• Humans
• Inflammatory Bowel Diseases/epidemiology
• Inflammatory Bowel Diseases/therapy
• Inflammatory Bowel Diseases/diagnosis
• Asia/epidemiology
• Prevalence
• Risk Factors
• Incidence
• Quality of Life
• Genetic Predisposition to Disease
• Comorbidity
• Delayed Diagnosis
• Male
• Asia, Southern

• K23 DK129762 NIDDK NIH HHS

• Characteristics
• Crohn's disease
• Epidemiology
• Inflammatory bowel disease
• South Asia
• Systematic review
• Ulcerative colitis

• Epidemiology
• inflammatory bowel disease
• risk factors

• Humans
• Incidence
• Inflammatory Bowel Diseases/epidemiology
• Inflammatory Bowel Diseases/therapy
• Risk Factors
• Prevalence
• Child
• Adolescent
• Smoking/epidemiology
• Smoking/adverse effects
• Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
• Adult
• Contraceptives, Oral/adverse effects
• Global Health/statistics & numerical data
• Anti-Bacterial Agents/therapeutic use

• Pfizer

• Crohn’s and Colitis
• Crohn’s disease
• Epidemiology
• Health systems
• Inflammatory bowel disease

• Humans
• Crohn Disease/diagnosis
• Crohn Disease/epidemiology
• Crohn Disease/therapy
• Cross-Sectional Studies
• Developing Countries
• Inflammatory Bowel Diseases/epidemiology
• Colitis, Ulcerative/epidemiology

• Leona M. and Harry B. Helmsley Charitable Trust

• Berberine
• IFN-γ
• Inflammation
• Ulcerative colitis

• Crohn's disease
• Epidemiology
• Montreal classification
• Upper gastrointestinal Crohn's disease

• Female
• Humans
• Male
• Crohn Disease/classification
• Crohn Disease/epidemiology
• Disease Progression
• Phenotype
• Prevalence
• Risk Factors
• Sex Factors
• Upper Gastrointestinal Tract/pathology

• Crohn disease
• epidemiology
• inflammatory bowel diseases
• population-based
• ulcerative colitis

Inflammatory bowel disease (IBD) is increasing in the Asia-Pacific region, with changes in disease phenotype and course. We aimed to assess the changing phenotypes of IBD over ten years, describe the early clinical course (ECC) and identify the clinical predictors (CP) of poor outcomes among a large, multi-centre, cohort of Sri Lankan IBD patients.

We included patients [diagnosed between June/2003–December/2009-Group-1(G1), January/2010–June/2016-Group-2(G2)] with ulcerative colitis (UC) and Crohn disease (CD) from five national-referral centres. Changing phenotype from G1 to G2, ECC (disease duration < 3-years) and CP of poor outcomes (disease duration ≥ 1-year) was assessed. Poor outcomes were complicated-disease (CompD-stricturing/penetrating-CD, extensive-UC/pancolitis, perforation/bleeding/colectomy/malignancy) and treatment-refractory disease (TRD-frequently-relapsing, steroid-dependent/refractory and biologic use).

375 (UC-227, CD-148) patients were recruited. Both G1/G2 had more UC than CD (77% vs 23%, 54.5 vs 45.5 respectively, p < 0.01). Increase of CD from G1-to-G2 was significant (23–45.4%, p < 0.001). In both groups, left-sided colitis (E2) and ileo-colonic (L3)/non-stricturing, non-penetrating disease behaviour (B1) CD predominated. Extensive-colitis (E3) (36.4% vs 22.7, p < 0.05) and stricturing-CD (B2) (26.1% vs 4.0%, p < 0.01) was commoner in G1. ECC was assessed in 173-patients (UC-94, CD-79). Aggressive disease behaviour and TRD were low among both UC and CD. Immunomodulator use was significantly higher among CD than UC (61.5% vs 29.0% respectively, p < 0.01). Anti-TNF use was low among both groups (UC-3.2%, CD-7.7%). Disease complications among UC [bleeding (2.1%), malignancy-(1.1%), surgery-(2.1%)] and CD [stricture-(3.9%), perforation-(1.3%), malignancy-(1.3%), surgery-(8.9%)] were generally low. CPs were assessed in 271-patients (UC-163, CD-108). Having a family history of IBD (for UC), extraintestinal manifestation (EIM), severe disease at presentation, being in younger age categories and severe disease at presentation, (for both UC and CD) predicted poor outcomes.

