The epidemiology, genetics, and clinical manifestations of Crohn's disease (CD) vary considerably among geographic areas and ethnic groups. Thus, identifying the characteristics of Korean CD is important for establishing management strategies appropriate for Korean patients. Since the mid-2000s, many studies have investigated the characteristic features of Korean CD. The incidence and prevalence rates of CD have been increasing rapidly in Korea, especially among the younger population. Unlike Western data, Korean CD shows a male predominance and a lower proportion of isolated colonic disease. Perianal lesions are more prevalent than in Western countries. Genome-wide association studies have confirmed that genetic variants in TNFSF15, IL-23R, and IRGM, but not ATG16L1, are associated with CD susceptibility in the Korean population. Studies of the associations between genetic mutations and the clinical course of CD are underway. Although it has been generally accepted that the clinical course of Korean CD is milder than that in Western countries, recent studies have shown a comparable rate of intestinal resection in Korean and Western CD patients. An ongoing nationwide, hospital-based cohort study is anticipated to provide valuable information on the natural history and prognosis of Korean CD in the near future.
*Crohn Disease/diagnosis/epidemiology/therapy ; Diagnosis, Differential ; Female ; Humans ; Male ; Prognosis ; Republic of Korea/epidemiology

INTRODUCTIONThis study examined the characteristics and trends in the incidence of inflammatory bowel disease (IBD) among children in Singapore.

METHODSWe retrospectively reviewed all patients under 18 years diagnosed with IBD over a 14-year period. Information on demographics, disease presentation, laboratory findings, radiological investigations, and endoscopic and histological findings were obtained from the patients' medical records.

RESULTS32 patients were diagnosed with IBD, 30 of whom had Crohn's disease and 2 had ulcerative colitis. The incidence of IBD rose from an initial rate of 2.2 per 100,000 patients in the year 2000 to a peak of 11.4 patients per 100,000 patients by 2008. Median age of onset of symptoms was 10.5 years. There were more boys (63%) than girls in the group and a higher representation of Indians (34.4%). The most common presenting symptoms were abdominal pain (87.5%), diarrhoea (75.0%) and weight loss (71.9%). Extraintestinal manifestations such as fever and arthralgia were found in over 50% of patients. The most common physical findings were perianal abnormalities (56.3%), mouth ulcers (37.5%) and growth failure (15.6%). Abnormal laboratory findings such as low albumin, raised erythrocyte sedimentation rate, anaemia, thrombocytosis and high C-reactive protein were found in nearly half of the patients. Endoscopic and histological findings showed that a majority of patients (90.6%) also had evidence of inflammation in the upper gastrointestinal tract.

CONCLUSIONPaediatric IBD is on the rise. The higher occurrence in Indians, earlier onset and more florid presentation may suggest different genetic and environmental influences specific to Asian children.

Adolescent ; Age of Onset ; Child ; Child, Preschool ; Colitis, Ulcerative ; diagnosis ; Crohn Disease ; diagnosis ; Environment ; Ethnic Groups ; Female ; Genetic Predisposition to Disease ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; diagnosis ; epidemiology ; ethnology ; therapy ; Male ; Retrospective Studies ; Singapore ; epidemiology ; Treatment Outcome

BACKGROUND/AIMS: The prevalence of Helicobacter pylori (H. pylori) infection has been reported to be lower in individuals with inflammatory bowel disease (IBD) in some Western countries. We investigated H. pylori infection in Korean patients with IBD and any possible associations of H. pylori infection with drug therapy for IBD and the phenotype of Crohn's disease (CD). METHODS: We studied 316 unselected patients with IBD, including 169 ulcerative colitis (UC) patients and 147 with CD, and the control group consisted of 316 age- and gender-matched healthy people who received a comprehensive medical examination for a regular checkup purpose. Infection rates of H. pylori as detected by the urea breath test were compared between the IBD patients and the controls. RESULTS: A statistically significant difference in H. pylori infection rate was noticed between the IBD patients (25.3%) and the controls (52.5%; p<0.001), and between UC (32.0%) and CD patients (17.7%; p=0.04). Among the IBD patients, the age group of <60 and individuals with a history of taking metronidazole (13.0%; p=0.038) or ciprofloxacin (6.7%; p=0.001) were found to have a meaningfully lower infection rate, but those who did not take antibiotics still showed H. pylori infection rate significantly lower than the controls (CD 22.0% vs. UC 33.8% vs. Control 52.5%, p<0.001). With an exception of age, phenotypic characteristics showed no significant relations with H. pylori infection rate in CD patients. CONCLUSIONS: Korean patients with IBD, particularly CD, were found to have a significantly lower H. pylori infection rate than the controls. This association was more evident in those <60 years old, which suggested that H. pylori infection might be deemed to lower possible risks of IBD in younger adults.
Adolescent ; Adult ; Age Factors ; Aged ; Colitis, Ulcerative/complications/diagnosis/drug therapy ; Crohn Disease/complications/diagnosis/drug therapy ; Female ; Helicobacter Infections/complications/diagnosis/*epidemiology ; *Helicobacter pylori ; Humans ; Inflammatory Bowel Diseases/*complications/diagnosis/drug therapy ; Korea ; Male ; Middle Aged ; Phenotype ; Prevalence

