In the past decade, many countries in Asia, in particularly in East Asia, are experiencing a progressive rise in the incidence and prevalence of inflammatory bowel disease (IBD). Improved physician awareness and diagnostic methods are unlikely to fully account for this rapid increase. This epidemiological shift is likely to relate to industralization, westernization of lifestyles and changes in eating habits, as part of the socioeconomic development in Asia, although many of these putative environmental factors have not been formally investigated in Asian cohorts. Genetic factors for IBD differ between Asia and the West. NOD2/CARD15 mutation, repeatedly observed in the Caucasian populations, is not associated with Crohn's disease in Asian populations. Familial clustering is generally uncommon in Asia but it is expected to increase as the IBD prevalence in this region rises. Ethnic-racial differences of IBD have been described and Indians appear to be most affected in South-East Asia. Clinical manifestation of IBD in Asia resemble the Western population in general, but with some differences, including higher prevalence of males and ileocolonic disease, lower disease severity, surgical rates and extraintestinal manifestations. These differences may relate to time factor, genetic background and environmental factors. This review summarises recent epidemiological data of IBD including environmental factors associated with the development of IBD in Asia. Future research focusing on studying the epidemiology of IBD in an area of rapidly increasing prevalence such as Asia will allow the opportunity to identify potential risk factors and provide a better understanding of the aetiology of disease in the Asian population.
Asia ; Asian Continental Ancestry Group ; Cohort Studies ; Crohn Disease ; Eating ; Far East ; Humans ; Incidence ; Inflammatory Bowel Diseases ; Life Style ; Male ; Polymethacrylic Acids ; Prevalence ; Risk Factors ; Time Factors

In the past decade, many countries in Asia, in particularly in East Asia, are experiencing a progressive rise in the incidence and prevalence of inflammatory bowel disease (IBD). Improved physician awareness and diagnostic methods are unlikely to fully account for this rapid increase. This epidemiological shift is likely to relate to industralization, westernization of lifestyles and changes in eating habits, as part of the socioeconomic development in Asia, although many of these putative environmental factors have not been formally investigated in Asian cohorts. Genetic factors for IBD differ between Asia and the West. NOD2/CARD15 mutation, repeatedly observed in the Caucasian populations, is not associated with Crohn's disease in Asian populations. Familial clustering is generally uncommon in Asia but it is expected to increase as the IBD prevalence in this region rises. Ethnic-racial differences of IBD have been described and Indians appear to be most affected in South-East Asia. Clinical manifestation of IBD in Asia resemble the Western population in general, but with some differences, including higher prevalence of males and ileocolonic disease, lower disease severity, surgical rates and extraintestinal manifestations. These differences may relate to time factor, genetic background and environmental factors. This review summarises recent epidemiological data of IBD including environmental factors associated with the development of IBD in Asia. Future research focusing on studying the epidemiology of IBD in an area of rapidly increasing prevalence such as Asia will allow the opportunity to identify potential risk factors and provide a better understanding of the aetiology of disease in the Asian population.
Asia ; Asian Continental Ancestry Group ; Cohort Studies ; Crohn Disease ; Eating ; Far East ; Humans ; Incidence ; Inflammatory Bowel Diseases ; Life Style ; Male ; Polymethacrylic Acids ; Prevalence ; Risk Factors ; Time Factors

Inflammatory bowel disease (IBD) has become more common in Asia over the past few decades. The rate of increase in prevalence of the disease varies greatly in Asia, with several countries in East Asia experiencing a more than doubled increase in IBD prevalence over the past decade. Historically, ulcerative colitis (UC) is more common than Crohn's disease (CD) in Asia. However, a reverse trend is beginning to appear in more developed countries in Asia such as Japan, Korea, and Hong Kong. While Asian IBD patients share many similarities with their Western counterparts, there are important differences with significant clinical implications. In Asia, there are more men with CD, more ileo-colonic involvement in CD, less familial aggregation, fewer extra-intestinal manifestations and worse clinical outcomes for older-onset patients with UC. These differences are likely related to the different genetic makeup and environmental exposures in different regions. Evaluation of the differences and rates in epidemiologic trends may help researchers and clinicians estimate disease burden and understand the reasons behind these differences, which may hold the key to unravel the etiology of IBD.
Asia* ; Asian Continental Ancestry Group ; Colitis, Ulcerative ; Crohn Disease ; Developed Countries ; Environmental Exposure ; Epidemiology ; Far East ; Hong Kong ; Humans ; Inflammatory Bowel Diseases* ; Japan ; Korea ; Male ; Prevalence

INTRODUCTIONThere is increasing belief that a formal protocol-based multidisciplinary care model should be adopted as an optimal care model in oncology. However, there is minimal outcome evidence to demonstrate an improvement in patient care. The aim of this study was to compare clinical quality outcomes between patients with high-grade glioma managed at one hospital using a formal neuro-oncology multidisciplinary tumour clinic (MTC) and a second hospital with a traditional on-call referral pattern (non-MTC).

MATERIALS AND METHODSPatients with high-grade glioma managed radically with radiation therapy at 2 Singapore hospitals from May 2002 to May 2006 were entered into a prospective database. Patients were grouped into management via MTC or non-MTC. Four clinical quality indicators were chosen retrospectively to assess the variation in practice: a) Use of computed tomography (CT) or magnetic resonance (MR) imaging post-resection (POI) for assessment of residual disease; b) Commencement of radiation therapy (RT) within 28 days of surgery; c) Adjuvant chemotherapy use for glioblastoma multiforme (CTGBM) and d) Median survival.

