Data on the natural history of inflammatory bowel disease(IBD) in Asia are limited. We aimed to determine the clinical features and outcomes of IBD patients from the largest centre in Singapore.
We collected data on 581 patients with IBD (334 ulcerative colitis [UC], 245 Crohn’s disease [CD], 2 IBD unclassified) from 1970 to 2017 using hospital administrative records. Disease phenotype, complications, use of medications, and surgery were analysed.
The median age in 2017 of patients with CD and UC was 45 (interquartile range (IQR), 30–59) years and 56 (IQR, 45 -65) years, respectively. Median age at diagnosis was 30 (IQR, 20–46) years for CD and 40 (IQR, 30–50) years for UC. Median follow-up was 9 years (4–17) for CD and 12 years (6–20) for UC. At diagnosis, in CD, ileocolonic disease (58.7%) and inflammatory behaviour (62.3%) were the most frequent phenotype. Perianal disease developed in 17% of patients. At maximal follow-up disease location extension occurred in 3.8% and stricturing and penetrating (B2+B3) complications increased from 37.7% to 55.5% of patients. In UC, 21.5% of patients had proctitis, 44.8% left-sided and 33.6% extensive colitis. Proximal disease extension during follow-up occurred in 16.5%. A family history of IBD was reported in 5.5% of patients. Colorectal cancer developed in 0.5% of the cohort. In CD the cumulative probabilities of receiving corticosteroids (CS), immunosuppressive therapies (IS) and anti-tumour necrosis factor (anti-TNF) therapy were 78.7%, 73.7% and 35.5%, respectively, at maximal follow-up. In UC cumulative probabilities of receiving CS, IS and anti-TNF were 65.5%, 34.1%, and 9.3%, respectively, at maximal follow-up. Cumulative probabilities of surgery at 1 year and 10 years were 11.4% and 22.9%,, respectively, in CD and 1.8% and 4.5%, respectively, in UC (Figure 1 and Table 1).
The disease phenotype and natural history of IBD in our cohort follow that of the western countries. CD is a disabling disease with higher surgical rates and requires more immunosuppressive therapies and biological therapies compared with UC.
1. Burisch J, et al. Initial disease course and treatment in an inflammatory bowel disease inception cohort in Europe. Inflamm Bowel Dis 2014;20:36–46.