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Abstracts Search 2019

P739 The progression of inflammatory bowel disease throughout Latin America: a systematic review

P. Kotze*1, F. Underwood2, A. Damiao3, J. Ferraz2, R. Saad-Hossne4, M. Toro5, B. Iade6, F. Bosques-Padilla7, F. Teixeira8, F. Juliao-Baños9, D. Simian10, S. Ghosh11, R. Panaccione2, G. Kaplan2

1Catholic University of Paraná, IBD Outpatient Clinics, Colorectal Surgery Unit, Curitiba, Brazil, 2University of Calgary, Division of Gastroenterology and Hepatology, Calgary, Canada, 3University of Sao Paulo, Gastroenterology, Sao Paulo, Brazil, 4UNESP, Digestive Surgery, Botucatu, Brazil, 5Cuyo National University, Gastroenterology, Mendoza, Argentina, 6Hospital Maciel, Gastroenterology, Montevideo, Uruguay, 7Autonomous University of Nuevo Leon, Gastroenterology, Monterey, Mexico, 8Clinica Gastrosaude, IBD unit, Marilia, Brazil, 9Hospital Pablo Tobon Uribe, Gastroenterology, Medellin, Colombia, 10Clinica Las Condes, IBD unit, Santiago, Chile, 11NIHR Biomedical Research Centre, Institute of translational Medicine, Birmingham, UK

Background

The incidence and prevalence of ulcerative colitis (UC) and Crohn's disease (CD) is stabilising in the Western world, but increasing in developing countries. Epidemiological data on IBD is lacking from Latin American countries. The aim of this systematic review is to summarise the clinical and epidemiological information on IBD arising from countries in Latin America.

Methods

Three databases (MEDLINE, EMBASE, SciELO) were searched until September 12, 2018 for clinical or epidemiological data on IBD from all Latin American countries and territories. We assessed the following outcomes: incidence and prevalence; ratio of patients diagnosed with UC vs. CD (ratios greater than 1 favour UC); phenotype as defined by the Montreal Classification; proportion of population prescribed IBD medications (i.e., steroids, 5-ASA, immunomodulators, and anti-TNF agents); and proportion of intestinal resections. Choropleth maps of the UC:CD ratio were created using Jenks Natural Breaks.

Results

We identified 1434 abstracts with 126 articles selected for full-text review, and 61 articles were used for data extraction. Incidence and prevalence of IBD is steadily rising throughout Latin America. For example, the incidence of CD in Brazil rose from 0.08 in 1988 to 0.68 (1991–1995) to 5.5 per 100000 in 2015. The highest reported prevalence of IBD is in Argentina (2007) at 15 and 82 per 100 000 for CD and UC, respectively. The UC:CD ratio exceeds 1 in all regions throughout Latin America with the exception of Brazil where the states of Alagoas, Rio de Janeiro, and Mato Grosso do Sul reported more CD than UC patients

Figure 1. UC:CD ratio map.

The proportion of patients prescribed anti-TNF has steadily risen for CD (e.g. Brazil: 29.6% in 2005–2012 to 43.4% in 2014), but not UC (e.g. Brazil: 4.5% in 2014). Surgery for IBD is overall declining. In contrast, other regions showed stable colectomy rates pre- and post-introduction of anti-TNF for UC: e.g. in Peru, colectomy for UC 6.9% in 2001–2003 and 6.2% in 2004–2014

Figure 2. Proportion of Crohn’s disease (CD) and ulcerative colitis (UC) patients prescribed anti-TNF therapy and undergoing an intestinal resection in Latin America.

Conclusion

The burden of IBD is expanding throughout Latin America. Heterogeneity between countries may offer important clues into the pathogenesis of IBD, as well as identify regions requiring standardisation in management and healthcare delivery. Additional population-based epidemiologic studies are needed to better define the evolving burden of IBD throughout Latin America.