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Clinical epidemiology of Crohn's disease in Arabs based on the Montreal classification

journal contribution
posted on 2023-06-08, 17:58 authored by Iqbal Siddique, Waleed Alzami, Jaber Al-Ali, Ahmad Al-Fadhi, Nabeel Alateeqi, Anjum MemonAnjum Memon, Fuad Hasan
Background: There has been a remarkable increase in the incidence of Crohn's disease (CD) among Arabs in recent years. We conducted this study to determine the clinical epidemiology of CD in Kuwait. Methods: Sociodemographic and clinical information was collected for a continuous series of 206 Arab patients with CD and age at diagnosis and location and behavior of disease was determined according to the Montreal Classification. Results: Among the 206 patients, 100 (48.5%) were males and 106 (51.5%) females. The mean age at diagnosis (±SD) was 21.9 ± 10 years. Family history of CD was reported by 39 (18.9%) patients. The disease was limited to the ileum in 115 (55.8%) patients, whereas in 28 (13.6%) it involved the colon and in 63 (30.6%) it involved both the ileum and colon. The behavior of the disease was nonstricturing, nonpenetrating in 146 (70.9%) patients, whereas 49 (23.8%) had stricturing and 11 (5.3%) penetrating disease. Perianal disease was present in 41 (19.9%) patients. In the multivariate analysis, the use of biologic therapy and duration of the disease for =6 years were significantly associated with the presence of perianal disease, and the need for surgery was significantly associated with stricturing and penetrating disease behavior. Conclusions: CD among Arabs is equally common in males and females, presents at a relatively younger age, and in about half of the patients is limited to the small bowel. These features may indicate an underlying genetic predisposition for the disease in this population, which needs further investigation. (Inflamm Bowel Dis 2012;) Crohn's disease (CD) is a chronic, relapsing, inflammatory process that affects the gastrointestinal tract resulting in long-term morbidity. The etiology of CD is largely unknown; it is believed that the condition occurs due to interactions between genetic and environmental factors along with alterations in the mechanisms that regulate immune response.1, 2 It therefore follows that both ethnicity and geographic location affect the incidence of CD. The highest incidence rates of the disease are reported among the white population in northern Europe, the UK, North America, and Jews of European decent.3 There is growing evidence that the disease is being increasingly diagnosed in parts of Africa and Asian populations.4–6 The first report of CD in the Middle East was published from Kuwait in 1984.7 This was followed by reports in the 1990s from Saudi Arabia and Kuwait indicating that CD was becoming increasingly common among Arabs.8–10 The aim of this study was to describe the clinical epidemiology of CD in Kuwait, based on the standardized Montreal Classification, and compare its presentation and clinical features with other populations.


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Inflammatory Bowel Diseases




Lippincott, Williams & Wilkins





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