Browsing by Author "Bell, S."

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Early course of inflammatory bowel disease in a population-based Inception cohort study from 8 countries in Asia and Australia
(Baltimore, 2016) Ng, S.C.; Zeng, Z.; Niewiadomski, O.; Tang, W.; Bell, S.; Kamm, M.A.; Hu, P.; de Silva, H.J.; Niriella, M.A.; Udara, W.Y.; Ong, D.; Ling, K.L.; Ooi, C.J.; Hilmi, I.; Goh, K.L.; Ouyang, Q.; Wang, Y.F.; Wu, K.; Wang, X.; Pisespongsa, P.; Manatsathit, S.; Aniwan, S.; Limsrivilai, J.; Gunawan, J.; Simadibrata, M.; Abdullah, M.; Tsang, S.W.; Lo, F.H.; Hui, A.; Chow, C.M.; Yu, H.H.; Li, M.F.; Ng, K.K.; Ching, J.Y.; Chan, V.; Wu, J.C.; Chan, F.K.; Chen, M.; Sung, J.J.; Asia-Pacific Crohn's and Colitis Epidemiology Study (ACCESS) Group
Background & Aims: 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 IBD unclassified [IBDU]; median age, 37 years) from 2011 through 2013. We analyzed 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 (TNF) 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-TNF therapy within 1 year of its diagnosis (HR, 2.97; 95% CI, 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 to patients with inflammatory disease (HR, 7.67; 95% CI, 3.93–14.96). Overall mortality for patients with IBD was 0.7%. Conclusion: In a prospective population-based study, we found that the early course of disease in patients with IBD in Asia was comparable to 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.
Environmental risk factors in inflammatory bowel disease: a population-based case-control study in Asia-Pacific
(British Medical Assosiation, 2015) Ng, S.C.; Tang, W.; Leong, R.W.; Chen, M.; Ko, Y.; Studd, C.; Niewiadomski, O.; Bell, S.; Kamm, M.A.; de Silva, H.J.; Kasturiratne, A.; Senanayake, Y.U.; Ooi, C.J.; Ling, K.L.; Ong, D.; Goh, K.L.; Hilmi, I.; Ouyang, Q.; Wang, Y.F.; Hu, P.; Zhu, Z.; Zeng, Z.; Wu, K.; Wang, X.; Xia, B.; Li, J.; Pisespongsa, P.; Manatsathit, S.; Aniwan, S.; Simadibrata, M.; Abdullah, M.; Tsang, S. W.; Wong, T.C.; Hui, A.J.; Chow, C.M.; Yu, H.H.; Li, M.F.; Ng, K.K.; Ching, J.; Wu, J.C.; Chan, F.K.; Sung, J.J.
OBJECTIVE: The rising incidence of inflammatory bowel disease in Asia supports the importance of environmental risk factors in disease aetiology. This prospective population-based case-control study in Asia-Pacific examined risk factors prior to patients developing IBD. DESIGN: 442 incident cases (186 Crohn's disease (CD); 256 UC; 374 Asians) diagnosed between 2011 and 2013 from eight countries in Asia and Australia and 940 controls (frequency-matched by sex, age and geographical location; 789 Asians) completed an environmental factor questionnaire at diagnosis. Unconditional logistic regression models were used to estimate adjusted ORs (aOR) and 95% CIs. RESULTS: In multivariate model, being breast fed >12 months (aOR 0.10; 95% CI 0.04 to 0.30), antibiotic use (aOR 0.19; 0.07 to 0.52), having dogs (aOR 0.54; 0.35 to 0.83), daily tea consumption (aOR 0.62; 0.43 to 0.91) and daily physical activity (aOR 0.58; 0.35 to 0.96) decreased the odds for CD in Asians. In UC, being breast fed >12 months (aOR 0.16; 0.08 to 0.31), antibiotic use (aOR 0.48; 0.27 to 0.87), daily tea (aOR 0.63; 0.46 to 0.86) or coffee consumption (aOR 0.51; 0.36 to 0.72), presence of hot water tap (aOR 0.65; 0.46 to 0.91) and flush toilet in childhood (aOR 0.71; 0.51 to 0.98) were protective for UC development whereas ex-smoking (aOR 2.02; 1.22 to 3.35) increased the risk of UC. CONCLUSIONS: This first population-based study of IBD risk factors in Asia-Pacific supports the importance of childhood immunological, hygiene and dietary factors in the development of IBD, suggesting that markers of altered intestinal microbiota may modulate risk of IBD later in life. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn's and colitis epidemiology study
