Introduction:
The global incidence of inflammatory bowel disease (IBD) continues to rise, particularly in newly industrialized countries. This comprehensive systematic review evaluated how race, ethnicity, geography, and migration influence the clinical phenotype and outcomes of Crohn's disease (CD) and ulcerative colitis (UC).
Why was this study needed?
- The global epidemiology of IBD is rapidly evolving.
- The influence of ethnicity and geography on disease phenotype remains incompletely understood.
- Migration may alter disease risk and clinical presentation.
- Understanding phenotypic differences is essential for personalized IBD care.
- Large global population-based data have been lacking.
Results:
- Crohn's disease showed significant ethnic differences, with Asian patients having the highest prevalence of perianal disease, whereas ulcerative colitis demonstrated fewer phenotypic differences across ethnic groups.
- Family history of IBD varied substantially, being more common among Middle Eastern populations and Asian immigrants than native Asian populations, suggesting an interaction between genetics and environmental exposure.
- Persistent differences in sex distribution, disease phenotype, and clinical presentation across racial and geographic populations indicate that IBD is not a uniform global disease.
Clinical Impact:
This landmark meta-analysis demonstrates that ethnicity, geography, and migration significantly influence the clinical expression of IBD, particularly Crohn's disease. These findings support the development of personalized risk assessment, surveillance strategies, and precision medicine, while emphasizing the need for future multi-omics research in diverse populations.
Bottom Line:
IBD is a heterogeneous global disease shaped by genetics, environment, and migration. Recognizing ethnic and geographic differences in disease phenotype is essential for improving diagnosis, individualized management, and future precision medicine approaches.