Clinical and Experimental Gastroenterology (Jun 2023)
A Multicentre Study of the Clinical and Epidemiological Profile of Inflammatory Bowel Disease in Northeast Brazil
Abstract
Carlos Alexandre Antunes de Brito,1– 4 Lívia Medeiros Soares Celani,2,5 Marcelo Vicente Toledo de Araújo,2,6 Maurilio Toscano de Lucena,7 Graciana Bandeira Salgado Vasconcelos,1,2,8 Gustavo André Silva Lima,1,2,4 Fernando Jorge Firmino Nóbrega,2,6 George Tadeu Nunes Diniz,9 Norma Lucena-Silva,9 Germano Tose Toneto,4 João Victor de Carvalho Falcão,4 Pedro Martinelli Barbosa,4 Priscylla Rayanne Fernandes de Oliveira,7 Luan Samy Xavier Dantas,5 Luanna Karen Chagas Fernandes,6 Samara Amorim de Araújo,6 Valéria Ferreira Martinelli1,2,4 1Department of Gastroenterology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil; 2Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil; 3Department of Internal Medicine, Centre of Medical Sciences of the Federal University of Pernambuco, Recife, Pernambuco, Brazil; 4Department of Immunology, Autoimune Research Institute, Recife, Pernambuco, Brazil; 5Department of Gastroenterology, Onofre Lopes Hospital, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil; 6Department of Gastroenterology, Lauro Wanderley Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil; 7Department of Coloproctology, Barão de Lucena Hospital, Recife, Pernambuco, Brazil; 8Department of Gastroenterology, University of Pernambuco, Recife, Pernambuco, Brazil; 9Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, BrazilCorrespondence: Carlos Alexandre Antunes de Brito, Division of Immunology, Autoimune Research Institute, 715 Rui Barbosa Avenue, Recife, Pernambuco, 52011-040, Brazil, Tel +55 81 31480101, Email [email protected]: Ulcerative colitis (UC) and Crohn’s disease (CD) are inflammatory bowel diseases (IBDs) with multifactorial causes. They are becoming more prevalent in developing countries such as Brazil; however, relevant studies in poorer regions of the country are limited. Here, we report the clinical–epidemiological profile of patients with IBD treated at reference centers in three states of Northeast Brazil.Patients and Methods: This was a prospective cohort study involving patients at referral outpatient clinics for IBD from January 2020 through December 2021.Results: Of 571 patients with IBD, 355 (62%) had UC, and 216 (38%) had CD. The patients were predominantly women (355, 62%) for both UC and CD. Extensive colitis was the pattern present in 39% of the UC cases. For CD, ileocolonic disease was the predominant manifestation (38%), with 67% of cases showing penetrating and/or stenosing behavior. The majority of patients were diagnosed between the ages of 17 and 40, corresponding to 60.2% in CD and 52.7% in UC. The median time between symptom onset and diagnosis was 12 months for CD and 8 months for UC (p=0.042). Joint involvement was the most frequent extraintestinal manifestation, with arthralgia and arthritis present in 41.9% and 18.6% of the patients, respectively. Biological therapy was prescribed to 73% of CD patients and 26% of UC patients. A progressive increase in new cases was observed in every 5-year interval over the last five decades, with 58.6% being diagnosed in the last 10 years.Conclusion: More extensive disease behavior patterns predominated in UC, while forms associated with complications were prevalent in CD. A prolonged time to diagnosis may have contributed to these findings. A progressive increase in IBD incidence was observed and may be related to greater urbanization and better access to specialized outpatient clinics, resulting in improvements in diagnosis.Keywords: inflammatory bowel disease, ulcerative colitis, Crohn’s disease, epidemiology
