Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Nov 6, 2016; 7(4): 556-563
Published online Nov 6, 2016. doi: 10.4292/wjgpt.v7.i4.556
Family history and disease outcomes in patients with Crohn’s disease: A comparison between China and the United States
Pei-Qi Wang, Jun Hu, Elie S Al Kazzi, Eboselume Akhuemonkhan, Min Zhi, Xiang Gao, Raquel Holand de Paula Pessoa, Sami Ghazaleh, Tuhina Cornelius, Suhel Abbas Sabunwala, Shadi Ghadermarzi, Kartikeya Tripathi, Mark Lazarev, Pin-Jin Hu, Susan Hutfless
Pei-Qi Wang, Eboselume Akhuemonkhan, Shadi Ghadermarzi, Mark Lazarev, Susan Hutfless, Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD 21287, United States
Jun Hu, Guangdong provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Jun Hu, Min Zhi, Xiang Gao, Pin-Jin Hu, Department of Gastroenterology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Elie S Al Kazzi, Department of Medicine, MedStar Health Internal Medicine, Baltimore, MD 21287, United States
Raquel Holand de Paula Pessoa, Department of Health and Sport Sciences, Federal University of Acre, Rio Branco, Acre 69915-900, Brazil
Sami Ghazaleh, Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus 00972, Palestine
Tuhina Cornelius, Suhel Abbas Sabunwala, Ravindra Nath Tagore Medical College, Udaipur, Rajasthan 313001, India
Kartikeya Tripathi, St Vincent Hospital, Worcester, MA 01608, United States
Susan Hutfless, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, United States
Author contributions: Wang PQ participated in study design, analyzed and interpreted the data, and drafted the initial manuscript; Hutfless S as the principle investigator, supervised and advised the study; Hu J, Al Kazzi ES, Akhuemonkhan E, Zhi M, Gao X, de Paula Pessoa RH, Ghazaleh S, Cornelius T, Sabunwala SA, Ghadermarzi S and Tripathi K participated in recruitment of study participants; all authors participated in reviewing and revising the manuscript.
Supported by (in part) Johns Hopkins Institute for Clinical and Translational Research, No. UL1TR001079.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Boards at Johns Hopkins Medicine and the Institutional Review Boards at the Sixth Affiliated Hospital of Sun Yat-sen University.
Informed consent statement: All study participants provided consent.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Susan Hutfless, PhD, Assistant Professor, Director, Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, 600 N Wolfe Street, Blalock 449, Baltimore, MD 21287, United States. shutfle1@jhmi.edu
Telephone: +1-410-5020194
Received: June 6, 2016
Peer-review started: June 12, 2016
First decision: July 20, 2016
Revised: August 5, 2016
Accepted: September 13, 2016
Article in press: September 15, 2016
Published online: November 6, 2016
Processing time: 146 Days and 10.1 Hours
Abstract
AIM

To investigate the differences in family history of inflammatory bowel disease (IBD) and clinical outcomes among individuals with Crohn’s disease (CD) residing in China and the United States.

METHODS

We performed a survey-based cross-sectional study of participants with CD recruited from China and the United States. We compared the prevalence of IBD family history and history of ileal involvement, CD-related surgeries and IBD medications in China and the United States, adjusting for potential confounders.

RESULTS

We recruited 49 participants from China and 145 from the United States. The prevalence of family history of IBD was significantly lower in China compared with the United States (China: 4.1%, United States: 39.3%). The three most commonly affected types of relatives were cousin, sibling, and parent in the United States compared with child and sibling in China. Ileal involvement (China: 63.3%, United States: 63.5%) and surgery for CD (China: 51.0%, United States: 49.7%) were nearly equivalent in the two countries.

CONCLUSION

The lower prevalence of familial clustering of IBD in China may suggest that the etiology of CD is less attributed to genetic background or a family-shared environment compared with the United States. Despite the potential difference in etiology, surgery and ileal involvement were similar in the two countries. Examining the changes in family history during the continuing rise in IBD may provide further insight into the etiology of CD.

Keywords: Crohn’s disease; Family history; Disease outcome; Inflammatory bowel disease; Epidemiology; genetics; Environment; Medication; Surgery

Core tip: Crohn’s disease (CD) diagnoses are increasing in Asia. While family history of inflammatory bowel disease (IBD) is recognized as the strongest independent risk factor for CD in western populations, it is unknown if family history plays a role in Asians. This study compares the prevalence of IBD family history, the relationships of affected relatives, and CD-related outcomes such as ileal involvement, surgery, and medication use between China and the United States.