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Inflammatory bowel disease: an expanding global health problem.

M'Koma AE - Clin Med Insights Gastroenterol (2013)

Bottom Line: In addition, IBD-associated CRC has a worse prognosis than sporadic CRC, even when the stage at diagnosis is taken into account.A continuing increase in IBD incidence worldwide associated with childhood-onset of IBD coupled with the diseases' longevity and an increase in oncologic transformation suggest a rising disease burden, morbidity, and healthcare costs.IBD and its associated neoplastic transformation appear inevitable, which may significantly impact pediatric gastroenterology and adult CRC care.

View Article: PubMed Central - PubMed

Affiliation: Laboratory of Inflammatory Bowel Disease Research, Department of Biochemistry and Cancer Biology, Meharry Medical College, Nashville TN. Departments of General Surgery, Colon and Rectal Surgery, and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville TN.

ABSTRACT
This review provides a summary of the global epidemiology of inflammatory bowel diseases (IBD). It is now clear that IBD is increasing worldwide and has become a global emergence disease. IBD, which includes Crohn's disease (CD) and ulcerative colitis (UC), has been considered a problem in industrial-urbanized societies and attributed largely to a Westernized lifestyle and other associated environmental factors. Its incidence and prevalence in developing countries is steadily rising and has been attributed to the rapid modernization and Westernization of the population. There is a need to reconcile the most appropriate treatment for these patient populations from the perspectives of both disease presentation and cost. In the West, biological agents are the fastest-growing segment of the prescription drug market. These agents cost thousands of dollars per patient per year. The healthcare systems, and certainly the patients, in developing countries will struggle to afford such expensive treatments. The need for biological therapy will inevitably increase dramatically, and the pharmaceutical industry, healthcare providers, patient advocate groups, governments and non-governmental organizations should come to a consensus on how to handle this problem. The evidence that IBD is now affecting a much younger population presents an additional concern. Meta-analyses conducted in patients acquiring IBD at a young age also reveals a trend for their increased risk of developing colorectal cancer (CRC), since the cumulative incidence rates of CRC in IBD-patients diagnosed in childhood are higher than those observed in adults. In addition, IBD-associated CRC has a worse prognosis than sporadic CRC, even when the stage at diagnosis is taken into account. This is consistent with additional evidence that IBD negatively impacts CRC survival. A continuing increase in IBD incidence worldwide associated with childhood-onset of IBD coupled with the diseases' longevity and an increase in oncologic transformation suggest a rising disease burden, morbidity, and healthcare costs. IBD and its associated neoplastic transformation appear inevitable, which may significantly impact pediatric gastroenterology and adult CRC care. Due to an infrastructure gap in terms of access to care between developed vs. developing nations and the uneven representation of IBD across socioeconomic strata, a plan is needed in the developing world regarding how to address this emerging problem.

No MeSH data available.


Related in: MedlinePlus

Worldwide CD incidence rates and/or prevalence for countries reporting data: (A) before 1960, (B) from 1960 to 1979, and (C) after 1980. Incidence and prevalence values were ranked into quintiles representing low (dark and light blue) to intermediate (green) to high (yellow and red) occurrence of disease. Reproduced with permission from the publisher: Molodecky et al. Gastroenterology. 2012;142:46–54, e42.5
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Related In: Results  -  Collection


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f2-cgast-6-2013-033: Worldwide CD incidence rates and/or prevalence for countries reporting data: (A) before 1960, (B) from 1960 to 1979, and (C) after 1980. Incidence and prevalence values were ranked into quintiles representing low (dark and light blue) to intermediate (green) to high (yellow and red) occurrence of disease. Reproduced with permission from the publisher: Molodecky et al. Gastroenterology. 2012;142:46–54, e42.5

Mentions: To date, there are 3,028 publications from six of the seven continents reporting the incidence or prevalence for IBD worldwide (569 from Asia/Middle East, 102 from Africa, 692 from North America, 60 from South America, 1,507 from Europe, 98 from Australia, and 0 from Antarctica). The results showed that the incidence and prevalence of IBD has been increasing worldwide. Since the 19th century, the incidence of IBD has increased steadily in North America and Europe until stabilizing in the middle and latter part of the 20th century to 2–15 per 100,000 person-years for UC and 3–15 per 100,000 person-years for CD. The annual incidence rates vary by geographic region as depicted in Table 1 and Figures 1, 2, and 3. Table 2 describes the ranges in incidence and prevalence stratified into quintiles levels for CD and UC. The highest annual incidence of UC is currently 24.3 per 100,000 person-years in Europe, 6.3 per 100,000 person-years in Asia and the Middle East, and 19.2 per 100,000 person-years in North America. The highest annual incidence of CD is reported to be 12.7 per 100,000 person-years in Europe, 5.0 per 100,000 person-years in Asia and the Middle East, and 20.2 per 100,000 person-years in North America. The highest reported prevalence values for IBD were in Europe (UC, 505 per 100,000 persons; CD, 322 per 100,000 persons) and North America (UC, 249 per 100,000 persons; CD, 319 per 100,000 persons). In time-trend analyses, 75% of CD studies and 60% of UC studies showed increased incidence rates over times that were of statistical significance (P < 0.05). Incidence rates stratified by gender were reported in 50 UC and 59 CD studies. The female to male ratio varied from 0.51 to 1.58 for UC studies and 0.34 to 1.65 for CD studies, suggesting that IBD diagnosis was not gender-specific.5


Inflammatory bowel disease: an expanding global health problem.

