Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Aug 6, 2016; 7(3): 428-433
Published online Aug 6, 2016. doi: 10.4292/wjgpt.v7.i3.428
Ethnic variations in ulcerative colitis: Experience of an international hospital in Thailand
Vibhakorn Permpoon, Krit Pongpirul, Sinn Anuras
Vibhakorn Permpoon, Sinn Anuras, Digestive Disease Center, Bumrungrad International Hospital, Bangkok 10600, Thailand
Krit Pongpirul, Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Krit Pongpirul, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
Krit Pongpirul, Bumrungrad Research Center, Bumrungrad International Hospital, Bangkok 10110, Thailand
Author contributions: Permpoon V and Anuras S initiated and designed the study; Pongpirul K helped to collect, analyze, and interpret the data; Permpoon V and Pongpirul K drafted the manuscript; all authors read and approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Bumrungrad International Institutional Review Board No. BI/IRB No.146-09-11.
Informed consent statement: All subjects in this study gave their written informed consent. Participant’s identifiable information was removed.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at doctorkrit@gmail.com. The presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Krit Pongpirul, MD, MPH, PhD, Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd., Pathumwan, Bangkok 10330, Thailand. doctorkrit@gmail.com
Telephone: +66-86-6055088
Received: February 9, 2016
Peer-review started: February 11, 2016
First decision: March 14, 2016
Revised: April 12, 2016
Accepted: May 7, 2016
Article in press: May 9, 2016
Published online: August 6, 2016
Processing time: 173 Days and 16.8 Hours
Abstract

AIM: To investigate the clinical characteristics, treatment, medication use, and treatment response in patients with ulcerative colitis (UC) across ethnic groups.

METHODS: This study retrospectively analyzed medical records of all 268465 patients who visited the Bumrungrad International Digestive Disease Center during 2005-2010. The demographics, clinical characteristics, medication use, results of investigations, and medical and surgical management for patients with UC were evaluated. Evaluation included sigmoidoscopy and colonoscopy performed in compliance with the American Society of Gastrointestinal Endoscopy practice guidelines. Patient ethnicities were categorized into seven groups: Thai, Oriental, South Asian (SA), Middle Eastern (ME), Caucasian, African, and Hispanic. UC pathological severity was classified into inactive, mild, moderate, and severe. Associations between categorical variables were analyzed using the χ2 or Fischer’s exact test. Associations between categorical and interval variables were analyzed using Student’s t-test and/or analysis of covariance.

RESULTS: UC was diagnosed in 371 of the 268465 patients: male 56.33%; ME 42%, Caucasian 23%, and Thai 19%. Annual incidence of UC was 82 cases per 100000 with wide ethnic variation, ranging from 29 to 206 cases per 100000 in Oriental and ME patients, respectively. Of the patients with UC, 16.71% had severe UC with highest incidence among the patients from ME (20.39%) and lowest among the Caucasian population (11.90%). ME had highest proportion of pancolitis (52.90%), followed by Caucasian (45.35%) and Asian (34.40%). Only 20.93% of Caucasian patients received steroid, compared with 26.40% and 27.10% of Asian and Middle Eastern, respectively (P = 0.732). Overall, 13.72% of UC patients did not respond to steroid therapy, with non-significantly higher proportions of non-responders among Asian and Middle Eastern patients (15.22% and 15.04%, respectively) (P = 0.781). On average, 5.93% underwent surgical management with ethnic variation, ranging from 0% in African to 18% in SA. Cancer was found in three (Thai, ME, and African) cases (0.82 institution-specific incidence).

CONCLUSION: Incidence, symptom duration, pathological severity, clinical manifestations, medication use, treatment response, need for surgical consultation, and cancer incidence of patients with UC potentially vary by ethnicity.

Keywords: Ulcerative colitis; Ethnic groups; Anatomical pathological conditions; Medical tourism; Retrospective studies

Core tip: Incidence and prevalence of ulcerative colitis have been shown to vary across geographical areas and ethnic groups. Patients from different ethnic origins and/or healthcare systems have been managed using the same guidelines for diagnosis and treatment of ulcerative colitis. In this study, comparative analysis of symptom duration, pathological severity, extra-intestinal manifestations, surgical consultation need, medication use, and cancer incidence across ethnic groups were presented. Understanding how these attributes vary by ethnicity is useful for service delivery design, especially in this facility that is responsible for the care of patients from diverse backgrounds.