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Title: Inflammatory bowel disease in immigrant populations
Author: Butcher, Rhys
ISNI:       0000 0005 0289 4279
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2017
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Background and Aims: The impact of ethnicity and migration on IBD phenotype and disease course and other outcomes is understudied. The aim of this work was to delineate the phenotype and disease course of Australian IBD patients of Middle Eastern descent and UK IBD patients of South Asian descent. IBD-related knowledge, information resource and Complementary and alternative medicine (CAM) use was also characterised in Middle Eastern patients. Methods: IBD phenotype and disease course was characterised through retrospective case-control studies. A prospective questionnaire-based cross-sectional survey was also undertaken to assess IBD-related knowledge and other outcomes in Middle Eastern patients. Results: In Australia, 250 Middle Eastern and 250 age-at-diagnosis (median 26.0 vs. 26.0 years; P=0.30) and disease duration (median 7.0 vs. 7.5 years; P=0.33) group-matched white Caucasians were compared. CD was more common than UC in Middle Eastern patients. Middle Eastern patients were more likely than white Caucasians to have a family history of IBD (31.5% vs. 15.6%; P<0.0005), perianal CD (41.3% vs. 29.6%; P=0.04) or to have received methotrexate for CD (P=0.01). EIMs were less common in Middle Eastern patients (26.0% vs. 34.4%; P=0.04). Second generation migrants were younger at diagnosis (median 22.0 vs. 33.0 years; P<0.0005) and more likely to have a family history of IBD (P<0.0005) or extensive CD disease (P=0.02). A non-significant trend towards more extensive UC in second generation migrants was also noted (P=0.07). In the UK, 120 South Asian and 120 age-at-diagnosis (median 29.0 vs. 28.5 years; P=0.92) and disease duration (median 6.4 vs. 6.7 years; P=0.86) group-matched white Caucasians were compared. UC was more common than CD in South Asian patients. EIMs were less common (9.2% vs. 19.2%; P=0.03) and Vitamin D deficiency more common (44.0% vs. 10.3%; P<0.0005) in South Asians. UC South Asian patients were more likely to have received thiopurines than white Caucasians (P=0.007). Second generation migrants were younger at diagnosis (median 20.0 vs. 40.0 years; P<0.0005) and were more likely to have a family history of IBD (P=0.01), extensive UC (P=0.045) or perianal CD (P=0.04). Two hundred (100 Middle Eastern; 100 white Caucasian) consecutive IBD patients also completed the IBD questionnaire. The mean and median CCKNOW scores were significantly lower at 7.53 +/- 4.11 and 7.00 (IQR: 6) in Middle Eastern patients than in white Caucasian patients where scores of 11.31 +/- 5.57 and 11.00 (IQR: 7) respectively were found (P<0.0005). A significant knowledge difference was maintained when comparing first and second generation Middle Eastern migrants (P =0.003) and separately second Generation Middle Eastern and white Caucasian patients (P =0.003). Middle Eastern patients were less likely to access the IBD specialist nurse or support groups for IBD-related information. CAM use was similar in both ethnic groups. Conclusions: Perianal CD was more common in Middle Eastern patients whereas EIM's of IBD were less common in both Middle Eastern and South Asian patients. The finding of more extensive disease in second generation Middle Eastern and South Asian migrants raises the possibility that exposure to environmental risk factors after migration modified IBD risk, a hypothesis requiring further research. The IBD knowledge deficit observed in Middle Eastern migrants may represent an unmet need in these patients with potential to impact on their ongoing care.
Supervisor: Mclaughlin, John Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: South Asian ; Middle Eastern ; Inflammatory bowel disease ; Immigrant populations