RESULTSSixty-seven patients were managed radically, with 47 by MTC and by 20 by non-MTC. MTC patients were more likely to have POI (P = 0.042), and CTGBM (P = 0.025). Although the RT start time was similar for the whole cohort (60% versus 45%: P = 0.296); for GBM patients, the RT start was earlier (63% vs 33% P = 0.024). The median survival for the MTC group was 18.7 months versus 11.9 months for the non-MTC group (P = 0.11).

CONCLUSIONClinical quality outcomes were significantly improved in patients with high-grade glioma managed in this neuro-oncology MTC.

Cancer Care Facilities ; Female ; Glioma ; classification ; drug therapy ; pathology ; radiotherapy ; Humans ; Interdisciplinary Communication ; Male ; Middle Aged ; Prospective Studies ; Quality Indicators, Health Care ; Quality of Health Care ; Survival Analysis

INTRODUCTIONThe use of adjuvant temozolomide (TMZ) in patients managed with surgery and adjuvant radiation therapy (RT) for glioblastoma multiforme (GBM) has been demonstrated to improve median and 2-year survival in a recent large international multicentre study. To confirm this result in routine clinical practice, an audit of the management and outcome of patients with GBM at The Cancer Institute Radiation Oncology was performed.

MATERIALS AND METHODSAll patients with GBM managed radically at The Cancer Institute Radiation Oncology from May 2002 to 2006 were entered into a prospective database. Patient, tumour and treatment factors were analysed for association with the outcome of median survival (MS). Survival was calculated using the Kaplan-Meier technique and correlation was assessed using Cox proportional hazards regression.

RESULTSForty-one patients with GBM were managed with radical intent over the 4- year period. The median age was 54 years and 66% were Eastern Cooperative Oncology Group (ECOG) 0-1 performance status. Macroscopic, subtotal and biopsy alone procedures were performed in 61%, 29% and 10% of patients, respectively. The median time from surgery to RT was 26 days. Adjuvant TMZ was used in 44% of patients (n = 18). The MS of the total group was 13.6 months, with a 24% 2-year overall survival. The use of TMZ was associated with improved MS (19.6 versus 12.8 months; P = 0.035) and improved 2-year survival (43% versus 0%). A requirement of dexamethasone dose greater than 4 mg at the end of RT (P = 0.012) was associated with worse survival, but there was no association of MS with age, ECOG, tumour size or extent of surgery.

CONCLUSIONThe median and 2-year survival outcomes are comparable to the results of the European Multicentre Study and justify the continued use of TMZ in routine clinical practice.

Antineoplastic Agents, Alkylating ; administration & dosage ; therapeutic use ; Brain Neoplasms ; drug therapy ; radiotherapy ; surgery ; Chemotherapy, Adjuvant ; Dacarbazine ; administration & dosage ; analogs & derivatives ; therapeutic use ; Female ; Glioblastoma ; drug therapy ; radiotherapy ; surgery ; Humans ; Male ; Middle Aged ; Prospective Studies ; Singapore ; Survival Analysis

BACKGROUND/AIMS: To examine the association between use of oral contraceptive pills (OCPs) and the risk of developing inflammatory bowel diseases (IBD), in a modern cohort. METHODS: A prospective nested case-control study across sites in the Asia-Pacific region was conducted; involving female IBD cases and asymptomatic controls. Subjects completed a questionnaire addressing questions related to OCP use. Primary outcome was the risk of development of IBD of those exposed to OCP versus non-exposure. Secondary outcomes were development of Crohn's disease (CD) versus ulcerative colitis (UC), and whether age of first use of OCP use may be associated with risk of IBD. RESULTS: Three hundred and forty-eight female IBD cases (41% CD, median age: 43 years) and 590 female age-matched controls were recruited. No significant association was found between OCP use and the risk of IBD (odds ratio [OR], 1.65; 95% confidence interval, 0.77–3.13; P=0.22), CD (OR, 1.55) or UC (OR, 1.01). The lack of association persisted when results were adjusted for age and smoking. IBD cases commenced OCP use at a younger age than controls (18 years vs. 20 years, P=0.049). CONCLUSIONS: In this large cohort of subjects from the Asia-Pacific region, we found a modest but not significantly increased risk of developing IBD amongst OCP users.
Case-Control Studies ; Cohort Studies ; Colitis, Ulcerative ; Contraceptives, Oral ; Crohn Disease ; Female ; Humans ; Inflammatory Bowel Diseases* ; Prospective Studies ; Smoke ; Smoking

Inflammatory bowel disease (IBD), once considered a disease of the Western hemisphere, has emerged as a global disease. As the disease prevalence is on a steady rise, management of IBD has come under the spotlight. 5-Aminosalicylates, corticosteroids, immunosuppressive agents and biologics are the backbone of treatment of IBD. With the advent of biologics and small molecules, the need for surgery and hospitalization has decreased. However, economic viability and acceptability is an important determinant of local prescription patterns. Nearly one-third of the patients in West receive biologics as the first/initial therapy. The scenario is different in developing countries where biologics are used only in a small proportion of patients with IBD. Increased risk of reactivation of tuberculosis and high cost of the therapy are limitations to their use. Thiopurines hence become critical for optimal management of patients with IBD in these regions. However, approximately one-third of patients are intolerant or develop adverse effects with their use. This has led to suboptimal use of thiopurines in clinical practice. This review article discusses the clinical aspects of thiopurine use in patients with IBD with the aim of optimizing their use to full therapeutic potential.