Ng Siew C
Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Chinese University of Hong Kong, Hong Kong.
J Gastroenterol Hepatol. 2015 Mar;30(3):440-5. doi: 10.1111/jgh.12859.
More than a decade ago, inflammatory bowel disease (IBD) is rare in Asia. Today, the importance of IBD in Asia is exemplified by its rapidly increasing incidence, complicated disease behavior, and substantial morbidity. In the first large-scale population-based epidemiologic study in Asia, the incidence of IBD varied from 0.60 to 3.44 per 100,000. There has been a twofold to threefold increase in the incidence of IBD in several countries in Asia. Ulcerative colitis (UC) is more prevalent than Crohn's disease (CD), although CD incidence is rapidly increasing. A positive family history is much less common than in the West, as are extra-intestinal disease manifestations. Complicated and penetrating CD are common in Asia. These epidemiologic changes may relate to increased contact with the West, westernization of diet, improved hygiene, increasing antibiotics use, or changes in the gut microbiota. Asian patients with CD have altered gut microbiota compared with their healthy counterparts and Caucasian CD subjects. Mucosa-associated microbiota in IBD may differ geographically. In a population-based case-control study, breast-feeding, having pets, and better sanitary conditions were protective of IBD, suggesting that childhood environment plays an important role in modulating disease development. Genetic factors also differ between Asians and Caucasians. Nucleotide oligomerization domain-2 (NOD2) and autophagy variants were not associated with CD, but tumor necrosis factor superfamily gene-15 polymorphisms were strongly associated with CD in East Asians. Research in Asia, an area of rapidly changing IBD epidemiology, may lead to the discovery of critical etiologic factors that lead to the development of IBD.
十多年前，炎症性肠病（IBD）在亚洲还很罕见。如今，IBD在亚洲的重要性体现在其发病率迅速上升、疾病行为复杂以及高发病率上。在亚洲首次大规模基于人群的流行病学研究中，IBD的发病率为每10万人0.60至3.44例。亚洲几个国家的IBD发病率已经增长了两倍到三倍。溃疡性结肠炎（UC）比克罗恩病（CD）更常见，尽管CD的发病率正在迅速上升。与西方相比，家族史阳性的情况要少见得多，肠外疾病表现也是如此。复杂型和穿透型CD在亚洲很常见。这些流行病学变化可能与与西方接触增加、饮食西化、卫生条件改善、抗生素使用增加或肠道微生物群的变化有关。与健康对照者和白种人CD患者相比，亚洲CD患者的肠道微生物群发生了改变。IBD中与黏膜相关的微生物群可能存在地域差异。在一项基于人群的病例对照研究中，母乳喂养、养宠物和更好的卫生条件对IBD有保护作用，这表明儿童时期的环境在调节疾病发展中起重要作用。亚洲人和白种人的遗传因素也有所不同。核苷酸寡聚化结构域2（NOD2）和自噬变异与CD无关，但肿瘤坏死因子超家族基因15多态性与东亚人的CD密切相关。在IBD流行病学迅速变化的亚洲地区开展研究，可能会发现导致IBD发病的关键病因。
