Characterization of the Clinical and Phenotypic Features of South Asian Patients with Inflammatory Bowel Disease at an IBD Referral Center in the United States

Introduction: The prevalence and clinical features of Crohn's disease (CD) and ulcerative colitis (UC) vary amongst different racial and ethnic groups. Patients of South Asian (SA) origin living in a Western industrialized country were reported to have more aggressive disease features than Caucasian patients. Methods: We retrospectively identified all patients with an established or eventual diagnosis of CD or UC who presented initially to our IBD referral center from 2012 to 2016 and had subsequent follow-up. The demographic, clinical and phenotypic characteristics of 31 SA-CD patients and 42 SA-UC patients were compared with those of 245 Caucasian American (CA)-CD patients and 163 CA-UC patients, respectively. SA was defined as a person born in or having two parents born in India, Pakistan or Bangladesh. Demographics considered were those listed in Table 1. Maximal disease extent was analyzed per the Montreal protocol. Continuous and categorical variables were compared using the Mann-Whitney U and Chi-squared tests, respectively. Results: The proportion of patients who were active or former smokers was significantly lower in SA-CD (9.7% vs 35.5%; p = 0.004) and SA-UC patients (9.8% vs 26.4%; p = 0.020) compared to CA-CD and CA-UC patients, respectively (Table 1). SA-CD patients were less likely to have a family history of IBD (9.7% vs 26.9%; p = 0.037) (Table 1) and had fewer CD-related hospitalizations (38.8% vs. 55.5%; p = 0.035) than CA-CD patients (Table 2). SA-UC patients had a higher incidence of Clostridium difficile infection than CA-UC patients (19.0% vs 8.6%; p = 0.050)(Table 3). There were no significant differences between SA and CA patients in regards to disease location, disease phenotype, incidence of extraintestinal manifestations, treatment with biologic therapy, and other parameters of disease progression (Tables 2 and 3). Conclusion: A cohort of SA patients with CD and UC at an IBD referral center in the United States had differing demographic and clinical features compared to CA patients, including a lower rate of current or past smoking. In contrast to past reports, there were no significant differences in disease phenotype between SA and CA patients. Variation of the clinical and phenotypic features of IBD in different racial and ethnic groups may provide insights into the mechanistic contributions of genetics and environment to these diseases.710_A Figure 1. shows the demographic characteristics of South Asian and Caucasian American patients with Inflammatory Bowel Disease.710_B Figure 2. shows the clinical and phenotypic features of South Asian and Caucasian American patients with Crohn's Disease.710_C Figure 3. shows the clinical and phenotypic features of South Asian and Caucasian American patients with ulcerative colitis.

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