease and consumption of sugars. Eur J Clin Nutr. 1998; 52:229–238. PMID: 9578334.

48. Hou JK, Abraham B, El-Serag H. Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. Am J Gastroenterol. 2011; 106:563–573. PMID: 21468064.

49. Shoda R, Matsueda K, Yamato S, Umeda N. Epidemiologic analysis of Crohn disease in Japan: increased dietary intake of n-6 polyunsaturated fatty acids and animal protein relates to the increased incidence of Crohn disease in Japan. Am J Clin Nutr. 1996; 63:741–745. PMID: 8615358.

50. Sakamoto N, Kono S, Wakai K, et al. Dietary risk factors for inflammatory bowel disease: a multicenter case-control study in Japan. Inflamm Bowel Dis. 2005; 11:154–163. PMID: 15677909.

51. Ng SC, Tang W, Leong RW, et al. Environmental risk factors in inflammatory bowel disease: a population-based case-control study in Asia-Pacific. Gut. 2015; 64:1063–1071. PMID: 25217388.

52. Virta L, Auvinen A, Helenius H, Huovinen P, Kolho KL. Association of repeated exposure to antibiotics with the development of pediatric Crohn's disease–a nationwide, register-based finnish case-control study. Am J Epidemiol. 2012; 175:775–784. PMID: 22366379.

53. Shaw SY, Blanchard JF, Bernstein CN. Association between the use of antibiotics and new diagnoses of Crohn's disease and ulcerative colitis. Am J Gastroenterol. 2011; 106:2133–2142. PMID: 21912437.

54. Hviid A, Svanström H, Frisch M. Antibiotic use and inflammatory bowel diseases in childhood. Gut. 2011; 60:49–54. PMID: 20966024.

55. Bernstein CN, Wajda A, Svenson LW, et al. The epidemiology of inflammatory bowel disease in Canada: a population-based study. Am J Gastroenterol. 2006; 101:1559–1568. PMID: 16863561.

56. Vind I, Riis L, Jess T, et al. Increasing incidences of inflammatory bowel disease and decreasing surgery rates in Copenhagen City and County, 2003-2005: a population-based study from the Danish Crohn colitis database. Am J Gastroenterol. 2006; 101:1274–1282. PMID: 16771949.

57. Yao T, Matsui T, Hiwatashi N. Crohn's disease in Japan: diagnostic criteria and epidemiology. Dis Colon Rectum. 2000; 43(10 Suppl):S85–S93. PMID: 11052483.

58. Jiang L, Xia B, Li J, et al. Retrospective survey of 452 patients with inflammatory bowel disease in Wuhan city, central China. Inflamm Bowel Dis. 2006; 12:212–217. PMID: 16534423.

59. Loftus EV Jr, Sandborn WJ. Epidemiology of inflammatory bowel disease. Gastroenterol Clin North Am. 2002; 31:1–20. PMID: 12122726.

60. Jiang XL, Cui HF. An analysis of 10218 ulcerative colitis cases in China. World J Gastroenterol. 2002; 8:158–161. PMID: 11833094.

61. Wang YF, Zhang H, Ouyang Q. Clinical manifestations of inflammatory bowel disease: East and West differences. J Dig Dis. 2007; 8:121–127. PMID: 17650222.

62. Zeng Z, Zhu Z, Yang Y, et al. Incidence and clinical characteristics of inflammatory bowel disease in a developed region of Guangdong Province, China: a prospective population-based study. J Gastroenterol Hepatol. 2013; 28:1148–1153. PMID: 23432198.

63. Oriuchi T, Hiwatashi N, Kinouchi Y, et al. Clinical course and longterm prognosis of Japanese patients with Crohn's disease: predictive factors, rates of operation, and mortality. J Gastroenterol. 2003; 38:942–953. PMID: 14614601.

64. Chow DK, Leong RW, Lai LH, et al. Changes in Crohn's disease phenotype over time in the Chinese population: validation of the Montreal classification system. Inflamm Bowel Dis. 2008; 14:536–541. PMID: 18058793.

65. Ng SC. Epidemiology of inflammatory bowel disease: focus on Asia. Best Pract Res Clin Gastroenterol. 2014; 28:363–372. PMID: 24913377.

66. Park SH, Yang SK, Park SK, et al. Long-term prognosis of Crohn's disease and its temporal change between 1981 and 2012: a hospital-based cohort study from Korea. Inflamm Bowel Dis. 2014; 20:488–494. PMID: 24412992.

67. Sachar DB, Bodian CA, Goldstein ES, et al. Is perianal Crohn's disease associated with intestinal fistulization? Am J Gastroenterol. 2005; 100:1547–1549. PMID: 15984979.

68. Eglinton TW, Barclay ML, Gearry RB, Frizelle FA. The spectrum of perianal Crohn's disease in a population-based cohort. Dis Colon Rectum. 2012; 55:773–777. PMID: 22706129.

69. Beaugerie L, Seksik P, Nion-Larmurier I, Gendre JP, Cosnes J. Predictors of Crohn's disease. Gastroenterology. 2006; 130:650–656. PMID: 16530505.

70. Prideaux L, Kamm MA, De Cruz PP, Chan FK, Ng SC. Inflammatory bowel disease in Asia: a systematic review. J Gastroenterol Hepatol. 2012; 27:1266–1280. PMID: 22497584.