The aims of this study were to assess the risk of tuberculosis (TB) and the status of latent tuberculosis infection (LTBI) in Korean patients with inflammatory bowel disease (IBD) receiving tumor necrosis factor (TNF)-alpha blockers. We reviewed medical records of 525 Korean IBD patients (365 TNF-alpha blocker naive and 160 TNF-alpha blocker exposed) between January 2001 and December 2013. The crude incidence of TB was significantly higher in IBD patients receiving TNF-alpha blockers compared to TNF-alpha-blocker-naive patients (3.1% vs. 0.3%, P=0.011). The mean incidence of TB per 1,000 patient-years was 1.84 for the overall IBD population, 4.89 for TNF-alpha blocker users, and 0.45 for TNF-alpha-blocker-naive patients. The adjusted risk ratio of TB in IBD patients receiving TNF-alpha blocker was 11.7 (95% confidence interval, 1.36-101.3). Pulmonary TB was prevalent in patients treated with TNF-alpha blockers (80.0%, 4/5). LTBI was diagnosed in 17 (10.6%) patients, and none of the 17 LTBI patients experienced reactivation of TB during treatment with TNF-alpha blockers. Treatment with TNF-alpha blockers significantly increased the risk of TB in IBD patients in Korea. De novo pulmonary TB infection was more prevalent than reactivation of LTBI, suggesting an urgent need for specific recommendations regarding TB monitoring during TNF-alpha blocker therapy.
6-Mercaptopurine/adverse effects/analogs & derivatives/therapeutic use ; Adult ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects/therapeutic use ; Antibodies, Monoclonal/adverse effects/therapeutic use ; Cohort Studies ; Colitis, Ulcerative/*drug therapy ; Crohn Disease/*drug therapy ; Female ; Humans ; Latent Tuberculosis/chemically induced/diagnosis/*epidemiology ; Male ; Mycobacterium tuberculosis/isolation & purification ; Republic of Korea ; Retrospective Studies ; Tuberculosis, Pulmonary/chemically induced/diagnosis/*epidemiology ; Tumor Necrosis Factor-alpha/*antagonists & inhibitors

The aims of this study were to assess the risk of tuberculosis (TB) and the status of latent tuberculosis infection (LTBI) in Korean patients with inflammatory bowel disease (IBD) receiving tumor necrosis factor (TNF)-alpha blockers. We reviewed medical records of 525 Korean IBD patients (365 TNF-alpha blocker naive and 160 TNF-alpha blocker exposed) between January 2001 and December 2013. The crude incidence of TB was significantly higher in IBD patients receiving TNF-alpha blockers compared to TNF-alpha-blocker-naive patients (3.1% vs. 0.3%, P=0.011). The mean incidence of TB per 1,000 patient-years was 1.84 for the overall IBD population, 4.89 for TNF-alpha blocker users, and 0.45 for TNF-alpha-blocker-naive patients. The adjusted risk ratio of TB in IBD patients receiving TNF-alpha blocker was 11.7 (95% confidence interval, 1.36-101.3). Pulmonary TB was prevalent in patients treated with TNF-alpha blockers (80.0%, 4/5). LTBI was diagnosed in 17 (10.6%) patients, and none of the 17 LTBI patients experienced reactivation of TB during treatment with TNF-alpha blockers. Treatment with TNF-alpha blockers significantly increased the risk of TB in IBD patients in Korea. De novo pulmonary TB infection was more prevalent than reactivation of LTBI, suggesting an urgent need for specific recommendations regarding TB monitoring during TNF-alpha blocker therapy.
6-Mercaptopurine/adverse effects/analogs & derivatives/therapeutic use ; Adult ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects/therapeutic use ; Antibodies, Monoclonal/adverse effects/therapeutic use ; Cohort Studies ; Colitis, Ulcerative/*drug therapy ; Crohn Disease/*drug therapy ; Female ; Humans ; Latent Tuberculosis/chemically induced/diagnosis/*epidemiology ; Male ; Mycobacterium tuberculosis/isolation & purification ; Republic of Korea ; Retrospective Studies ; Tuberculosis, Pulmonary/chemically induced/diagnosis/*epidemiology ; Tumor Necrosis Factor-alpha/*antagonists & inhibitors