Trends of inflammatory bowel disease at a tertiary care center in northern India

Abstract

Background/aims: Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), is increasingly being reported from India and other Asian countries. This study looks into the changing trends of IBD at a tertiary care center in north India over last two decades.

Methods: Retrospective analysis of a prospectively maintained database of patients diagnosed with IBD between January 1991 and December 2015 was conducted. The study period was divided into five times cohorts (1991-1995, 1996-2000, 2001-2005, 2006-2010, 2011-2015).

Results: During the study period, 2,467 patients (UC [n = 2,137, 86.6%], CD [n = 330, 13.3%], mean age 38.5 ± 13.3 years; 55.9% males) were registered. The proportion of patients with CD increased (ratio of UC to CD declined from 15.7:1 to 4:1). The mean age at diagnosis decreased for UC (45.7 ± 12.1 years in 1991-1995 vs. 37.6 ± 13.0 years in 2011-2015; P= 0.001) and remained consistent for CD (41.3 ± 13.6 years in 1996-2000 vs. 41.3 ± 16.9 years in 2011-2015, P= 0.86). Patients with proctitis in UC and isolated ileal disease in CD increased over the study period (P= 0.001 and P= 0.007, respectively). Inflammatory CD increased (P= 0.009) whereas stricturing CD decreased (P= 0.01) across all cohorts. There was a trend towards less severe presentation of both UC and CD. The use of thiopurines (P= 0.02) and biologics increased (P= 0.001) with no significant change in trends for requirements of surgery (P= 0.9).

Conclusions: Increasing prevalence of CD, younger age at diagnosis, diagnosis at an earlier and milder stage, greater use of thiopurines and biologics were observed.

Keywords: Crohn disease; India; Inflammatory bowel disease; Trends; Ulcerative colitis.

Fig. 1.

Temporal trends in occurrence of inflammatory bowel disease (1991-2015). R²: Coefficient of determination (0% indicates that the model explains none of the variability of the response data around its mean. 100% indicates that the model explains all the variability of the response data around its mean). UC, ulcerative colitis; CD, Crohn’s disease.

Fig. 2.

Trends in disease extent and location (1991–2015). (A) Disease extent in ulcerative colitis. (B) Disease location in Crohn’s disease. E1, proctitis; E2, left-sided colitis; E3, disease extending proximal to splenic flexure including pancolitis for adult patients, disease extending proximal to splenic flexure but distal to hepatic flexure for pediatric patients; E4, disease extending proximal to hepatic flexure in pediatric patients; L1, ileal disease; L2, colonic; L3, ileocolonic; L4, isolated upper disease.

Fig. 3.

Trends in disease behavior in Crohn’s disease (1996–2015). B1, non-penetrating, non-stricturing disease; B2, stricturing disease; B3, penetrating disease.

Fig. 4.

Trends (1991–2015) in disease severity of ulcerative colitis (UC) (A) and Crohn’s disease (CD) (B).

Fig. 5.

Trends in usage of various pharmacological agents in inflammatory bowel disease (1991–2015). (A) Ulcerative colitis (UC) and (B) Crohn’s disease (CD). 5-ASA, 5-aminosalicylic acid; 6-MP, 6-mercaptopurine; ATT, antitubercular therapy.