Asians have more perianal Crohn disease and ocular manifestations compared with white Americans

Bharati Kochar; Edward L Barnes; Hans H Herfarth; Christopher F Martin; Ashwin N Ananthakrishnan; Dermot McGovern; Millie Long; Robert S Sandler

doi:10.1159/000484347

Asians have more perianal Crohn disease and ocular manifestations compared with white Americans

Inflamm Intest Dis. 2018 Mar;2(3):147-153. doi: 10.1159/000484347. Epub 2017 Nov 18.

Authors

Bharati Kochar^{1

2}, Edward L Barnes^{1

2}, Hans H Herfarth^{1

2}, Christopher F Martin¹, Ashwin N Ananthakrishnan³, Dermot McGovern⁴, Millie Long^{1

2}, Robert S Sandler¹

Affiliations

¹ Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC.
² Multidisciplinary Center for Inflammatory Bowel Disease, University of North Carolina, Chapel Hill, NC.
³ Division of Gastroenterology, Massachusetts General Hospital, Boston, MA.
⁴ F. Widjaja Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA.

Abstract

Background: Inflammatory bowel disease (IBD) is increasing in Asians. We sought tobetter understand differences in IBD between Asians and whites in the United States (U.S.).

Methods: We used data from the Sinai-Helmsley Alliance for Research Excellence cohort to assess disease characteristics for U.S.-born Asians, Asian immigrants and whites. We used bivariate analyses to describe clinical characteristics by race. We used logistic regression to determine baseline odds of immunosuppression and binomial regression to estimate risk ratios for worsening disease at follow-up.

Results: We included 5,223 whites, 35 U.S.-born Asians and 81 Asian immigrants. Crohn's disease (CD) was present in 64% of whites, 40% of U.S.-born Asians and 51% of Asian immigrants. At baseline, 58% of whites, 62% of U.S.-born Asians and 67% of Asian immigrants were in remission by disease activity index score (p=0.238). There were no significant differences in CD location and behavior or ulcerative colitis (UC) extent. Asians had significantly more perianal disease than whites (33% versus 18%, p=0.007). Asians were more likely to have ocular manifestations compared with whites (3.4% versus 0.7%, p=0.022). Asians were also significantly less likely to be depressed than whites (25% versus 35%, p=0.022). Adjusting for confounders, Asians had half the odds of being treated with biologics compared with whites (OR: 0.45, 95% CI: 0.30-0.67). Adjusting for disease behavior and remission status, there were no differences in IBD-related surgery or hospitalization, new biologic or steroid prescription or relapse rates between Asians and whitesat follow-up.

Conclusion: Asians are more likely to have perianal disease and ocular extra-intestinal manifestations. After controlling for confounders, Asians were less likely to be treated with biologic agents. Despite this, there were no significant differences in outcome sover time between Asians and whites. Differences in disease phenotypes in Asians may reflect differences in genetics.

Keywords: Asian; Crohn's Disease; Immigrant; Inflammatory Bowel Disease; Race; Ulcerative Colitis.

Abstract

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