(Elsevier-W.B. Saunders, 2013) Ng, S.C.; Tang, W.; Ching, J.Y.; Wong, M.; Chow, C.M.; Hui, A.J.; Wong, T.C.; Leung, V.K.; Tsang, S.W.; Yu, H.H.; Li, M.F.; Ng, K.K.; Kamm, M.A.; Studd, C.; Bell, S.; Leong, R.; de Silva, H.J.; Kasturiratne, A.; Mufeena, M.N.; Ling, K.L.; Ooi, C.J.; Tan, P.S.; Ong, D.; Goh, K.L.; Hilmi, I.; Pisespongsa, P.; Manatsathit, S.; Rerknimitr, R.; Aniwan, S.; Wang, Y.F.; Ouyang, Q.; Zeng, Z.; Zhu, Z.; Chen, M.H.; Hu, P.J.; Wu, K.; Wang, X.; Simadibrata, M.; Abdullah, M.; Wu, J.C.; Sung, J.J.; Chan, F.K.; Asia-Pacific Crohn's and Colitis Epidemiologic Study (ACCESS) Study Group
BACKGROUND & AIMS: Inflammatory bowel diseases (IBD) are becoming more common in Asia, but epidemiologic data are lacking. The Asia Pacific Crohn's and Colitis Epidemiology Study aimed to determine the incidence and phenotype of IBD in 8 countries across Asia and in Australia. METHODS: We performed a prospective, population-based study of IBD incidence in predefined catchment areas, collecting data for 1 year, starting on April 1, 2011. New cases were ascertained from multiple overlapping sources and entered into a Web-based database. Cases were confirmed using standard criteria. Local endoscopy, pathology, and pharmacy records were searched to ensure completeness of case capture. RESULTS: We identified 419 new cases of IBD (232 of ulcerative colitis [UC], 166 of Crohn's disease [CD], and 21 IBD-undetermined). The crude annual overall incidence values per 100,000 individuals were 1.37 for IBD in Asia (95% confidence interval: 1.25-1.51; 0.76 for UC, 0.54 for CD, and 0.07 for IBD-undetermined) and 23.67 in Australia (95% confidence interval: 18.46-29.85; 7.33 for UC, 14.00 for CD, and 2.33 for IBD-undetermined). China had the highest incidence of IBD in Asia (3.44 per 100,000 individuals). The ratios of UC to CD were 2.0 in Asia and 0.5 in Australia. Median time from symptom onset to diagnosis was 5.5 months (interquartile range, 1.4-15 months). Complicated CD (stricturing, penetrating, or perianal disease) was more common in Asia than Australia (52% vs 24%; P = .001), and a family history of IBD was less common in Asia (3% vs 17%; P < .001). CONCLUSIONS: We performed a large-scale population-based study and found that although the incidence of IBD varies throughout Asia, it is still lower than in the West. IBD can be as severe or more severe in Asia than in the West. The emergence of IBD in Asia will result in the need for specific health care resources, and offers a unique opportunity to study etiologic factors in developing nations.
Incidence and Phenotype of Inflammatory Bowel Disease From 13 Countries in Asia-Pacific: Results From the Asia-Pacific Crohn's and Colitis Epidemiologic Study 2011-2013
(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2016) Ng, S.C.; Kaplan, G.; Banerjee, R.; Wei, Shu-Chen; Tang, Whitney; Zeng, Z.; Chen, Min-hu; Yang, H.; de Silva, H.J.; Niriella, M.A.; Ong, D.E.; Ling, Khoon-Lin; Hilmi, I; Pisespongsa, P.; Aniwan, S.; Limsrivilai, J.; Abdullah, M.; Chong, V.H.; Cao, Q.; Miao, Y.; Ong-Go, A.K.; Bell, S.; Niewiadomski, O.; Kamm, M.A.; Ng, K.K.; Yu, H.H.; Wang, Yu-Fang; Ouyang, Q.; Goh, K.L.; Lin, Hung-Hsin; Lin, Wei-Chen; Wu, K.; Simadibrata, M.; Chan, F.K.; Sung, J.
