title: Early Course of Inflammatory Bowel Disease in a Population-Based Inception Cohort Study From 8 Countries in Asia and Australia.
abstract: OBJECTIVE
  The incidence of inflammatory bowel disease (IBD) is increasing in Asia, but little is known about disease progression in this region. The Asia-Pacific Crohn's and Colitis Epidemiology Study was initiated in 2011, enrolling subjects from 8 countries in Asia (China, Hong Kong, Indonesia, Sri Lanka, Macau, Malaysia, Singapore, and Thailand) and Australia. We present data from this ongoing study.
  
  
  METHODS
  We collected data on 413 patients diagnosed with IBD (222 with ulcerative colitis [UC], 181 with Crohn's disease [CD], 10 with IBD unclassified; median age, 37 y) from 2011 through 2013. We analyzed the disease course and severity and mortality. Risks for medical and surgical therapies were assessed using Kaplan-Meier analysis.
  
  
  RESULTS
  The cumulative probability that CD would change from inflammatory to stricturing or penetrating disease was 19.6%. The cumulative probabilities for use of immunosuppressants or anti-tumor necrosis factor agents were 58.9% and 12.0% for patients with CD, and 12.7% and 0.9% for patients with UC, respectively. Perianal CD was associated with an increased risk of anti-tumor necrosis factor therapy within 1 year of its diagnosis (hazard ratio, 2.97; 95% confidence interval, 1.09-8.09). The cumulative probabilities for surgery 1 year after diagnosis were 9.1% for patients with CD and 0.9% for patients with UC. Patients with CD and penetrating disease had a 7-fold increase for risk of surgery, compared with patients with inflammatory disease (hazard ratio, 7.67; 95% confidence interval, 3.93-14.96). The overall mortality for patients with IBD was 0.7%.
  
  
  CONCLUSIONS
  In a prospective population-based study, we found that the early course of disease in patients with IBD in Asia was comparable with that of the West. Patients with CD frequently progress to complicated disease and have accelerated use of immunosuppressants. Few patients with early stage UC undergo surgery in Asia. Increasing our understanding of IBD progression in different populations can help optimize therapy and improve outcomes.
authors.affiliation: Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China. Electronic address: siewchienng@cuhk.edu.hk.
authors.forename: Siew C
authors.initials: SC
authors.lastname: Ng
authors.affiliation: The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Zhirong
authors.initials: Z
authors.lastname: Zeng
authors.affiliation: St Vincent's Hospital and University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Ola
authors.initials: O
authors.lastname: Niewiadomski
authors.affiliation: Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Whitney
authors.initials: W
authors.lastname: Tang
authors.affiliation: St Vincent's Hospital and University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Sally
authors.initials: S
authors.lastname: Bell
authors.affiliation: St Vincent's Hospital and University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kamm
authors.affiliation: The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Pinjin
authors.initials: P
authors.lastname: Hu
authors.affiliation: Faculty of Medicine, University of Kelaniya, Regama, Sri Lanka.
authors.forename: H Janaka
authors.initials: HJ
authors.lastname: de Silva
authors.affiliation: Faculty of Medicine, University of Kelaniya, Regama, Sri Lanka.
authors.forename: Madunil A
authors.initials: MA
authors.lastname: Niriella
authors.affiliation: Faculty of Medicine, University of Kelaniya, Regama, Sri Lanka.
authors.forename: W S A A Yasith
authors.initials: WS
authors.lastname: Udara
authors.affiliation: National University Hospital of Singapore, Singapore, Singapore.
authors.forename: David
authors.initials: D
authors.lastname: Ong
authors.affiliation: Singapore General Hospital, Singapore, Singapore.
authors.forename: Khoon Lin
authors.initials: KL
authors.lastname: Ling
authors.affiliation: Singapore General Hospital, Singapore, Singapore.
authors.forename: Choon Jin
authors.initials: CJ
authors.lastname: Ooi
authors.affiliation: University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Ida
authors.initials: I
authors.lastname: Hilmi
authors.affiliation: University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Khean
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authors.lastname: Lee Goh
authors.affiliation: West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Qin
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authors.lastname: Ouyang
authors.affiliation: West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Yu Fang
authors.initials: YF
authors.lastname: Wang
authors.affiliation: Xijing Hospital, Fourth Military Medical University, Xian, China.
authors.forename: Kaichun
authors.initials: K
authors.lastname: Wu
authors.affiliation: Xijing Hospital, Fourth Military Medical University, Xian, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Wang
authors.affiliation: Maharaj Nakorn Chiangmai Hospital, Chiangmai, Thailand.
authors.forename: Pises
authors.initials: P
authors.lastname: Pisespongsa
authors.affiliation: Siriraj Hospital, Bangkok, Thailand.
authors.forename: Sathaporn
authors.initials: S
authors.lastname: Manatsathit
authors.affiliation: King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Satimai
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authors.lastname: Aniwan
authors.affiliation: Siriraj Hospital, Bangkok, Thailand.
authors.forename: Julajak
authors.initials: J
authors.lastname: Limsrivilai
authors.affiliation: Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital.
authors.forename: Jeffri
authors.initials: J
authors.lastname: Gunawan
authors.affiliation: Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital.
authors.forename: Marcellus
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authors.lastname: Simadibrata
authors.affiliation: Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital.
authors.forename: Murdani
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authors.lastname: Abdullah
authors.affiliation: Tseung Kwan O Hospital, Hong Kong, China.
authors.forename: Steve W C
authors.initials: SW
authors.lastname: Tsang
authors.affiliation: North District Hospital, Hong Kong, China.
authors.forename: Fu Hang
authors.initials: FH
authors.lastname: Lo
authors.affiliation: Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China.
authors.forename: Aric J
authors.initials: AJ
authors.lastname: Hui
authors.affiliation: Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Chung Mo
authors.initials: CM
authors.lastname: Chow
authors.affiliation: Kiangwu Hospital, Macau, China.
authors.forename: Hon Ho
authors.initials: HH
authors.lastname: Yu
authors.affiliation: Kiangwu Hospital, Macau, China.
authors.forename: Mo Fong
authors.initials: MF
authors.lastname: Li
authors.affiliation: Hospital Conde S Januario, Macau, China.
authors.forename: Ka Kei
authors.initials: KK
authors.lastname: Ng
authors.affiliation: Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Jessica Y L
authors.initials: JY
authors.lastname: Ching
authors.affiliation: Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Victor
authors.initials: V
authors.lastname: Chan
authors.affiliation: Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Justin C Y
authors.initials: JC
authors.lastname: Wu
authors.affiliation: Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Francis K L
authors.initials: FK
authors.lastname: Chan
authors.affiliation: The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Minhu
authors.initials: M
authors.lastname: Chen
authors.affiliation: Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Joseph J Y
authors.initials: JJ
authors.lastname: Sung
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001208:Asia / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D004502:Education, Medical, Continuing; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: ACCESS; Natural History; Risk Factor; Treatment