P179. Clinical and evolutionary aspects of inflammatory bowel diseases in a developing country: Morocco. Is there a statistical deviation from developed countries? A university hospital based research
F.Z. Ajana1, Y. Cherradi1, W. Essamri1, I. Benelbaghdadi1, A. Essaid1
1Ibn Sina Hospital, Médecine C, Rabat, Morocco
Background: Inflammatory bowel diseases (IBD) are distributed randomly around the world. In Morocco, no epidemiological data are available. We aim to study the local IBD profile and to explore possible features specific to our population.
Methods: A retro-prospective, descriptive and analytic study was conducted during 10 years from January 1st, 1999 to September 31, 2009. Diagnosis of ulcerative colitis (UC) and Crohn disease (CD) was obtained from a series of clinical, biological, morphological, histological, and evolutionary criteria. Data concerning age, gender, origin, clinical illness history, biological and morphological parameters, treatment received and prognosis were collected and statistically analyzed using Pearson Chi Square test.
Results: Of 756 patients with IBD, 640 were considered with 316 CD (49%), 285 UC (45%) and 39 undetermined colitis. In UC group, female patients were prominent and present 56.5% versus 43% in CD population. Gender was not significant (p = 0.5). In the CD series, patients were younger compared to UC group and the age of onset was earlier. The average age is 33±11 years in CD's group versus 39±12 years in UC's. Urban versus rural origin wasn't statistically significant (p = 0.5). Appendectomy is an important factor in CD (p = 0.001, OR = 11.2). Smoking is not significant in our series (p = 0.4). 96% of patients in both groups had no family history of IBD. CD patients are significantly more hospitalized compared to UC (p = 0.001). In CD group, diagnosis was obtained immediately in 15% after an emergency surgery; ileal localization was reported in 68% and colonic CD presents 24%; the disease was controlled without recurrence after the first year in 24% and surgery was necessary in about 26%. Concerning UC population, 43% of patients were diagnosed with distal location, 34% with left sided colitis, and 23% with pancolitis; the treatment consisted primarily of drugs and surgery was necessary in only 2%. Over a 10 years follow-up period, complications were around 13% in the UC group versus 32% in CD's.
Conclusions: Despite the difficulty of accessing Infliximab and the absence of cyclosporine, the study demonstrates that the local population doesn't present more complications than those reported in the literature which suggests probably a more important role of environmental factors.