Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2021; 27(20): 2630-2642
Published online May 28, 2021. doi: 10.3748/wjg.v27.i20.2630
Inflammatory bowel disease in Tuzla Canton, Bosnia-Herzegovina: A prospective 10-year follow-up
Emir Tulumović, Nermin Salkić, Denijal Tulumović
Emir Tulumović, Nermin Salkić, Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla 75000, Tuzlanski Kanton, Bosnia and Herzegovina
Denijal Tulumović, Department of Nephrology, Dialysis and Transplantation, University Clinical Center Tuzla, Tuzla 75000, Tuzlanski Kanton, Bosnia and Herzegovina
Author contributions: Tulumović E contributed to data collection and analysis, and writing of the first draft of the paper; Salkić N contributed to study design and patient recruitment; Tulumović D contributed to data analysis and writing of the first draft of the paper; Salkić N and Tulumović D revised the article critically for important intellectual content.
Institutional review board statement: The study was reviewed and approved by the Ethical Board of University Clinical Center Tuzla by the declaration 02-09/2-78/20, on the 01.12.2020.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this manuscript.
Data sharing statement: The data underlying this article cannot be shared publicly, as it is provided with permission of University Clinical Center Tuzla. The data will be shared on reasonable request to the corresponding author with the permission of University Clinical Center Tuzla.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Emir Tulumović, MD, Doctor, Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Ibre Pašića bb, Tuzla 75000, Tuzlanski Kanton, Bosnia and Herzegovina. emir.tulumovic@ukctuzla.ba
Received: January 24, 2021
Peer-review started: January 24, 2021
First decision: March 7, 2021
Revised: March 15, 2021
Accepted: April 22, 2021
Article in press: April 22, 2021
Published online: May 28, 2021
Processing time: 115 Days and 10.6 Hours
ARTICLE HIGHLIGHTS
Research background

Recent epidemiological studies conducted in Southeastern Europe show increasing incidence of inflammatory bowel diseases (IBD) in areas previously characterized as low-incidence areas. However, the results are still heterogenous as studies were conducted in areas heterogenous in terms of ethnicity, genetics background and lifestyle.

Research motivation

The region of Eastern Europe, especially Balkan region, is poorly described in terms of epidemiology of inflammatory bowel disease. This obvious gap in our understanding of IBD epidemiology in this region of Europe was previously partially described, and this study represents a continuation of one of the longest continuous surveys in Europe at all with nearly 25 years of epidemiological data.

Research objectives

The authors sought to publish an epidemiological evaluation of IBD through a detailed 10-year follow-up of the clinical and epidemiological characteristics of the major forms of the disease.

Research methods

The study evaluated both IBD inpatients and outpatients residing in Tuzla Canton, and is single-hospital-based. Descriptive statistical parameters were used to determine basic characteristics of the study population. Incidence and prevalence calculations were performed using census data from the Statistical Office of the Federation of Bosnia-Herzegovina. The statistical level of 95% (P < 0.05) was considered significant for all statistical tests.

Research results

We observed 440 newly diagnosed patients with IBD: 240 (54.5%) with ulcerative colitis (UC), 190 (43.2%) with Crohn’s disease (CD), and 10 (2.3%) with indeterminate colitis (IC). The mean annual crude incidence rates were found to be 9.01/100000 population for IBD [95% confidence interval (CI): 8.17-9.85], with 4.91/100000 (95%CI: 4.29-5.54) for UC and 3.89/100000 (95%CI: 3.34-4.44) for CD. Calculated IBD prevalence in 2019 was 146.64/100000 (95%CI: 128.09-165.19), with 77.94/100000 (95%CI: 68.08-87.70) for UC and 65.77/100000 (95%CI: 54.45-74.1) for CD. The average annual IBD percentage change was 0.79% (95%CI: 0.60-0.88), with -2.82% (95%CI: -2.67 - -2.97) for UC and 6.92% (95%CI: 6.64-7.20) for CD.

Research conclusions

We conclude that our region of Europe has a relatively stable incidence of UC (5/100000) and CD (4/100000), which is in line with previous predictions that IBD incidence in Eastern Europe is approximately half of the incidence in Western Europe. Whether this is the result of lower ascertainment or there are other factors included remains to be seen in future research.

Research perspectives

The most important factor for future research is why the incidence is lower in Eastern Europe. There are numerous factors to be considered, which include environmental, genetic, and sociological peculiarities of the region and its population. All of these factors should be taken in consideration during the design of future research.