71. Orholm M, Munkholm P, Langholz E, Nielsen OH, Sorensen TI, Binder V. Familial occurrence of inflammatory bowel disease. N Engl J Med. 1991; 324:84–88. PMID: 1984188.

72. Peeters M, Nevens H, Baert F, et al. Familial aggregation in Crohn's disease: increased age-adjusted risk and concordance in clinical characteristics. Gastroenterology. 1996; 111:597–603. PMID: 8780562.

73. Yang H, McElree C, Roth MP, Shanahan F, Targan SR, Rotter JI. Familial empirical risks for inflammatory bowel disease: differences between Jews and non-Jews. Gut. 1993; 34:517–524. PMID: 8491401.

74. Roth MP, Petersen GM, McElree C, Vadheim CM, Panish JF, Rotter JI. Familial empiric risk estimates of inflammatory bowel disease in Ashkenazi Jews. Gastroenterology. 1989; 96:1016–1020. PMID: 2925048.

75. Kochhar R, Mehta SK, Nagi B, Bhatia V, Goenka MK, Malik AK. Extraintestinal manifestations of idiopathic ulcerative colitis. Indian J Gastroenterol. 1991; 10:88–89. PMID: 1916969.

76. Bandyopadhyay D, Bandyopadhyay S, Ghosh P, et al. Extraintestinal manifestations in inflammatory bowel disease: Prevalence and predictors in Indian patients. Indian J Gastroenterol. 2015; 34:387–394. PMID: 26614005.

77. Greenstein AJ, Janowitz HD, Sachar DB. The extra-intestinal complications of Crohn's disease and ulcerative colitis: a study of 700 patients. Medicine (Baltimore). 1976; 55:401–412. PMID: 957999.

78. Monsén U, Sorstad J, Hellers G, Johansson C. Extracolonic diagnoses in ulcerative colitis: an epidemiological study. Am J Gastroenterol. 1990; 85:711–716. PMID: 2353691.

79. Rankin GB, Watts HD, Melnyk CS, Kelley ML Jr. National Cooperative Crohn's Disease Study: extraintestinal manifestations and perianal complications. Gastroenterology. 1979; 77:914–920. PMID: 467943.

80. Ling KL, Ooi CJ, Luman W, Cheong WK, Choen FS, Ng HS. Clinical characteristics of ulcerative colitis in Singapore, a multiracial city-state. J Clin Gastroenterol. 2002; 35:144–148. PMID: 12172359.

81. Fujimoto T, Kato J, Nasu J, et al. Change of clinical characteristics of ulcerative colitis in Japan: analysis of 844 hospital-based patients from 1981 to 2000. Eur J Gastroenterol Hepatol. 2007; 19:229–235. PMID: 17301650.

82. Kim BJ, Yang SK, Kim JS, et al. Trends of ulcerative colitis-associated colorectal cancer in Korea: A KASID study. J Gastroenterol Hepatol. 2009; 24:667–671. PMID: 19378391.

83. Fujita T, Ando T, Watanabe O, et al. Clinicopathological study of colorectal cancer occurring in patients with ulcerative colitis: results from a single hospital in Japan. Hepatogastroenterology. 2010; 57:487–492. PMID: 20698214.

84. Dobbins WO 3rd. Dysplasia and malignancy in inflammatory bowel disease. Annu Rev Med. 1984; 35:33–48. PMID: 6372661.

85. Eaden JA, Abrams KR, Mayberry JF. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut. 2001; 48:526–535. PMID: 11247898.

86. Charpentier C, Salleron J, Savoye G, et al. Natural history of elderly-onset inflammatory bowel disease: a population-based cohort study. Gut. 2014; 63:423–432. PMID: 23408350.

87. Riegler G, Tartaglione MT, Carratú R, et al. Age-related clinical severity at diagnosis in 1705 patients with ulcerative colitis: a study by GISC (Italian Colon-Rectum Study Group). Dig Dis Sci. 2000; 45:462–465. PMID: 10749318.

88. Triantafillidis JK, Emmanouilidis A, Pomonis E, et al. Ulcerative colitis in the elderly: clinical patterns and outcome in 51 Greek patients. J Gastroenterol. 2001; 36:312–316. PMID: 11388393.

89. Lee JH, Cheon JH, Moon CM, et al. Do patients with ulcerative colitis diagnosed at a young age have more severe disease activity than patients diagnosed when older? Digestion. 2010; 81:237–243. PMID: 20110709.

90. Shi HY, Chan FK, Leung WK, et al. Natural history of elderly-onset ulcerative colitis: results from a territory-wide inflammatory bowel disease registry. J Crohns Colitis. 2016; 10:176–185. PMID: 26512132.

91. Matsumoto S, Miyatani H, Yoshida Y. Ulcerative colitis: comparison between elderly and young adult patients and between elderly patients with late-onset and long-standing disease. Dig Dis Sci. 2013; 58:1306–1312. PMID: 23306844.

92. Ananthakrishnan AN, Shi HY, Tang W, et al. Systematic review and meta-analysis: phenotype and clinical outcomes of older-onset inflammatory bowel disease. J Crohns Colitis. [published online ahead of print February 29, 2016]. DOI: 10.1093/ecco-jcc/jjw054.