South Asian Patients With Inflammatory Bowel Disease in the United States Demonstrate More Fistulizing and Perianal Crohn Phenotype
South Asian Patients With Inflammatory Bowel Disease in the United States Demonstrate More Fistulizing and Perianal Crohn Phenotype
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DOI：
10.1093/ibd/izaa029
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发表时间：
2020-12-01
影响因子：
4.9
通讯作者：
de Silva, Punyanganie
中科院分区：
文献类型：
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作者：
Jangi, Sushrut;Ruan, Alex;de Silva, Punyanganie
背景资料：南亚人最近被确定为在全世界炎症性肠病（IBD）的发病率和患病率迅速上升。然而，生活在美国的南亚人的纵向表型研究仍然稀缺。方法：我们回顾性研究了171例南亚IBD患者在2个美国三级中心谁提出了2000年和2016年之间。南亚IBD患者与性别和IBD亚型匹配（溃疡性结肠炎[UC] vs克罗恩病[CD]）的白色对照患者（n = 342）以1：2的比例随机匹配。对两组的人口统计学和表型特征进行评价和比较。结果：81例南亚人和162例白色人患CD，90例南亚人和180例白色人患UC。在CD组中，南亚患者的中位诊断年龄（28岁）大于白色患者（21岁; P < 0.003）。与白色患者相比，南亚CD患者中瘘管病（24.1% vs 8.6%; P < 0.002）、肛周疾病（20.3% vs 2.5%; P < 0.005）和直肠疼痛（16.2% vs 2.9%; P < 0.001）更常见。调整协变量后，南亚CD患者不太可能接受硫嘌呤（OR = 0.36; P < 0.007）或接受1种以上生物制剂（OR = 0.42; P < 0.040）。南亚UC患者发生直肠炎的可能性较低（10% vs 22.2%; P < 0.022），而发生原发性硬化性胆管炎的可能性较高（n = 7 vs n = 2; P < 0.007）。出生在美国或5岁以前移居美国的南亚患者在IBD诊断时年龄较小（18.9岁vs 32.4岁; P < 0.0005）。结论：我们发现南亚患者具有独特的人口统计学和表型特征，包括CD患者中穿透性疾病较多，UC患者中直肠炎较少，沿着药物使用模式的改变。南亚患者独特的环境暴露和潜在的独特遗传特征可能会赋予这种可变的表型表达，影响这一风险日益增加的人群的管理。
Background: South Asians have recently been identified as having a rapidly rising incidence and prevalence of inflammatory bowel disease (IBD) throughout the world. However, longitudinal phenotypic studies of South Asians living in the United States remain scarce.Methods: We retrospectively studied 171 South Asian patients with IBD treated at 2 US tertiary centers who presented between 2000 and 2016. South Asian IBD patients were randomly matched in a 1:2 ratio with sex and IBD subtype-matched (ulcerative colitis [UC] vs Crohn disease [CD]) white control patients (n = 342). Demographic and phenotypic characteristics were evaluated and compared between the 2 groups. Odds ratios (OR), logistic regression, and survival analysis were performed using R studio and STATA.Results: 81 South Asian patients and 162 white patients had CD, and 90 South Asians and 180 white patients had UC. Among the CD group, South Asian patients were diagnosed at a median older age (age 28) than white patients (21 years; P < 0.003). Fistulizing disease (24.1% vs 8.6%; P < 0.002), perianal disease (20.3% vs 2.5%; P < 0.005), and presentation of rectal pain (16.2% vs 2.9%; P < 0.001) were more common among South Asian patients with CD than among white patients. After adjusting for covariates, South Asian patients with CD were less likely to be placed on thiopurines (OR = 0.36; P < 0.007) or to receive more than 1 biologic (OR = 0.42; P < 0.040). South Asian patients with UC were less likely to have proctitis (10% vs 22.2%; P < 0.022) and more likely to have primary sclerosing cholangitis (n = 7 vs n = 2; P < 0.007). South Asian patients born in the United States or those who had migrated before age 5 were younger at the age of IBD diagnosis (age 18.9 vs 32.4; P < 0.0005).Conclusion: We found unique demographic and phenotypic characteristics among South Asian patients, including more penetrating disease in those with CD and less proctitis among those with UC, along with altered medication use patterns. Distinct environmental exposures and a potentially unique genetic profile of South Asian patients may confer this variable phenotypic expression, influencing management of this increasingly at-risk population.