There was an increase in CD over time without change in disease phenotype for both UC and CD. A relatively benign ECC was observed. Family history (UC), EIMs (UC/CD), severe disease at presentation (UC/CD), younger age (CD/UC) CPs of poor outcomes.

• Clinical course
• Clinical predictors
• Crohn disease
• Inflammatory bowel disease
• Phenotype
• Sri Lanka
• Ulcerative colitis

• Crohn’s disease
• Diagnostic/Treatment capacity
• Low and lower-middle income countries
• Scoping review
• Service utilization

• Crohn Disease/diagnosis
• Crohn Disease/epidemiology
• Crohn Disease/therapy
• Developing Countries
• Egypt
• Humans
• India
• Remission Induction
• Tunisia

• ATG16L1
• IRGM
• Crohn disease
• genetic polymorphism
• single nucleotide polymorphism

Symptomatic ulcerative colitis (UC) can be a chronic, disabling condition. Flares in disease activity are associated with many of the negative impacts of mild-to-moderate UC. Rapid resolution of flares can provide benefits to patients and healthcare systems. i Support Therapy–Access to Rapid Treatment (iSTART) introduces patient-centered care for mild-to-moderate UC. iSTART provides patients with the ability to self-assess symptomology and self-start a short course of second-line treatment when necessary. An international panel of experts produced consensus statements and recommendations. These were informed by evidence from systematic reviews on the epidemiology, mesalazine (5-ASA) treatment, and patient use criteria for second-line therapy in UC. Optimized 5-ASA is the first-line treatment in all clinical guidelines, but may not be sufficient to induce remission in all patients. Corticosteroids should be prescribed as second-line therapy when needed, with budesonide MMX^® being a preferred steroid option. Active involvement of suitable patients in management of UC flares has the potential to improve therapy, with patients able to show good accuracy for flare self-assessment using validated tools. There is a place in the UC treatment pathway for an approach such as iSTART, which has the potential to provide patient, clinical and economic benefits.

• Colitis, ulcerative
• Consensus guidelines
• Corticosteroids
• Mesalazine
• Patient reported outcome measures

There is increasing prevalence of inflammatory bowel disease (IBD) in Asia, but Sri Lankan data on the state of epidemiology and clinical course of IBD are scarce.

A hospital‐based study was done by recruiting IBD patients who permanently reside in the Central Province (population 2.57 million, 12.6% of Sri Lankan population) of Sri Lanka. Cases were confirmed by standard criteria and data were collected from health records and patient interviews at clinic visits and hospital admissions.

There were 200 cases of IBD; (ulcerative colitis [UC]—140, Crohn's disease [CD]—60, microscopic colitis—7). The crude prevalence rate of UC was 5.44/100 000 (95% CI 5.41–5.47/100 000) and CD was 2.33/100 000 (95% CI 2.31–2.35/100 000). Female to male ratios were 1:0.8 for UC but 1:1.5 for CD.

Mean age at diagnosis was 42.0 and 31.9 years for UC and CD, respectively. One UC and one CD patient had positive family history of IBD. Among the UC patients, 60.7%, 24.3%, and 15% had proctitis, left sided, and extensive disease, respectively. At presentation, 62.1% of the UC patients have had moderately severe disease. 60% of the CD patients had only large bowel involvement and 80% had nonstricturing and nonpenetrating disease. Extra intestinal manifestations were present in 45.7% and 60.0% of UC and CD patients, respectively, in which peripheral arthralgia and arthritis being the commonest. 6.4% of UC and 23.3% of the CD patients (total of 23) required infliximab for induction of remission.

