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P166 Upper gastrointestinal involvement in asymptomatic Crohn's disease patients in two countries of emerging disease: Asia and Eastern Europe

Z. Szepes*1, K. Farkas1, M. Rutka1, H. Chan2, F. Nagy1, L. Tiszlavicz3, W. Tang2, G. Wong2, R. Tang2, A. Lo2, C. Cheung2, S. Wong2, R. Lui2, S. Ng2, T. Molnar1

1University of Szeged, First Department of Medicine, Szeged, Hungary, 2The Chinese University of Hong Kong, Institue of Digestive Disease, Hong Kong, China, 3University of Szeged, Department of Pathology, Szeged, Hungary

Background

The incidence of inflammatory bowel disease (IBD) is still increasing in Asia and Eastern Europe. Disease phenotype may differ when compared the East and the West. However, limited studies have reported on the frequency of upper gastrointestinal (GI) involvement in patients with Crohn's disease (CD) in non-Western countries. In this prospective, international, multicenter study we compared the prevalence of macroscopic and microscopic upper GI manifestations and Helicobacter pylori positivity in asymptomatic CD patients in Asia and Eastern Europe in comparison with sex- and age-matched non-IBD controls.

Methods

Consecutive asymptomatic CD patients were prospectively recruited for upper GI endoscopy between 2013 and 2014 in Hong Kong and in Hungary. Endoscopy and biopsy findings were recorded and histology was performed to assess for Helicobacter pylori and microscopic signs characteristic for CD.

Results

One hundred and thirteen CD patients (50 Hong Kong; 63 Hungary; 66.4% male; median age, 35 years) and 114 controls (49 Hong Kong; 65 Hungary) were included. CD patients in Hungary (median age, 33 years, range 18-76) were younger than those in Hong Kong (median age 39 years, range 19-73; p=0.027). There was no difference in the presence of macroscopic inflammation (30% vs. 47.6%; p=0.059), microscopic inflammation (92% vs. 74.6%; p=0.075), gastroduodenal erosions (22% vs. 11%; p=0.122) or Helicobacter pylori positivity (6% vs 9.5%; p=0.376) in CD patients in Hong Kong and in Hungary. Peptic ulcer or duodenal strictures were found in 1.6% of patients in Hungary and none in Hong Kong. Granulomas were detected in 4% in Hong Kong and 9.5% in Hungary (p=0.135). Two CD cases (3.2%) in Hungary were diagnosed with celiac disease. Overall CD subjects had a significantly lower Helicobacter pylori positivity as compared to controls (8.0% vs 20.2%; p=0.010).

Conclusion

The rate of upper GI lesions in CD patients in Asia was similar to that of Hungary, and comparable to Western countries. CD patients had a significantly lower Helicobacter pylori positivity rate as compared to controls. The convincingly high frequency of macroscopic and especially microscopic inflammation observed in our study justifies the need of upper GI endoscopy in asymptomatic CD patients independently of ethnicity.