C0417 - Initial Descriptive Epidemiology of Inflammatory Bowel Disease in Northern Central America

Eleazar E. Montalvan-Sanchez, MD¹, Katherine Falloon, MD², Dalton A. Norwood, MD³, Luis Alfredo Najera Donis, MD⁴, Renato Beas, MD¹, Aida Rodriguez Murillo, MD⁵, Kathya Jimenez, MD⁶, Roberto Giron, MD⁶, Do Han Kim, MD⁷, Rawan Aljaras, MD¹, Jonathan Montrose, DO¹, Deborah Proctor, MD⁸, Douglas Morgan, MD, MPH^3
1Indiana University School of Medicine, Indianapolis, IN; ²Cleveland Clinic, Cleveland, OH; ³University of Alabama at Birmingham, Birmingham, AL; ⁴Hospital General San Juan de Dios, Ciudad de Guatemala, Sacatepequez, Guatemala; ⁵Western Honduras Gastric Cancer Prevention Initiative, Santa Rosa de Copan, Copan, Honduras; ⁶Universidad Evangelica de El Salvador, San Salvador, San Salvador, El Salvador; ⁷Universidad Francisco Marroquin, School of Medicine, Guatemala, Sacatepequez, Guatemala; ⁸Yale University School of Medicine, New Haven, CT

Introduction: The incidence of inflammatory bowel disease (IBD) is rising globally, and recent studies in Latin America have demonstrated an increase in the number of patients with IBD. Northern Central America (CA) is the core low-middle-income countries (LMIC) region in the Western Hemisphere. Populations in development transition such as this have seen an increase in gastrointestinal diseases and cancers. However, the prevalence and general characteristics of IBD behavior remain undetermined in CA. Hence, we present the initial descriptive epidemiology of IBD in the area.

Methods: We conducted a retrospective chart review of five principal hospitals and clinics with practicing gastroenterologists in Guatemala and Honduras. Cases were identified based on the international classification of disease (ICD) 10 IBD codes in the last ten years (2010-2020). Sociodemographic and clinical characteristics data were collected and analyzed using STATA 17.

Results: A total of 107 patients with IBD were identified, including 60 with ulcerative colitis (UC), 27 with indeterminant colitis (IC), and 20 with Crohn’s disease (CD). The median age at diagnosis was 42.7 years (IQR, 24.9, 50.7) in both sexes. Males were more commonly affected (56%), and 59.8% were from urban areas. Smoking was reported in 16 (6.7%) patients. Common clinical presentations were diarrhea, abdominal pain, anemia, and acute kidney injury (Table 1). The mean time between the onset of symptoms and diagnosis was 2.5+/-2.9 SD years. The most common complication was enteric fistula (6.5%). Pancolitis was found in 17% and colon cancer in 1% of included patients. The most common treatments were systemic steroids (IC, 74%; UC, 41%, CD 68%) and sulfasalazine (45%). Only 17 (15.9%) patients required surgery during the study period, and very few had access to biological agents (13%).

Discussion: This study supports the clinical impression that IBD is on the rise in CA LMIC setting. The most prevalent type of IBD among these populations is UC. Given the tendency towards a diagnosis of infectious colitis and the lack of data from private practice centers, these numbers are likely an underestimate. The use of steroids in this region is high. Moreover, the use of mesalamine compounds even for CD is common, likely due to the limited access to biologics. This study is the first step in describing the characteristics of IBD in the region, and the results can be used to help shape public health strategies in the region.



Disclosures:


Eleazar E. Montalvan-Sanchez, MD¹, Katherine Falloon, MD², Dalton A. Norwood, MD³, Luis Alfredo Najera Donis, MD⁴, Renato Beas, MD¹, Aida Rodriguez Murillo, MD⁵, Kathya Jimenez, MD⁶, Roberto Giron, MD⁶, Do Han Kim, MD⁷, Rawan Aljaras, MD¹, Jonathan Montrose, DO¹, Deborah Proctor, MD⁸, Douglas Morgan, MD, MPH³. C0417 - Initial Descriptive Epidemiology of Inflammatory Bowel Disease in Northern Central America, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.