M'Koma AE - Clin Med Insights Gastroenterol (2013)

Worldwide CD incidence rates and/or prevalence for countries reporting data: (A) before 1960, (B) from 1960 to 1979, and (C) after 1980. Incidence and prevalence values were ranked into quintiles representing low (dark and light blue) to intermediate (green) to high (yellow and red) occurrence of disease. Reproduced with permission from the publisher: Molodecky et al. Gastroenterology. 2012;142:46–54, e42.5
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4020403&req=5

f2-cgast-6-2013-033: Worldwide CD incidence rates and/or prevalence for countries reporting data: (A) before 1960, (B) from 1960 to 1979, and (C) after 1980. Incidence and prevalence values were ranked into quintiles representing low (dark and light blue) to intermediate (green) to high (yellow and red) occurrence of disease. Reproduced with permission from the publisher: Molodecky et al. Gastroenterology. 2012;142:46–54, e42.5
Mentions: To date, there are 3,028 publications from six of the seven continents reporting the incidence or prevalence for IBD worldwide (569 from Asia/Middle East, 102 from Africa, 692 from North America, 60 from South America, 1,507 from Europe, 98 from Australia, and 0 from Antarctica). The results showed that the incidence and prevalence of IBD has been increasing worldwide. Since the 19th century, the incidence of IBD has increased steadily in North America and Europe until stabilizing in the middle and latter part of the 20th century to 2–15 per 100,000 person-years for UC and 3–15 per 100,000 person-years for CD. The annual incidence rates vary by geographic region as depicted in Table 1 and Figures 1, 2, and 3. Table 2 describes the ranges in incidence and prevalence stratified into quintiles levels for CD and UC. The highest annual incidence of UC is currently 24.3 per 100,000 person-years in Europe, 6.3 per 100,000 person-years in Asia and the Middle East, and 19.2 per 100,000 person-years in North America. The highest annual incidence of CD is reported to be 12.7 per 100,000 person-years in Europe, 5.0 per 100,000 person-years in Asia and the Middle East, and 20.2 per 100,000 person-years in North America. The highest reported prevalence values for IBD were in Europe (UC, 505 per 100,000 persons; CD, 322 per 100,000 persons) and North America (UC, 249 per 100,000 persons; CD, 319 per 100,000 persons). In time-trend analyses, 75% of CD studies and 60% of UC studies showed increased incidence rates over times that were of statistical significance (P < 0.05). Incidence rates stratified by gender were reported in 50 UC and 59 CD studies. The female to male ratio varied from 0.51 to 1.58 for UC studies and 0.34 to 1.65 for CD studies, suggesting that IBD diagnosis was not gender-specific.5

Bottom Line: In addition, IBD-associated CRC has a worse prognosis than sporadic CRC, even when the stage at diagnosis is taken into account.A continuing increase in IBD incidence worldwide associated with childhood-onset of IBD coupled with the diseases' longevity and an increase in oncologic transformation suggest a rising disease burden, morbidity, and healthcare costs.IBD and its associated neoplastic transformation appear inevitable, which may significantly impact pediatric gastroenterology and adult CRC care.

View Article: PubMed Central - PubMed

Affiliation: Laboratory of Inflammatory Bowel Disease Research, Department of Biochemistry and Cancer Biology, Meharry Medical College, Nashville TN. Departments of General Surgery, Colon and Rectal Surgery, and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville TN.

ABSTRACT
This review provides a summary of the global epidemiology of inflammatory bowel diseases (IBD). It is now clear that IBD is increasing worldwide and has become a global emergence disease. IBD, which includes Crohn's disease (CD) and ulcerative colitis (UC), has been considered a problem in industrial-urbanized societies and attributed largely to a Westernized lifestyle and other associated environmental factors. Its incidence and prevalence in developing countries is steadily rising and has been attributed to the rapid modernization and Westernization of the population. There is a need to reconcile the most appropriate treatment for these patient populations from the perspectives of both disease presentation and cost. In the West, biological agents are the fastest-growing segment of the prescription drug market. These agents cost thousands of dollars per patient per year. The healthcare systems, and certainly the patients, in developing countries will struggle to afford such expensive treatments. The need for biological therapy will inevitably increase dramatically, and the pharmaceutical industry, healthcare providers, patient advocate groups, governments and non-governmental organizations should come to a consensus on how to handle this problem. The evidence that IBD is now affecting a much younger population presents an additional concern. Meta-analyses conducted in patients acquiring IBD at a young age also reveals a trend for their increased risk of developing colorectal cancer (CRC), since the cumulative incidence rates of CRC in IBD-patients diagnosed in childhood are higher than those observed in adults. In addition, IBD-associated CRC has a worse prognosis than sporadic CRC, even when the stage at diagnosis is taken into account. This is consistent with additional evidence that IBD negatively impacts CRC survival. A continuing increase in IBD incidence worldwide associated with childhood-onset of IBD coupled with the diseases' longevity and an increase in oncologic transformation suggest a rising disease burden, morbidity, and healthcare costs. IBD and its associated neoplastic transformation appear inevitable, which may significantly impact pediatric gastroenterology and adult CRC care. Due to an infrastructure gap in terms of access to care between developed vs. developing nations and the uneven representation of IBD across socioeconomic strata, a plan is needed in the developing world regarding how to address this emerging problem.

No MeSH data available.


Related in: MedlinePlus