Ng SC, et al. - A systematic review of population-based studies is done to evaluate the changing incidence and prevalence of inflammatory bowel disease around the world. The outcome of this study suggests that the inflammatory bowel disease has become a global disease with accelerating incidence in newly industrialised countries whose societies have become more westernised at the turn of the 21st century. Although the incidence is stabilising in western countries, the burden remains high as prevalence surpasses 0·3%. These information highlights the requirement for research into prevention of inflammatory bowel disease and innovations in health-care systems to manage this complex and costly disease.

Methods

• In this study, they searched MEDLINE and Embase up to and including Dec 31, 2016, to identify observational, population-based studies reporting the incidence or prevalence of Crohn's disease or ulcerative colitis from 1990 or later.
• A study was regarded as population-based if it involved all residents within a specific area and the patients were representative of that area.
• To be incorporated into the systematic review, ulcerative colitis and Crohn's disease should have been reported separately.
• Studies that did not report original data and studies that reported only the incidence or prevalence of paediatric-onset inflammatory bowel disease (diagnosis at age <16 years) were excluded.
• They created choropleth maps for the incidence (119 studies) and prevalence (69 studies) of Crohn's disease and ulcerative colitis.
• They utilized temporal trend analyses to report changes as an annual percentage change (APC) with 95% CI.

Results

• They identified total 147 studies that were qualified for final inclusion in the systematic review, including 119 studies of incidence and 69 studies of prevalence.
• The highest reported prevalence values were in Europe (ulcerative colitis 505 per 100000 in Norway; Crohn's disease 322 per 100000 in Germany) and North America (ulcerative colitis 286 per 100000 in the USA; Crohn's disease 319 per 100000 in Canada).
• The prevalence of inflammatory bowel disease exceeded 0·3% in North America, Oceania, and many countries in Europe.
• Overall, 16 (72·7%) of 22 studies on Crohn's disease and 15 (83·3%) of 18 studies on ulcerative colitis reported stable or reducing incidence of inflammatory bowel disease in North America and Europe.
• Since 1990, incidence has been rising in newly industrialised countries in Africa, Asia, and South America, including Brazil (APC for Crohn's disease +11·1% [95% CI 4·8-17·8] and APC for ulcerative colitis +14·9% [10·4-19·6]) and Taiwan (APC for Crohn's disease +4·0% [1·0-7·1] and APC for ulcerative colitis +4·8% [1·8-8·0]).