The prevalence of IBD in the Central Province of Sri Lanka is lower than other Asian and Western populations. There is a predominance of male gender and isolated colonic disease in CD patients. UC patients have an equal gender distribution and a higher proportion of proctitis. CD needed induction with infliximab than UC.

• Sri Lanka
• clinical course
• disease characteristics
• induction of remission
• prevalence of ibd

• Colorectal cancer
• Crohn disease
• Genetics
• Pregnancy
• Ulcerative colitis

Familial occurrence of inflammatory bowel disease (IBD) is well documented. Reports from Western countries have shown a higher familial occurrence of ulcerative colitis (UC) in first- and second-degree relatives than that in the Asian UC population. No data are currently available from the Indian subcontinent in this regard. We present our data on the familial aggregation of UC.

Records of patients with UC followed at the Inflammatory Bowel Disease Clinic at the All India Institute of Medical Sciences, New Delhi from August 2004 to January 2016 were reviewed. Details regarding the prevalence of family history and characteristics of these patients were recorded. Affected family members were contacted and disease characteristics were noted for assessment of familial aggregation.

Of the 2,058 UC patients included in the analysis, a positive family history of IBD was confirmed in 31 patients (1.5%), 24 (77.4%) of whom had only first-degree relatives affected. All the affected relatives had UC and none had Crohn's disease. Among first-degree relatives, siblings were found to have the highest prevalence of IBD (53.3%), followed by parents (26.7%).

The probability of occurrence of IBD in family members of affected North Indian UC patients is lower than that reported in Western populations.

• Colitis, ulcerative
• Medical history taking

• inflammatory bowel disease
• irritable bowel syndrome
• red flag score

Intestinal tuberculosis (TB) is an uncommon lesion for which differential diagnosis can be difficult. We present a case of a 53-year-old male and a systematic review of the literature, from clinical symptoms to differential diagnosis, unusual complications and therapy. The patient was admitted to the hospital with signs of acute abdomen as a result of a perforated terminal ileitis. Based on the skip lesions of the terminal ileum and cecum, Crohn’s disease (CD) was clinically suspected. An emergency laparotomy and right colectomy with terminal ileum resection was performed and systematic antibiotherapy was prescribed. The patient’s status deteriorated and he died 4 d after the surgical intervention. At the autopsy, TB ileotyphlitis was discovered. The clinical criteria of the differential diagnosis between intestinal TB and CD are not very well established. Despite the large amount of published articles on this subject, only 50 papers present new data regarding intestinal TB. Based on these studies and our experience, we present an update focused on the differential diagnosis and therapy of intestinal TB. We highlight the importance of considering intestinal TB as a differential diagnosis for inflammatory bowel disease. Despite the modern techniques of diagnosis and therapy, the fulminant evolution of TB can still lead to a patient’s death.

• Ileitis
• Autopsy
• Ileotyphlitis
• Crohn’s disease
• Tuberculosis
• Inflammatory bowel disease
• Ischemic colitis

Crohn disease has low prevalence in Sri Lanka while compared to the West, while intestinal tuberculosis is common in the region. Since clinical, endoscopic and investigation features of Crohn disease overlap with intestinal tuberculosis, differentiating these two conditions becomes a dilemma for the clinician in the intestinal tuberculosis endemic setting.

An 18-year old Sri Lankan Muslim female presented with chronic abdominal pain and weight loss. Colonoscopy revealed an ulcerated ileocaecal valve and a terminal ileal stricture. Biopsy confirmed Crohn disease with no supportive features to suggest intestinal tuberculosis. Despite treatment with adequate immunosuppression she failed to improve and underwent a limited right hemicolectomy and terminal ileal resection. Histology confirmed intestinal tuberculosis and she made full recover with 6 months of anti-tuberculosis treatment.

This case illustrates the importance of reviewing the diagnosis to include intestinal tuberculosis in an endemic setting, when already diagnosed Crohn disease is treatment refractory.

