P713 Exploring the epidemiological aspects of inflammatory bowel disease: preliminary data from ‘epimici’ study in San Marino
L. R. Lopetuso*1, A. Piscaglia2, L. Laterza1, V. Gerardi1, S. Boccia3, E. Leoncini2, E. Sacchini2, A. Armuzzi1, A. Gasbarrini1, M. L. Stefanelli2
1Catholic University of Sacred Heart, Internal Medicine Department, Gastroenterology Division, Rome, Italy, 2State Hospital, Endoscopy and Gastroenterology Unit, San Marino, San Marino, 3Catholic University of Sacred Heart, Rome, Italy
Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), are chronic relapsing conditions with an increasing worldwide incidence. San Marino is the third smallest country of the world, with peculiar epidemiologic aspects, and hence, it can represent an ideal population for studying IBD pathophysiological basis.
We studied the epidemiological aspects of IBD in the San Marino population, including all San Marino persons diagnosed with IBD between 1980 and 2014. Information on sociodemographic and clinical characteristics of patients were obtained via linkage to administrative databases. The principal variables evaluated were age at diagnosis, family history of IBD, disease localisation, extra-intestinal manifestations, therapies and their outcome, and need for surgery.
Amongst all San Marino inhabitants, the overall IBD prevalence was 610/100 000, 350/100 000 for UC and 260/100 000 for CD. The incidence of IBD progressively increased, especially for CD, during the studied period. Further, 15% of patients for CD and less than 10% for UC had a family history of IBD. At gender stratification, 52% UC and 51% CD patients were males. Average age at diagnosis was 38 for UC and 35 for CD. The time lapse between onset of symptoms and diagnosis was less than 1 year for UC and 1–2 years for CD. Extra-intestinal manifestations were observed in 10% of patients with UC and in 30% with CD. Of note, 1 UC patient had sclerosing cholangitis, and 1 CD patient had ankylosing spondylitis. Disease localisation for UC was rectum (33%), sigma-rectum (28%), and pancolitis (27%); whereas for CD was ileum (43%) and ileo-colon (41%). Colectomy was needed for 2 UC patients; whereas 20% of CD patients with ileal stenosis underwent surgery, and 80% of these experienced a disease recurrence after 5 years. Immunosuppressive drugs were needed in less than 10% of UC patients and in 17% of CD patients. Biologics were used only in 5 CD patients with achievement of remission.
Our preliminary data demonstrated that IBD prevalence is increased and gender distribution is different in the San Marino population when compared with Italian and European data. Early diagnosis and treatment could explain the overall good outcome of the patients evaluated. Further data are needed to confirm and better clarify these findings.