Published online Dec 21, 2019. doi: 10.3748/wjg.v25.i47.6866
Peer-review started: October 18, 2019
First decision: November 22, 2019
Revised: December 2, 2019
Accepted: December 13, 2019
Article in press: December 13, 2019
Published online: December 21, 2019
The worldwide epidemiology of inflammatory bowel disease (IBD) is rapidly changing. Increasing Crohn’s disease (CD) and ulcerative colitis (UC) incidence and prevalence have been recorded in developing regions such as Asia, Africa and Eastern Europe where it was previously thought to be uncommon. Whether this is also the case in South America is not well known. Demonstration that developing regions worldwide have increasing IBD incidence would indicate that environmental change plays a significant role in the development of IBD.
To report the incidence, prevalence and disease characteristics of CD and UC within the South American continent.
A systematic review was conducted by searching published studies in major international and regional databases (MEDLINE, EMBASE and Scopus) between January 1990 and December 2018. Outcomes considered were incidence, prevalence, phenotype, environmental and genetic factors, ethnicity and gender. A pair of independent reviewers screened and reviewed all identified articles.
One hundred and sixty two citations were initially retrieved with 18 studies included in this systematic review. The majority of included studies were from Brazil (n =13, 72%). The incidence of UC ranged from 4.3-5.3/100000 person-years whilst the incidence of CD ranged from 0.74-3.5/100000 person-years. Prevalence ranged from 15.0-24.1/100000 inhabitants for UC and from 2.4-14.1/100000 inhabitants for CD. The incidence and prevalence of both UC and CD has increased significantly in Brazil over the past 21 years. Pancolitis was the most common disease distribution in patients with UC whilst colonic involvement was the most common distribution in CD. People residing in urban areas were at higher risk of developing both CD and UC.
The IBD burden in South America is increasing at a rate possibly even greater than other developing regions around the world. There is a paucity of high-quality epidemiological studies and further robust and representative data are required to further explore modifiable risk factors and disease phenotypes.
Core tip: The worldwide epidemiology of inflammatory bowel disease (IBD) is rapidly changing with increasing disease incidence and prevalence noted in developing regions such as Asia, Africa and Eastern Europe where it was previously thought to be uncommon. Whether this is the case in South America was previously not well known. Our systematic review demonstrates that the IBD burden in South America is precipitously increasing, particularly in industrialised regions. With a total population exceeding 400 million, the South American continent is expected to carry a significant proportion of the future global IBD burden.