• Crohn disease
• Intestinal
• Tuberculosis

• CXCL16
• Crohn’s disease
• NOD1
• SNP
• STAT6
• TLR4

• Crohn
• IBD
• consensus
• definition
• diagnosis
• epidemiology
• gastroenterology
• guidelines
• incidence
• investigation

• Crohn’s disease
• IBD
• Iran
• Ulcerative colitis

Ulcerative colitis (UC) is a chronic disease characterized by diffuse inflammation of the mucosa of the colon and rectum. The hallmark clinical symptom of UC is bloody diarrhea. The clinical course is marked by exacerbations and remissions, which may occur spontaneously or in response to treatment changes or intercurrent illnesses. UC is most commonly diagnosed in late adolescence or early adulthood, but it can occur at any age. The incidence of UC has increased worldwide over recent decades, especially in developing nations. In contrast, during this period, therapeutic advances have improved the life expectancy of patients, and there has been a decrease in the mortality rate over time. It is important to emphasize that there is considerable variability in the phenotypic presentation of UC. Within this context, certain clinical and demographic characteristics are useful in identifying patients who tend to have more severe evolution of the disease and a poor prognosis. In this group of patients, better clinical surveillance and more intensive therapy may change the natural course of the disease. The aim of this article was to review the epidemiology and demographic characteristics of UC and the factors that may be associated with its clinical prognosis.

• Ulcerative colitis
• Incidence
• Prevalence
• Risk factors
• Predictive factors

• Adolescent
• Adult
• Age Distribution
• Age of Onset
• Aged
• Colitis, Ulcerative/diagnosis
• Colitis, Ulcerative/epidemiology
• Colitis, Ulcerative/mortality
• Colitis, Ulcerative/therapy
• Humans
• Incidence
• Middle Aged
• Phenotype
• Predictive Value of Tests
• Prevalence
• Prognosis
• Risk Factors
• Young Adult

• Asia
• Epidemiology
• Ethnic
• Genetics
• Incidence
• Inflammatory bowel disease

• Asia/epidemiology
• Colitis, Ulcerative/epidemiology
• Crohn Disease/epidemiology
• Developing Countries
• Diet
• Humans
• Incidence
• Life Style
• Prevalence

AIM: To investigate the clinical and pathological characteristics of inflammatory bowel disease to raise the early diagnosis of this disease.

METHODS: One hundred and twenty-two cases of inflammatory bowel disease including 101 cases of ulcerative colitis and 21 cases of Crohn's disease were analyzed.

RESULTS: Non-necrotizing granuloma, fissure ulcer and chronic inflammation were morphological features of Crohn's disease. Massive inflammatory cell infiltration in the lamina propria, destroyed glands and reduced secretion, and polyangitis were the hallmarks of ulcerative colitis.

CONCLUSION: The diagnosis of inflammatory bowel disease should be made based on endoscopic, macroscopic and clinical findings. Awareness of the clinical and pathologic features of inflammatory bowel disease can help make an early diagnosis of this disease.

• Inflammatory bowel disease
• Ulcerative colitis
• Crohn' disease
• Pathological histology

AIM: To study the natural history, patterns and clinical characteristics of inflammatory bowel diseases (IBD) in Egypt.

METHODS: We designed a case-series study in the gastroenterology centre of the Internal Medicine department of Cairo University, which is a tertiary care referral centre in Egypt. We included all patients in whom the diagnosis of ulcerative colitis (UC) or Crohn’s disease (CD) was confirmed by clinical, laboratory, endoscopic, histological and/or radiological criteria over the 15 year period from 1995 to 2009, and we studied their sociodemographic and clinical characteristics. Endoscopic examinations were performed by 2 senior experts. This hospital centre serves patients from Cairo, as well as patients referred from all other parts of Egypt. Our centre received 24156 patients over the described time period for gastro-intestinal consultations and/or interventions.

