The inflammatory bowel diseases (IBD) comprising Crohn’s disease (CD) and ulcerative colitis (UC) are idiopathic diseases of the gastrointestinal tract characterized by a relapsing and remitting course.¹ Despite the increasing incidence of IBD, much uncertainty still exists about the relationship between ethnicity and differences in the epidemiology and features of IBD. This study seeks to explore the effects of ethnicity on the diagnosis, management, and outcomes of patients with IBD.

Sixty-two paediatric IBD patients in a university gastroenterology practice in the UK, between 2018 and 2022 were retrospectively analysed to study the variation of clinical presentation by ethnicity. Patient self-reported ethnicity was obtained from the hospital administrative records and three subgroups were identified: Whites, Asians and Blacks. The study cohort included 35 CD patients, 22 UC patients and 5 IBD unclassified patients.

We noted that out of the 35 CD patients, 60% were Whites, whereas 28.6% belonged to the Asian group and 11.4% were Blacks. Similarly in the UC subgroup, Whites constituted the majority (54.5%) whereas 40.9% were Asians and less than 5% were Blacks.

Among the Asian population, the proportions of CD and UC were almost equal. In contrast, 58.3% of Whites presented with CD compared to 33.3% with ulcerative colitis. The difference was more pronounced in Blacks with 80% presenting with CD and 20% with UC, although these results were not statistically significant.

Further analysis showed that among those who first presented with symptoms of IBD at less than 5 years of age, a significantly higher proportion were Asians at 50% and 37.5% were Blacks compared to 12.5% Whites. However, nearly two-thirds of those who first presented at the age of 6–10 years and 11–15 years were Whites (p = 0.010).

When comparing disease extent in CD, 80% of the Asians presented with ileocolonic disease whereas half the Black population had localised ileal involvement. However, the incidence of upper gastrointestinal involvement was higher in the White ethnicity. In UC, nearly three-quarters of those presenting with extensive colitis belonged to the Asian ethnicity as opposed to Whites who were more likely to have proctitis or left-sided colitis (p = 0.013). Four out of six patients that developed extraintestinal manifestations of IBD were Whites.

Among children requiring less than two hospital admissions for flare-up of IBD symptoms, approximately two-thirds were Whites. Only two patients required more than two hospital admissions and they belonged to the Asian subgroup. With regard to treatment, our results demonstrated that 60% of the Blacks required biological therapy, whereas equal proportions of the Asian and White subgroups were treated with immunomodulators like azathioprine or aminosalicylates and biologicals. Lastly, allergic reactions to azathioprine and biologicals were more commonly noted in the White population.

Despite the relatively limited sample size, this study certainly provides valuable insights into the differences in phenotypes and presentations of IBD across paediatric patients of various ethnicities. There is a defined need for further research to assess the role of ethnicity in the pathogenesis and progression of paediatric IBD patients.

Reference

1. Nimmons D, Limdi JK. Elderly patients and inflammatory bowel disease. World J Gastrointest Pharmacol Ther 2016;7:51–65.