Division of Gastroenterology, University of California San Diego, San Diego, California, USA.
Division of Pediatrics, Children's Hospital of Pennsylvania, Pittsburgh, Pennsylvania, USA.
Inflamm Bowel Dis. 2020 Nov 19;26(12):1933-1942. doi: 10.1093/ibd/izaa029.
South Asians have recently been identified as having a rapidly rising incidence and prevalence of inflammatory bowel disease (IBD) throughout the world. However, longitudinal phenotypic studies of South Asians living in the United States remain scarce.
We retrospectively studied 171 South Asian patients with IBD treated at 2 US tertiary centers who presented between 2000 and 2016. South Asian IBD patients were randomly matched in a 1:2 ratio with sex and IBD subtype-matched (ulcerative colitis [UC] vs Crohn disease [CD]) white control patients (n = 342). Demographic and phenotypic characteristics were evaluated and compared between the 2 groups. Odds ratios (OR), logistic regression, and survival analysis were performed using R studio and STATA.
81 South Asian patients and 162 white patients had CD, and 90 South Asians and 180 white patients had UC. Among the CD group, South Asian patients were diagnosed at a median older age (age 28) than white patients (21 years; P < 0.003). Fistulizing disease (24.1% vs 8.6%; P < 0.002), perianal disease (20.3% vs 2.5%; P < 0.005), and presentation of rectal pain (16.2% vs 2.9%; P < 0.001) were more common among South Asian patients with CD than among white patients. After adjusting for covariates, South Asian patients with CD were less likely to be placed on thiopurines (OR = 0.36; P < 0.007) or to receive more than 1 biologic (OR = 0.42; P < 0.040). South Asian patients with UC were less likely to have proctitis (10% vs 22.2%; P < 0.022) and more likely to have primary sclerosing cholangitis (n = 7 vs n = 2; P < 0.007). South Asian patients born in the United States or those who had migrated before age 5 were younger at the age of IBD diagnosis (age 18.9 vs 32.4; P < 0.0005).
We found unique demographic and phenotypic characteristics among South Asian patients, including more penetrating disease in those with CD and less proctitis among those with UC, along with altered medication use patterns. Distinct environmental exposures and a potentially unique genetic profile of South Asian patients may confer this variable phenotypic expression, influencing management of this increasingly at-risk population.
南亚人在全球范围内的炎症性肠病（IBD）发病率和患病率呈快速上升趋势。然而，在美国生活的南亚人进行的纵向表型研究仍然很少。
我们回顾性研究了 2000 年至 2016 年期间在 2 家美国三级中心治疗的 171 名南亚 IBD 患者。南亚 IBD 患者与性别和 IBD 亚型匹配（溃疡性结肠炎 [UC]与克罗恩病 [CD]）的白人对照患者（n = 342）以 1：2 的比例随机匹配。评估并比较了两组患者的人口统计学和表型特征。使用 R 工作室和 STATA 进行比值比（OR）、逻辑回归和生存分析。
81 名南亚患者和 162 名白人患者患有 CD，90 名南亚患者和 180 名白人患者患有 UC。在 CD 组中，南亚患者的中位诊断年龄（28 岁）大于白人患者（21 岁；P < 0.003）。瘘管病（24.1%比 8.6%；P < 0.002）、肛周疾病（20.3%比 2.5%；P < 0.005）和直肠疼痛（16.2%比 2.9%；P < 0.001）在南亚 CD 患者中更为常见。调整协变量后，南亚 CD 患者使用硫嘌呤的可能性较低（OR = 0.36；P < 0.007）或接受超过 1 种生物制剂的可能性较低（OR = 0.42；P < 0.040）。南亚 UC 患者中更有可能患有直肠炎（10%比 22.2%；P < 0.022），而原发性硬化性胆管炎的发病率更高（n = 7 比 n = 2；P < 0.007）。在美国出生或 5 岁前移民的南亚患者的 IBD 诊断年龄更年轻（年龄 18.9 岁比 32.4 岁；P < 0.0005）。
我们发现南亚患者存在独特的人口统计学和表型特征，包括 CD 患者中更具穿透性的疾病和 UC 患者中较少的直肠炎，以及改变的药物使用模式。南亚患者独特的环境暴露和潜在的独特遗传特征可能导致这种可变的表型表达，影响这一风险日益增加的人群的管理。