RESULTS: A total of 157 patients with established IBD were included in this study. Of these, 135 patients were diagnosed with UC (86% of the total), and 22 patients, with CD (14% of the total). The mean ages at diagnosis were 27.3 and 29.7, respectively. Strikingly, we noticed a marked increase in the frequency of both UC and CD diagnoses during the most recent 10 years of the 15 year period studied. Regarding the gender distribution, the male:female ratio was 1:1.15 for UC and 2.6:1 for CD. The mean duration of follow up for patients with UC was 6.2 ± 5.18 years, while the mean duration of follow up for patients with CD was 5.52 ± 2.83 years. For patients with UC we found no correlation between the severity of the disease and the presence of extraintestinal manifestations. Eleven patients had surgical interventions during the studied years: 4 cases of total colectomy and 7 cases of anal surgery.

CONCLUSION: We observed a ratio of 6:1 for UC to CD in our series. The incidence of IBD seems to be rising in Egypt.

• Natural history of Inflammatory bowel diseases
• Epidemiology of Ulcerative colitis
• Epidemiology of Crohn’s disease
• Epidemiology of inflammatory bowel diseases in Egypt
• inflammatory bowel diseases Prevalence
• Incidence of ulcerative colitis
• Incidence of Crohn’s disease

• Adolescent
• Adult
• Colectomy
• Colitis, Ulcerative/diagnosis
• Colitis, Ulcerative/epidemiology
• Colitis, Ulcerative/therapy
• Crohn Disease/diagnosis
• Crohn Disease/epidemiology
• Crohn Disease/therapy
• Disease Progression
• Egypt/epidemiology
• Endoscopy, Gastrointestinal
• Female
• Humans
• Incidence
• Male
• Prognosis
• Registries
• Risk Factors
• Severity of Illness Index
• Tertiary Care Centers
• Time Factors
• Young Adult

Introduction. Available evidence for routine terminal ileoscopy during colonoscopy is equivocal. We investigated the place of routine terminal ileoscopy and biopsy during colonoscopy, in a tropical setting. Materials and Methods. All consenting adults undergoing colonoscopy had routine TI and biopsy. Patients with right iliac fossa (RIF) pain, diarrhoea, anaemia, suspected inflammatory bowel disease (IBD), and raised inflammatory markers were defined as Group A and all others undergoing colonoscopy as Group B. Results. Caecal intubation and TI were achieved in 988/1096 (90.15%) and 832/1096 (75.9%) cases, respectively. 764/832(91.8%) patients were included in final analysis. 81/764 (10.6%) patients had either macroscopic (34/81) or microscopic (47/81) abnormalities of terminal ileum; 20/81 had both. These were CD (28/47), tuberculosis (TB) (6/47), ileitis due to resolving infection (8/47), and drug-induced ileitis (5/47). 27/81 with macroscopically normal ileum had CD (18/27), ileitis due to resolving infection (5/27) and drug-induced ileitis (4/27) on histology. 12/764 (1.57%) patients with macroscopically normal colon had ileal CD (8/12), drug-induced ileitis (2/12), and resolving ileal infection (2/12) on histology. 47/764 (6.15%) patients had ileal pathology that influenced subsequent management. These were significantly higher in Group A (43/555 (8%)) than in Group B (4/209 (1.9%)) (P = 0.0048, χ² = 7.968). Conclusion. TI and biopsy improve diagnostic yield of colonoscopy in patients with RIF pain, diarrhoea, anaemia, suspected IBD, and raised inflammatory markers.

• colectomy
• colorectal carcinoma
• survival

• disease burden
• epidemiology
• medical expenditures
• ulcerative colitis

• Demography
• Incidence
• Iran
• Prevalence
• Ulcerative colitis

• crohn's disease
• rising trend
• saudi arabia
• ulcerative colitis

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Child
• Female
• Humans
• Incidence
• Inflammatory Bowel Diseases/epidemiology
• Male
• Middle Aged
• Outpatients/statistics & numerical data
• Prevalence
• Retrospective Studies
• Saudi Arabia/epidemiology
• Young Adult