Background: The Asia-Pacific Crohn's and Colitis Epidemiology Study, initiated in 2011, aimed to determine the incidence and phenotype of inflammatory bowel disease (IBD) in Asia-Pacific. We herein present incidence and phenotype data from 2011 through 2013 for 12 countries or areas in Asia (Brunei, China, Hong Kong, India, Indonesia, Macau, Malaysia, Philippines, Singapore, Sri Lanka, Taiwan, Thailand) and Australia. Methods: We performed a prospective, population-based study of IBD incidence in predefined catchment areas using a web-based database. New cases were diagnosed based on standard criteria and ascertained from multiple sources. Endoscopy, pathology, and pharmacy records were searched for completeness of case capture. Age-standardized incidence was calculated with 95% confidence interval (CI). Crude incidence in different regions within Asia was pooled together using a random effect model. Results: We identified 1,572 new IBD patients (2011-2012, n=419; 2012-2013, n=1,153; 131 from Australia) including 1,057 (67%) ulcerative colitis (UC) and 515 (33%) Crohn's disease (CD). The mean annual incidence for IBD per 100,000 was 1.68 (95% CI, 1.59-1.77) in Asia and 22.28 (95% CI, 18.48-26.71) in Australia. The three countries within Asia with the highest incidence per 100,000 was India (9.31; 95% CI, 8.38-10.31), China (Guangzhou) (3.30; 95% CI, 2.68-4.06) and Hong Kong (2.58; 95% CI, 2.20-3.03). Within five regions of China, IBD incidence varied from 0.49 to 3.30 per 100,000. Pooled incidence of UC and CD within East Asia (China, Macau, Hong Kong, Taiwan) was 1.12 (95% CI, 0.77-1.48) and 0.33 (95% CI, 0.17-0.49), respectively. Pooled incidence of UC and CD within South East Asia (Brunei, Malaysia, Singapore, Indonesia, Thailand, Philippines) was 0.38 (0.21-0.55) and 0.30 (95% CI, 0.22-0.38), respectively. Ratio of UC:CD was 2.21 in Asia and 0.64 in Australia. Median time from symptom onset to diagnosis was 3 months [interquartile range (IQR), 2-10] for UC and 7 months (IQR 2-19) for CD. Stricturing, penetrating and perianal CD at diagnosis was common (21%, 10% and 17%, respectively) in Asia. Conclusion: Robust large-scale comparative epidemiologic IBD data from newly industrialized countries are emerging. Incidence of IBD varies throughout Asia with a higher incidence in East than South-East Asia. Complicated CD at diagnosis remains prevalent in Asia. Emergence of IBD in Asia will result in the need for specific health-care resources.
Population density and risk of inflammatory bowel disease: a prospective population-based study in 13 countries or regions in Asia-Pacific.
(Wolters Kluwer Health, 2019) Ng, S.C.; Kaplan, G.G.; Tang, W.; Banerjee, R.; Adigopula, B.; Underwood, F.E.; Tanyingoh, D.; Wei, S.C.; Lin, W.C.; Lin, H.H.; Li, J.; Bell, S.; Niewiadomski, O.; Kamm, M.A.; Zeng, Z.; Chen, M.; Hu, P.; Ong, D.; Ooi, C.J.; Ling, K. L.; Miao, Y.; Miao, J.; de Silva, H.J.; Niriella, M.A.; Aniwan, S.; Limsrivilai, J.; Pisespongsa, P.; Wu, K.; Yang, H.; Ng, K.K.; Yu, H. H.; Wang, Y.; Ouyang, Q.; Abdullah, M.; Simadibrata, M.; Gunawan, J.; Hilmi, I.; Goh, K. L.; Cao, Q.; Sheng, H.; Ong-Go, A.; Chong, V. H.; Ching, J. Y. L.; Wu, J. C. Y.; Chan, F.K.L.; Sung, J.J.Y.
INTRODUCTION: Living in an urban environment may increase the risk of developing inflammatory bowel disease (IBD). It is unclear if this observation is seen globally. We conducted a population-based study to assess the relationship between urbanization and incidence of IBD in the Asia-Pacific region. METHODS: Newly diagnosed IBD cases between 2011 and 2013 from 13 countries or regions in Asia-Pacific were included. Incidence was calculated with 95% confidence interval (CI) and pooled using random-effects model. Meta-regression analysis was used to assess incidence rates and their association with population density, latitude, and longitude. RESULTS: We identified 1175 ulcerative colitis (UC), 656 Crohn's disease (CD), and 37 IBD undetermined (IBD-U). Mean annual IBD incidence per 100 000 was 1.50 (95% CI: 1.43-1.57). India (9.31; 95% CI: 8.38-10.31) and China (3.64; 95% CI, 2.97-4.42) had the highest IBD incidence in Asia. Incidence of overall IBD (incidence rate ratio [IRR]: 2.19; 95% CI: 1.01-4.76]) and CD (IRR: 3.28; 95% CI: 1.83-9.12) was higher across 19 areas of Asia with a higher population density. In China, incidence of IBD (IRR: 2.37; 95% CI: 1.10-5.16) and UC (IRR: 2.63; 95% CI: 1.2-5.8) was positively associated with gross domestic product. A south-to-north disease gradient (IRR: 0.94; 95% CI: 0.91-0.98) was observed for IBD incidence and a west-to-east gradient (IRR: 1.14; 95% CI: 1.05-1.24) was observed for CD incidence in China. This study received IRB approval. CONCLUSIONS: Regions in Asia with a high population density had a higher CD and UC incidence. Coastal areas within China had higher IBD incidence. With increasing urbanization and a shift from rural areas to cities, disease incidence may continue to climb in Asia.