Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2021; 27(20): 2630-2642
Published online May 28, 2021. doi: 10.3748/wjg.v27.i20.2630
Inflammatory bowel disease in Tuzla Canton, Bosnia-Herzegovina: A prospective 10-year follow-up
Emir Tulumović, Nermin Salkić, Denijal Tulumović
Emir Tulumović, Nermin Salkić, Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla 75000, Tuzlanski Kanton, Bosnia and Herzegovina
Denijal Tulumović, Department of Nephrology, Dialysis and Transplantation, University Clinical Center Tuzla, Tuzla 75000, Tuzlanski Kanton, Bosnia and Herzegovina
Author contributions: Tulumović E contributed to data collection and analysis, and writing of the first draft of the paper; Salkić N contributed to study design and patient recruitment; Tulumović D contributed to data analysis and writing of the first draft of the paper; Salkić N and Tulumović D revised the article critically for important intellectual content.
Institutional review board statement: The study was reviewed and approved by the Ethical Board of University Clinical Center Tuzla by the declaration 02-09/2-78/20, on the 01.12.2020.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this manuscript.
Data sharing statement: The data underlying this article cannot be shared publicly, as it is provided with permission of University Clinical Center Tuzla. The data will be shared on reasonable request to the corresponding author with the permission of University Clinical Center Tuzla.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Emir Tulumović, MD, Doctor, Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Ibre Pašića bb, Tuzla 75000, Tuzlanski Kanton, Bosnia and Herzegovina. emir.tulumovic@ukctuzla.ba
Received: January 24, 2021
Peer-review started: January 24, 2021
First decision: March 7, 2021
Revised: March 15, 2021
Accepted: April 22, 2021
Article in press: April 22, 2021
Published online: May 28, 2021

The incidence and prevalence of inflammatory bowel disease (IBD) vary between regions but have risen globally in recent decades. A lack of data from developing nations limits the understanding of IBD epidemiology.


To perform a follow-up review of IBD epidemiology in the Tuzla Canton of Bosnia-Herzegovina during a 10-year period (2009-2019).


We prospectively evaluated the hospital records of both IBD inpatients and outpatients residing in Tuzla Canton for the specified period of time between January 1, 2009 and December 31, 2019. Since all our patients had undergone proximal and distal endoscopic evaluations at the hospital endoscopy unit, we used the hospital’s database as a primary data source, alongside an additional cross-relational search of the database. Both adult and pediatric patients were included in the study. Patients were grouped by IBD type, phenotype, age, and gender. Incidence rates were calculated with age standardization using the European standard population. Trends in incidence and prevalence were evaluated as a 3-year moving average and average annual percentage change rates.


During the 10-year follow-up period, 651 patients diagnosed with IBD were monitored (of whom 334, or 51.3%, were males, and 317, or 48.7%, were females). Of all the patients, 346 (53.1%) had been diagnosed with ulcerative colitis (UC), 292 (44.9%) with Crohn’s disease (CD), and 13 (2%) with indeterminate colitis (IC). We observed 440 newly diagnosed patients with IBD: 240 (54.5%) with UC, 190 (43.2%) with CD, and 10 (2.3%) with IC. The mean annual crude incidence rates were found to be 9.01/100000 population for IBD [95% confidence interval (CI): 8.17-9.85], with 4.91/100000 (95%CI: 4.29-5.54) for UC and 3.89/100000 (95%CI: 3.34-4.44) for CD. Calculated IBD prevalence in 2019 was 146.64/100000 (95%CI: 128.09-165.19), with 77.94/100000 (95%CI: 68.08-87.70) for UC and 65.77/100000 (95%CI: 54.45-74.1) for CD. The average annual IBD percentage change was 0.79% (95%CI: 0.60-0.88), with -2.82% (95%CI: -2.67 to -2.97) for UC and 6.92% (95%CI: 6.64-7.20) for CD. During the study period, 24,509 distal endoscopic procedures were performed. The incidence of IBD was 3.16/100 examinations (95%CI: 2.86-3.45) or 1.72/100 examinations (95%CI: 1.5-1.94) for UC and 1.36/100 examinations (95%CI: 1.17-1.56) for CD.


Trends in the incidence and prevalence of IBD in Tuzla Canton are similar to Eastern European averages, although there are significant epidemiological differences within geographically close and demographically similar areas.

Keywords: Inflammatory bowel disease, Crohn's disease, Ulcerative colitis, Indeterminate colitis, Epidemiology, Endoscopy

Core Tip: The greatest gap in knowledge about the epidemiological picture of inflammatory bowel disease relates to developing countries, such as those in Eastern Europe. The heterogeneity between the results among the few available epidemiological studies concerning Eastern Europe is intriguing. Therefore, we aimed to perform a follow-up review of inflammatory bowel disease epidemiology in the Tuzla Canton of Bosnia-Herzegovina during a 10-year period (2009-2019).