C0412 - Comparison of Demographics and Phenotypic Behavior of Inflammatory Bowel Disease Among Southeast Asians and Caucasians at a Tertiary Center in Houston

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Ayushi Shah, MBBS

Houston Methodist Hospital
Houston, TX

Ayushi Shah, MBBS¹, Medha Narwankar, BA, MA², Manuel Garza, MD, MS¹, Bincy Abraham, MD, MS, FACG³
¹Houston Methodist Hospital, Houston, TX; ²Texas A&M University School of Engineering Medicine, Houston, TX; ³Houston Methodist Academic Institute, Houston, TX

Introduction: The incidence and prevalence of inflammatory bowel disease (IBD) has increased in Southeast Asians (SEA). Our objective was to determine clinical features and phenotype of IBD in SEA in the U.S. in comparison to Caucasians.

Methods: Seventy SEA (38 Crohn’s disease (CD), 32 Ulcerative Colitis (UC)) patients were compared to 70 consecutive White patients (50 CD, 20 UC patients) using Chi-square and Fischer’s exact test. Bonferroni’s correction was applied for multiple comparisons.

Results: UC was more prevalent in SEA compared to Caucasians (45.7% vs 28.5%, p=0.03).

64% of SEA CD patients were men compared to 28% of White CD patients (p< 0.001). Majority of SEA CD patients were diagnosed between the age of 17-40 (p=0.008). B1 disease was more prevalent in SEA with CD and B2 disease was more common in Caucasians (p< 0.01).

SEA with CD had a reduced need for bowel surgery (21% vs 52% in the non-SEA group, p=0.002) and hospitalizations (21% vs 62% respectively, p value< 0.01). Ileocolonic disease was the most prevalent location of CD in both groups (71% & 56% respectively for SEA & White patients).

Majority (85%) of the White patients with UC were women compared to 51.6% in the SEA group, p value=0.005. Both the groups had predominantly pancolitis at 64% and 70% respectively, with no significant difference in median age of diagnosis, response to biologic therapy, need for surgery and hospitalizations.

Discussion: Knowledge of ethnic differences in IBD behavior, location and treatment responses can impact clinical care and treatment. A study done by Bodiwala et al also showed UC being more prevalent in South Asians with IBD (58% UC in SEA), similar to our study. Our study showed a male preponderance in the SEA CD and a female preponderance for the White UC patients. The same trend was observed in Walker et al’s study in North London. In our study, a higher rate of B2 stricturing disease was noted in Caucasians in contrast from Walker et al, where the Caucasian patients had more B3 penetrating CD.

We found that SEA with IBD had milder disease with lower rate of CD/UC related surgery, hospitalizations compared to the Caucasian group, which is similar to other studies done on IBD behavior of SEA in the US. There could be a role of environmental, genetic, and dietary factors that needs to be explored further to explain the differences in severity of the disease.

Crohn's Disease	South-East Asians (N=38) N (%)	Caucasians (N=50) N (%)	p-value
Gender			< .001
Females	13 (34.2)	35 (70)
Males	25 (65.7)	15 (30)
Age at diagnosis (Montreal Classification)
< 16 years	10 (25.6)	17 (34)	0.39
17-40 years	24 (64)	18 (36)	0.008
>40 years	4 (10)	14 (28)	0.06
Mean duration of disease in years	13.1 years	17 years	0.57
Family history of IBD	6 (15.3)	8 (16)	0.89
History of smoking	3(7)	4 (12.5)	0.95
Disease extent
Ileal(L1)	10 (26.3)	12 (24.3)	0.8
Colonic(L2)	3 (7.8)	7 (14)	0.5
Ileocolonic (L3)	25 (65.7)	31 (62)	0.71
Upper GI involvement (L4)	2 (5)	6(12)	0.45
Perianal disease	10 (26.3)	12 (24)	0.71
Non-stricturing, non-penetrating disease (B1)	29 (76.3)	12 (24)	< .001
Stricturing (B2)	3 (7.8)	21(42)	< .001
Penetrating (B3)	6 (15.7)	13 (26)	0.24
History of bowel surgery for IBD	11 (28.9)	26 (52)	0.002
History of biologic therapy	33 (84)	46 (92)	0.27
Presence of extra-intestinal manifestations	12 (28.94)	23 (46)	0.14
Prior hospitalizations	8 (21)	31 (62)	< .001
Ulcerative Colitis	South-East Asians (N=32)	Caucasians (N=20)
Gender distribution			0.005
Females	16 (50)	17 (85)
Males	16 (50)	3 (15)
Median age at diagnosis	27 years	28.5 years	0.72
Family history of IBD	4 (12.9)	5 (25)	0.26
History of smoking	1 (3)	4(20)	0.07
Disease extent
Ulcerative Proctitis (E1)	6 (19.3)	2 (10)	0.46
Left sided UC (E2)	5 (16.1)	4 (25)	0.71
Pancolitis (E3)	20 (64)	14 (70)	0.58
History of bowel resection	2 (6.4)	5 (25)	0.14
History of biologic therapy	18 (58%)	14 (70)	0.38
Presence of extra-intestinal manifestations	10 (32.2)	4 (20)	0.53
Prior hospitalizations	9 (29)	6 (30)	0.94

Table: Demographics and clinical features of South Asian and Caucasian patients with Crohn's disease and Ulcerative Colitis

Disclosures:

Ayushi Shah indicated no relevant financial relationships.

Medha Narwankar indicated no relevant financial relationships.

Manuel Garza indicated no relevant financial relationships.

Bincy Abraham: AbbVie – Consultant, Speakers Bureau. Bristol Myers Squibb – Consultant, Speakers Bureau. Eli Lilly – Consultant, Speakers Bureau. Janssen – Consultant, Speakers Bureau. Medtronic – Consultant. Pfizer – Consultant, Speakers Bureau. Takeda – Consultant, Grant/Research Support, Speakers Bureau.

Ayushi Shah, MBBS¹, Medha Narwankar, BA, MA², Manuel Garza, MD, MS¹, Bincy Abraham, MD, MS, FACG³. C0412 - Comparison of Demographics and Phenotypic Behavior of Inflammatory Bowel Disease Among Southeast Asians and Caucasians at a Tertiary Center in Houston, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.