Clinico-Epidemiological Characteristics of Patients With Inflammatory Bowel Disease in Egypt: A Nationwide Multicenter Study

Mohamed Elbadry, Mohamed O Nour, Mohamed Hussien, Elsayed Awad Ghoneem, Mohammed A Medhat, Hany Shehab, Sherif Galal, Mohamed Eltabbakh, Fathiya El-Raey, Mohamed Negm, Shimaa Afify, Walaa Abdelhamed, Ahmed Sherief, Ahmed Abdelaziz, Mohamed Abo Elkasem, Aya Mahrous, Ghada Kamal, Maha Maher, Omar Abdel-Hameed, Abubakr Elbasuny, Islam El-Zayyadi, Ahmed Bassiony, Abdelmajeed Moussa, Essam Bedewy, Asem Elfert, Mohamed El Kassas, Mohamed Elbadry, Mohamed O Nour, Mohamed Hussien, Elsayed Awad Ghoneem, Mohammed A Medhat, Hany Shehab, Sherif Galal, Mohamed Eltabbakh, Fathiya El-Raey, Mohamed Negm, Shimaa Afify, Walaa Abdelhamed, Ahmed Sherief, Ahmed Abdelaziz, Mohamed Abo Elkasem, Aya Mahrous, Ghada Kamal, Maha Maher, Omar Abdel-Hameed, Abubakr Elbasuny, Islam El-Zayyadi, Ahmed Bassiony, Abdelmajeed Moussa, Essam Bedewy, Asem Elfert, Mohamed El Kassas

Abstract

Background and aims: Ulcerative colitis (UC) and Crohn's disease (CD) are the most common types of Inflammatory bowel disease (IBD), with variable responses to traditional therapies and unpredicted prognosis. In Egypt and most developing countries, the lack of recent epidemiological and prognostic data adversely affects management strategies. We collected and analyzed data of patients with IBD from multiple centers across Egypt to evaluate patients' clinical and epidemiological characteristics.

Methods: This retrospective multicenter study included patients diagnosed with IBD between May 2018 and August 2021, at 14 tertiary gastroenterology units across Egypt. Record analysis addressed a combination of clinico-epidemiological characteristics, biochemical tests, stool markers, endoscopic features, histological information, and different lines for IBD treatment.

Results: We identified 1104 patients with an established diagnosis of IBD; 81% of them had UC, and 19% showed CD. The mean age of onset was 35.1 ± 12.5 years ranging from 5 to 88 years, the mean duration of illness at inclusion was 13.6 ± 16.7 years, gender distribution was almost equal with a significant male dominance (60.4%, p = 0.003) among patients with CD, 57% were living in rural areas, and 70.5% were from Delta and Coastal areas. Two hundred nineteen patients (19.8%) displayed comorbid conditions, primarily associated with CD. The most frequent complaints were diarrhea (73.2%), rectal bleeding (54.6%) that was significantly higher among patients with UC (64%, p < 0.001), and 46.8% with abdominal pain (more often with CD: 71%, p < 0.001). Conventional therapy was effective in treating 94.7% of patients. The main lesion in patients with CD was ileal (47.8%); patients with UC mainly exhibited proctosigmoiditis (28.4%). Dysplasia was detected in 7.2% of patients, mainly subjects with UC.

Conclusions: To our knowledge, our effort is the first and largest cohort of Egyptian patients with IBD to describe clinical and epidemiological characteristics, and diagnostic and management approaches. More extensive prospective studies are still needed to fully characterize disease distribution, environmental factors, and pathological features of the disease.

Keywords: Crohn's disease; Egypt; inflammatory bowel disease; multicenter study; ulcerative colitis.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Elbadry, Nour, Hussien, Ghoneem, Medhat, Shehab, Galal, Eltabbakh, El-Raey, Negm, Afify, Abdelhamed, Sherief, Abdelaziz, Abo Elkasem, Mahrous, Kamal, Maher, Abdel-Hameed, Elbasuny, El-Zayyadi, Bassiony, Moussa, Bedewy, Elfert and El Kassas.

Figures

Figure 1
Figure 1
Distribution of the participating centers in the study across Egypt.
Figure 2
Figure 2
Location and behavior of lesions by colonoscopy in patients with Crohn's disease in Egypt (May 2018 to August 2021) at the time of diagnosis.
Figure 3
Figure 3
Disease extent and severity by colonoscopy in patients with ulcerative colitis in Egypt (May 2018 to August 2021).

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