Five-year clinical outcomes of Crohn’s disease: a report of 287 multiethnic cases from an International Hospital in Thailand

Abstract

Vibhakorn Permpoon,1 Krit Pongpirul,2–4 Sinn Anuras11Digestive Disease Center, Bumrungrad International Hospital, Bangkok, Thailand; 2Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 3Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 4Bumrungrad Research Center, Bumrungrad International Hospital, Bangkok, ThailandBackground: Crohn’s disease (CD) has been relatively rare in Asian region whereas its clinical outcomes have been dominated by evidence from Caucasians in developed countries. This study reported clinical characteristics and outcomes of the multiethnic patients who visited our institution.Materials and methods: Medical records of all patients who visited our institution during 2005–2010 were reviewed. Colonoscopy and sigmoidoscopy were performed in compliance with the ASGE guidelines.Results: A total of 287 CD patients were followed up for 5.65 years on average: 41.80% Middle Eastern (ME), 29.62% Caucasian, 28.57% Asian. ME and Caucasian had higher CD prevalence than Asian (286.71, 278.66, and 43.10 per 100,000 population, respectively). Significant variation in male proportion was observed (p=0.001): 39.02% Asian, 65.83% ME, 68.24% Caucasian. The mean age was 39.46 years (ME 32.88, Asian 43.35, Caucasian 45.00; p<0.001). ME had alonger duration of symptoms (26.55 months) than Caucasian (11.98 months) and Asian (12.35 months) (p=0.0008). The proportions of perianal lesions were statistically different across ethnic origins (p=0.014): 9.76% Asian, 24.17% ME and 12.94% Caucasian. Caucasian was severely active, compared with ME (10.83%) and Asian (6.10%). Disease progression existed in 88 of 254 patients who initially had non-severe pathology: 19.63% ME, 40% Caucasian, 50.65% Asian (p<0.0001). Clinical improvement was observed in 82% of the patients. Seventy-five patients required either surgery or hospitalization with a significant ethnic variation: 37.65% Caucasian, 28.33% ME, 10.98% Asian (p<0.0001).Conclusions: Crohn’s disease prevalence, gender, age, duration of symptoms, perianal lesion, pathological severity and disease progression varied across ethnic origins.Keywords: Crohn’s Disease, ethnic groups, anatomical pathological conditions, medical tourism, retrospective studie