Goren Idan, Sharar Fischler Tali, Yanai Henit, Pal Partha, Adigopula Bhargavi, Pendyala Sushmitha, Ganesh Girish, Vishnubhotla Ravikanth, Rabinowitz Keren Masha, Shaham Barda Efrat, Yadamreddy Durga, Godny Lihi, Peleg Noam, Banerjee Rupa, Dotan Iris
IBD Center, Division of Gastroenterology, Rabin Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva 49100, Israel.
Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
J Clin Med. 2022 Nov 22;11(23):6899. doi: 10.3390/jcm11236899.
Background: Crohn’s disease (CD) incidence is rising in India. However, features of newly diagnosed patients with CD in this population are largely unknown. The Indo-Israeli IBD GastroEnterology paRtnership (TiiiGER) aimed to investigate differences in presentation among patients with newly diagnosed CD in India and Israel, and to explore phenotype−serotype correlations. Methods: A prospective observational cohort study of consecutive adults (>18 years) conducted in two large referral centers in India and Israel (2014−2018). Clinical data, an antiglycan serological panel, and 20 CD-associated genetic variants were analyzed. Outcomes: complicated phenotype at diagnosis and early complicated course (hospitalizations/surgeries) within 2 years of diagnosis. Results: We included 260 patients (104, Indian (65.4%, male; age, 37.8); 156 Israeli (49.4%, male; 31.8, age)). Median lag time from symptoms onset to diagnosis was 10.5 (IQR 3−38) vs. 3 (IQR 1−8) months in Indian vs. Israeli patients (p < 0.001). Complicated phenotype at diagnosis was observed in 48% of Indian and 30% of Israeli patients (p = 0.003). Complicated phenotype was associated with higher anti-Saccharomyces cerevisiae antibody (ASCA) seropositivity rate among Israeli patients (p < 0.001), but not among Indian patients. Antiglycan serology did not correlate with the tested genetic variants. Early complicated course occurred in 28 (18%) Israeli and 13 (12.5%) Indian patients. The time from diagnosis to complication was comparable (log rank p = 0.152). Antiglycan serology did not correlate with a complicated early course in either cohort. Conclusions: There are significant differences in patients presenting with newly diagnosed CD in India and Israel, including phenotype and distinct biomarkers at diagnosis. These differences suggest different genetic and environmental disease modifiers.
印度克罗恩病（CD）的发病率正在上升。然而，该人群中新诊断的CD患者的特征在很大程度上尚不清楚。印度-以色列炎症性肠病胃肠病学合作项目（TiiiGER）旨在调查印度和以色列新诊断的CD患者临床表现的差异，并探索表型-血清型相关性。方法：在印度和以色列的两个大型转诊中心（2014 - 2018年）对连续的成年人（>18岁）进行一项前瞻性观察队列研究。分析临床数据、抗聚糖血清学指标以及20个与CD相关的基因变异。结果：我们纳入了260例患者（104例印度患者（65.4%为男性；年龄37.8岁）；156例以色列患者（49.4%为男性；年龄31.8岁））。印度患者从症状出现到诊断的中位延迟时间为10.5（四分位间距3 - 38）个月，而以色列患者为3（四分位间距1 - 8）个月（p < 0.001）。48%的印度患者和30%的以色列患者在诊断时出现复杂表型（p = 0.003）。复杂表型在以色列患者中与较高的抗酿酒酵母抗体（ASCA）血清阳性率相关（p < 0.001），但在印度患者中并非如此。抗聚糖血清学与所检测的基因变异无相关性。28例（18%）以色列患者和13例（12.5%）印度患者出现早期复杂病程。从诊断到出现并发症的时间相当（对数秩检验p = 0.152）。在两个队列中，抗聚糖血清学与早期复杂病程均无相关性。结论：印度和以色列新诊断的CD患者存在显著差异，包括表型以及诊断时不同的生物标志物。这些差异提示存在不同的遗传和环境疾病修饰因素。
