Epidemiology and clinical course of inflammatory bowel disease in the Central Province of Sri Lanka: A hospital-based study

Abstract

Background and aim: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Sri Lanka; clinical course; disease characteristics; induction of remission; prevalence of ibd.

Figure 1

Map of Sri Lanka with the location of secondary and tertiary care institutions of the Central Province in which IBD patients are followed up.

Figure 2

Age‐adjusted prevalence of IBD in the Central Province of Sri Lanka. Prevalence of UC is always higher than CD except in the age group of 10 to 19 years. , Prevalence UC per 100 000; , Prevalence CD per 100 000; , Population (× 100 000).

Figure 3

Prevalence of IBD in different ethnic groups in the Central Province of Sri Lanka. The prevalence of IBD was the highest in Sinhalese people 9.8 (UC—7.0, CD—2.8) per 100 000, and the lowest in Tamil people 4.1 (UC—1.3, CD—1.1) per 100 000. , Prevalence of UC per 100 000; , Prevalence of CD per 100 000; , Population (× 100 000).

Figure 4

Extent of the disease: IBD. Among UC patients, 61.4% had proctitis (E1), 23.6% had left‐sided (E2), and 15% had extensive (E3) disease. , Distal disease; , Left‐sided disease; , Extensive disease. Among CD patients 60% had only large bowel (L2) involvement followed by ileocolonic (L3) disease (23.3%) and ileal disease (L1) (16.7%). , Only small intestinal involvement; , Only large intestinal involvement; , Large and small intestinal involvement; , SI and upper GI; , LI and upper GI.

Figure 5

Drugs used in Induction of Remission in IBD. In UC, 99% were given oral 5ASA and 68% of them were given combined treatment with oral steroids. Azathioprine was used in 15% of patients and 6% of patients were given infliximab. 40% of the CD patients achieved remission with combined treatment with systemic steroids, 5ASA drugs, and azathioprine. 23% of the CD patients needed induction with infliximab.