Ethnic variations in ulcerative colitis: Experience of an international hospital in Thailand.
OBJECTIVE
To investigate the clinical characteristics, treatment, medication use, and treatment response in patients with ulcerative colitis (UC) across ethnic groups.


METHODS
This study retrospectively analyzed medical records of all 268465 patients who visited the Bumrungrad International Digestive Disease Center during 2005-2010. The demographics, clinical characteristics, medication use, results of investigations, and medical and surgical management for patients with UC were evaluated. Evaluation included sigmoidoscopy and colonoscopy performed in compliance with the American Society of Gastrointestinal Endoscopy practice guidelines. Patient ethnicities were categorized into seven groups: Thai, Oriental, South Asian (SA), Middle Eastern (ME), Caucasian, African, and Hispanic. UC pathological severity was classified into inactive, mild, moderate, and severe. Associations between categorical variables were analyzed using the χ(2) or Fischer's exact test. Associations between categorical and interval variables were analyzed using Student's t-test and/or analysis of covariance.


RESULTS
UC was diagnosed in 371 of the 268465 patients: male 56.33%; ME 42%, Caucasian 23%, and Thai 19%. Annual incidence of UC was 82 cases per 100000 with wide ethnic variation, ranging from 29 to 206 cases per 100000 in Oriental and ME patients, respectively. Of the patients with UC, 16.71% had severe UC with highest incidence among the patients from ME (20.39%) and lowest among the Caucasian population (11.90%). ME had highest proportion of pancolitis (52.90%), followed by Caucasian (45.35%) and Asian (34.40%). Only 20.93% of Caucasian patients received steroid, compared with 26.40% and 27.10% of Asian and Middle Eastern, respectively (P = 0.732). Overall, 13.72% of UC patients did not respond to steroid therapy, with non-significantly higher proportions of non-responders among Asian and Middle Eastern patients (15.22% and 15.04%, respectively) (P = 0.781). On average, 5.93% underwent surgical management with ethnic variation, ranging from 0% in African to 18% in SA. Cancer was found in three (Thai, ME, and African) cases (0.82 institution-specific incidence).


CONCLUSIONS
Incidence, symptom duration, pathological severity, clinical manifestations, medication use, treatment response, need for surgical consultation, and cancer incidence of patients with UC potentially vary by ethnicity.
Vibhakorn Permpoon, Sinn Anuras, Digestive Disease Center, Bumrungrad International Hospital, Bangkok 10600, Thailand.
Vibhakorn
V
Permpoon
Vibhakorn Permpoon, Sinn Anuras, Digestive Disease Center, Bumrungrad International Hospital, Bangkok 10600, Thailand.
Krit
K
Pongpirul
Vibhakorn Permpoon, Sinn Anuras, Digestive Disease Center, Bumrungrad International Hospital, Bangkok 10600, Thailand.
Sinn
S
Anuras
Anatomical pathological conditions; Ethnic groups; Medical tourism; Retrospective studies; Ulcerative colitis