Observational Study
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World J Gastroenterol. Dec 14, 2014; 20(46): 17525-17531
Published online Dec 14, 2014. doi: 10.3748/wjg.v20.i46.17525
Clinical epidemiology of ulcerative colitis in Arabs based on the Montréal classification
Othman R Alharbi, Nahla A Azzam, Ahmed S Almalki, Majid A Almadi, Khalid A Alswat, Nazia Sadaf, Abdulrahman M Aljebreen
Othman R Alharbi, Nahla A Azzam, Majid A Almadi, Khalid A Alswat, Nazia Sadaf, Abdulrahman M Aljebreen, Gastroenterology Division, King Khalid University Hospital, King Saud University, Riyadh 11461, Saudi Arabia
Ahmed S Almalki, Gastroenterology Division, Riyadh Military Hospital, Riyadh 11461, Saudi Arabia
Majid A Almadi, Gastroenterology Division, the McGill University Health Center, Montréal General Hospital, McGill University, Montréal H3A 1W9, Canada
Author contributions: The work presented here was carried out in collaboration between all the authors; Alharbi OR defined the research theme and authored the manuscript; Azzam NA, Almadi MA and Almalki AS designed the methods, analyzed the data and interpreted the results; Alsawat KA and Sadaf N were involved in the editing of the manuscript; the paper was critically reviewed and finalized by Aljebreen AM, Almadi MA and Alharbi OR; all the authors gave approval for the final version of the manuscript; Alharbi OR is responsible for the integrity of this study from its conception to publication.
Correspondence to: Othman R Alharbi, MD, FRCPC, Gastroenterology Division, Internal Medicine Department, King Khalid University Hospital, King Saud University, PO Box 2925, Riyadh 11461, Saudi Arabia. ohmanalharbi@ksu.edu.sa
Telephone: +966-1-4671192 Fax: +966-1-4671217
Received: May 18, 2014
Revised: June 26, 2014
Accepted: July 29, 2014
Published online: December 14, 2014
Processing time: 213 Days and 21.7 Hours
Abstract

AIM: To determine the clinical, epidemiological and phenotypic characteristics of ulcerative colitis (UC) in Saudi Arabia by studying the largest cohort of Arab UC patients.

METHODS: Data from UC patients attending gastroenterology clinics in four tertiary care centers in three cities between September 2009 and September 2013 were entered into a validated web-based registry, inflammatory bowel disease information system (IBDIS). The IBDIS database covers numerous aspects of inflammatory bowel disease. Patient characteristics, disease phenotype and behavior, age at diagnosis, course of the disease, and extraintestinal manifestations were recorded.

RESULTS: Among 394 UC patients, males comprised 51.0% and females 49.0%. According to the Montréal classification of age, the major chunk of our patients belonged to the A2 category for age of diagnosis at 17-40 years (68.4%), while 24.2% belonged to the A3 category for age of diagnosis at > 40 years. According to the same classification, a majority of patients had extensive UC (42.7%), 35.3% had left-sided colitis and 29.2% had only proctitis. Moreover, 51.3% were in remission, 16.6% had mild UC, 23.4% had moderate UC and 8.6% had severe UC. Frequent relapse occurred in 17.4% patients, infrequent relapse in 77% and 4.8% had chronic disease. A majority (85.2%) of patients was steroid responsive. With regard to extraintestinal manifestations, arthritis was present in 16.4%, osteopenia in 31.4%, osteoporosis in 17.1% and cutaneous involvement in 7.0%.

CONCLUSION: The majority of UC cases were young people (17-40 years), with a male preponderance. While the disease course was found to be similar to that reported in Western countries, more similarities were found with Asian countries with regards to the extent of the disease and response to steroid therapy.

Keywords: Ulcerative colitis; Inflammatory bowel disease information system; Saudi Arabia; Epidemiology

Core tip: Despite several reports suggesting an increase in the incidence of ulcerative colitis (UC) among Arabs in recent years, there is insufficient information about it, particularly in Saudi Arabia. Our aim was to determine the clinical, epidemiological and phenotypic characteristics of UC in Saudi Arabia by studying the largest cohort of Arab UC patients. We found that UC has a relatively higher incidence in Saudi Arabia and the majority of UC cases are diagnosed in young people (17-40 years), with a male preponderance.