title: Racial and Ethnic Minorities with Inflammatory Bowel Disease in the United States: A Systematic Review of Disease Characteristics and Differences.
abstract: Inflammatory bowel disease (IBD) has predominantly affected whites, particularly Ashkenazi Jews. Over the last 2 decades, IBD has "emerged" in minorities. Differences in natural history and disease characteristics have been suggested. The objective of this systematic review is to summarize these differences in studies from the United States.
  
  
  
  A structured search was performed within the Medline database through PubMed, EMBASE, and Cochrane databases. Published studies of genetics, pathogenesis, prevalence or incidence, disease location and behavior, extraintestinal manifestations, disparities and access to care in patients with IBD who are of African American, Asian, and Hispanic descent living in the United States were eligible.
  
  
  
  A total of 47 studies were included for African Americans (n = 20,054), Hispanics (n = 10,762), and Asians (n = 2668). The incidence and prevalence of IBD is increasing among minorities. There is less of a genetic influence in the pathogenesis of IBD among African Americans; however, novel variants have been identified. There is a predilection for pancolonic ulcerative colitis among Hispanics and Asians. Crohn's disease-related hospitalizations are increasing in Asians, whereas African Americans are more likely to use the emergency department. No major differences are seen in disease location and behavior, upper gastrointestinal tract, and perianal involvement and extraintestinal manifestations among races and ethnic groups. Medication utilization seems to be similar. Differences in surgery are likely explained by health insurance status.
  
  
  
  Future prospective studies are needed to fully characterize disease characteristics and treatment response among minorities. With novel IBD therapies in the pipeline, enrollment in clinical trials should emphasize increased representation of all races and ethnic groups.
authors.affiliation: *Department of Medicine, Division of Gastroenterology, Harborview Medical Center, University of Washington, Seattle, Washington; University of Washington Inflammatory Bowel Disease Program; and†Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland; University of Maryland Inflammatory Bowel Disease Program.
authors.forename: Anita
authors.initials: A
authors.lastname: Afzali
authors.forename: Raymond K
authors.initials: RK
authors.lastname: Cross
mesh_terms: D001741:Black or African American / Q000235:genetics / Q000706:statistics & numerical data*; D017668:Age of Onset; D001213:Asian / Q000235:genetics / Q000706:statistics & numerical data*; D003093:Colitis, Ulcerative / Q000208:ethnology* / Q000235:genetics / Q000473:pathology / Q000628:therapy; D003424:Crohn Disease / Q000208:ethnology* / Q000235:genetics / Q000473:pathology / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000235:genetics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007348:Insurance, Health; D015995:Prevalence; D012720:Severity of Illness Index; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology