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. 2024 Mar 15:70:102542.
doi: 10.1016/j.eclinm.2024.102542. eCollection 2024 Apr.

Inflammatory bowel disease evolution in the past two decades: a chronological multinational study

Pezhman Alavinejad  1 , Seyed Jalal Hashemi  1 , Nitin Behl  2 , Ahmad Hormati  3 , Abubakr Elbasuny  4 , Naser Ebrahimi Daryani  5 , Mehdi Pezeshgi Modarres  6 , Masoud Arshadzadeh  5 , Samira Panahande  1 , Dao Viet Hang  7 , Aya Mohammed Mahros  8 , Abazar Parsi  1 , Hazhir Javaherizadeh  1 , Ata Rehman  9 , Katarzyna M Pawlak  10 , Mitra Ahmadi  1 , Mohammed Hussien Ahmed  8 , Farnaz Farsi  11 , Mohammad Arefi  12 , Afreen Quadri  13 , Quang Trung Tran  14 , Foroogh Alborzi  5 , Seyed Mohammad Amin Alavi  1 , Bahman Cheraghian  1 , Elmira Ramezani  15 , Mohammed Fathi Gouda  16   17 , Babak Saadati  18 , Ahmed Alam Quadri  19 , Rahim Hirani  20 , Maha Maher  21 , Elsayed Ghoneem  17   21
Affiliations

Inflammatory bowel disease evolution in the past two decades: a chronological multinational study

Pezhman Alavinejad et al. EClinicalMedicine. .

Abstract

Background: The multifactorial nature of inflammatory bowel disease (IBD), which manifests differently in individuals creates a need for a better understanding of the behaviour and pattern of the disease due to environmental factors. The current study aimed to study the changes in IBD behaviour, presentation, and characteristics in patients over the past two decades with a goal of improving patients' diagnosis, management and outcomes.

Methods: During a 6-month period (1/02/2022-30/07/2022), the information of patients with IBD who attended IBD outpatient clinics of 11 referral centre's in six countries was collected, and based on the first time of diagnosis with IBD, they were allocated as group A (those who were diagnosed more than 15 years ago), group B (those who were diagnosed with IBD between 5 and 15 years ago) and group C (IBD cases who diagnosed in recent 5 years). Then the most prevalent subtypes and characters of the disease are evaluated and compared to make clear if the presenting pattern and behaviour of the disease has changed in the last 2 decades.

Findings: Overall 1430 patients with IBD including 1207 patients with ulcerative colitis (UC) (84.5%) and 205 patients with Crohn's disease (CD; 14.3%) included. Mean age of participants at the first time of diagnosis with IBD was 30 years. The extra-intestinal involvement of IBD in groups A and B was more prevalent in comparison with group C. Most of those in groups A & B had academic education but in group C, the most prevalent educational status was high school or diploma (P = 0.012). In contrast to groups A and B, the relative prevalence of medium socioeconomic level in group C had decreased (65%). Relative prevalence of UC subtypes was similar among groups A and B (extensive colitis as most prevalent) but in group C, the most prevalent subtype is left side colitis (38.17%). The most prevalent subtype of CD in groups A and B was ileocolic involvement while in group C, upper GI involvement is significantly increased. The rate of food sensitivity among groups A and B was more than group C (P = 0.00001). The relative prevalence of patients with no flare has increased with a steady slope (P < 0.00001). Relative prevalence of presenting symptoms among patients with UC in group C differs and nowadays the rate abdominal pain (70.7%) and bloating (43.9%) have increased and frequency of diarrhoea (67.4%) has decreased.

Interpretation: In the recent 5 years, the pattern of UC presentation has changed. The rate of upper GI involvement in CD and relative prevalence of patients with no disease flare increased and the rate of extra intestinal involvement decreased.

Funding: None.

Keywords: Behavior; CD; Flare; IBD; UC.

PubMed Disclaimer

Conflict of interest statement

The authors have none to declare.

Figures

Fig. 1
Fig. 1
Original country of participants.
Fig. 2
Fig. 2
Educational condition of participants.
Fig. 3
Fig. 3
Relative proportion of IBD among different socioeconomic condition (IBD, inflammatory bowel disease).
Fig. 4
Fig. 4
Relative proportion of UC subtypes (UC, ulcerative colitis; Montreal Classification; E1, ulcerative Proctitis; E2, left sided UC; E3, Extensive UC).
Fig. 5
Fig. 5
Relative proportion of CD subtypes (CD, Crohn's disease; GI, gastrointestinal; Montreal Classification; L1, Terminal Ilium; L2, Colon; L3, Ileocolon; L4, upper GI; L1 + L4, Terminal Ilium + Upper GI; L2 + L4, Colon + Upper GI; L3 + L4, Ileocolon + Upper GI).
Fig. 6
Fig. 6
The rate of disease flare per year.
See this image and copyright information in PMC

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