Gastroenterology

Gastroenterology

Volume 142, Issue 1, January 2012, Pages 46-54.e42
Gastroenterology

Original Research
Clinical—Alimentary Tract
Increasing Incidence and Prevalence of the Inflammatory Bowel Diseases With Time, Based on Systematic Review

https://doi.org/10.1053/j.gastro.2011.10.001Get rights and content

Background & Aims

We conducted a systematic review to determine changes in the worldwide incidence and prevalence of ulcerative colitis (UC) and Crohn's disease (CD) in different regions and with time.

Methods

We performed a systematic literature search of MEDLINE (1950–2010; 8103 citations) and EMBASE (1980–2010; 4975 citations) to identify studies that were population based, included data that could be used to calculate incidence and prevalence, and reported separate data on UC and/or CD in full manuscripts (n = 260). We evaluated data from 167 studies from Europe (1930–2008), 52 studies from Asia and the Middle East (1950–2008), and 27 studies from North America (1920–2004). Maps were used to present worldwide differences in the incidence and prevalence of inflammatory bowel diseases (IBDs); time trends were determined using joinpoint regression.

Results

The highest annual incidence of UC was 24.3 per 100,000 person-years in Europe, 6.3 per 100,000 person-years in Asia and the Middle East, and 19.2 per 100,000 person-years in North America. The highest annual incidence of CD was 12.7 per 100,000 person-years in Europe, 5.0 person-years in Asia and the Middle East, and 20.2 per 100,000 person-years in North America. The highest reported prevalence values for IBD were in Europe (UC, 505 per 100,000 persons; CD, 322 per 100,000 persons) and North America (UC, 249 per 100,000 persons; CD, 319 per 100,000 persons). In time-trend analyses, 75% of CD studies and 60% of UC studies had an increasing incidence of statistical significance (P < .05).

Conclusions

Although there are few epidemiologic data from developing countries, the incidence and prevalence of IBD are increasing with time and in different regions around the world, indicating its emergence as a global disease.

Section snippets

Search Strategy

We conducted a systematic literature search using a predetermined protocol and in accordance with the quality of reporting meta-analyses of observational studies (MOOSE).10 We searched 2 computer-stored databases, MEDLINE (1950 to December 2010) and EMBASE (Excerpta Medica Database; 1980 to December 2010) for studies investigating the epidemiology of IBD. The detailed search strategy was developed in consultation with a research librarian and is outlined in Appendix 1. The search was not

Results

The search strategy retrieved 8444 unique citations; 8103 were identified from MEDLINE and 4975 from EMBASE. Of these, 7938 citations were excluded after the first screening based on titles and abstracts, leaving 506 articles for full text review (Figure 1). The observed agreement between reviewers for eligibility of articles on this first screening was 97%, corresponding to a κ statistic of 0.77. On full text review of 506 articles, 246 were excluded for the reasons listed in Figure 1, leaving

Discussion

We present a comprehensive review of the worldwide incidence and prevalence of IBD. This review will help researchers estimate the global public health burden of IBD and the allocation of appropriate health care resources and research in specific geographic regions. Furthermore, by collating more than 200 reports on the incidence and/or prevalence of IBD, we anticipate that this report will serve as an essential resource for gastroenterologists and epidemiologists. Considerable differences were

Acknowledgments

The authors thank Dr Brenda Hemmelgarn, Dr Reg Sauve, and Diane Lorenzetti for their helpful comments and suggestions, as well as Belle Kaplan, Ken Fyie, David Doctor, and Samuel Quan with their assistance with this work.

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    This article has an accompanying continuing medical education activity on page e30. Learning Objective: Upon completion of this assessment, successful learners will be able to understand epidemiological factors of the inflammatory bowel diseases.

    Conflicts of interest The authors disclose no conflicts.

    Funding G.G.K. is supported by a New Investigator Award from the Canadian Institute of Health Research and a Population Health Investigator Award from the Alberta Heritage Foundation for Medical Research. N.A.M. is supported by an Alberta Heritage Foundation for Medical Research and Crohn's and Colitis Foundation Partnership Studentship. This research is supported by the Alberta IBD Consortium, which is funded by an AHFMR Interdisciplinary Team Grant. AHFMR is now Alberta Innovates - Health Solutions.

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