Browsing by Author "Senanayake, Y.U."

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Environmental risk factors in inflammatory bowel disease: a population-based case-control study in Asia-Pacific
(British Medical Assosiation, 2015) Ng, S.C.; Tang, W.; Leong, R.W.; Chen, M.; Ko, Y.; Studd, C.; Niewiadomski, O.; Bell, S.; Kamm, M.A.; de Silva, H.J.; Kasturiratne, A.; Senanayake, Y.U.; Ooi, C.J.; Ling, K.L.; Ong, D.; Goh, K.L.; Hilmi, I.; Ouyang, Q.; Wang, Y.F.; Hu, P.; Zhu, Z.; Zeng, Z.; Wu, K.; Wang, X.; Xia, B.; Li, J.; Pisespongsa, P.; Manatsathit, S.; Aniwan, S.; Simadibrata, M.; Abdullah, M.; Tsang, S. W.; Wong, T.C.; Hui, A.J.; Chow, C.M.; Yu, H.H.; Li, M.F.; Ng, K.K.; Ching, J.; Wu, J.C.; Chan, F.K.; Sung, J.J.
OBJECTIVE: The rising incidence of inflammatory bowel disease in Asia supports the importance of environmental risk factors in disease aetiology. This prospective population-based case-control study in Asia-Pacific examined risk factors prior to patients developing IBD. DESIGN: 442 incident cases (186 Crohn's disease (CD); 256 UC; 374 Asians) diagnosed between 2011 and 2013 from eight countries in Asia and Australia and 940 controls (frequency-matched by sex, age and geographical location; 789 Asians) completed an environmental factor questionnaire at diagnosis. Unconditional logistic regression models were used to estimate adjusted ORs (aOR) and 95% CIs. RESULTS: In multivariate model, being breast fed >12 months (aOR 0.10; 95% CI 0.04 to 0.30), antibiotic use (aOR 0.19; 0.07 to 0.52), having dogs (aOR 0.54; 0.35 to 0.83), daily tea consumption (aOR 0.62; 0.43 to 0.91) and daily physical activity (aOR 0.58; 0.35 to 0.96) decreased the odds for CD in Asians. In UC, being breast fed >12 months (aOR 0.16; 0.08 to 0.31), antibiotic use (aOR 0.48; 0.27 to 0.87), daily tea (aOR 0.63; 0.46 to 0.86) or coffee consumption (aOR 0.51; 0.36 to 0.72), presence of hot water tap (aOR 0.65; 0.46 to 0.91) and flush toilet in childhood (aOR 0.71; 0.51 to 0.98) were protective for UC development whereas ex-smoking (aOR 2.02; 1.22 to 3.35) increased the risk of UC. CONCLUSIONS: This first population-based study of IBD risk factors in Asia-Pacific supports the importance of childhood immunological, hygiene and dietary factors in the development of IBD, suggesting that markers of altered intestinal microbiota may modulate risk of IBD later in life. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Incidence and phenotype of Inflammatory Bowel Disease from 2012-2013 across 9 countries in Asia: results from the 2012 access inception cohort
(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2015) Ng, S.C.; Zeng, Z.; Chen, M.; Tang, W.; de Silva, H.J.; Niriella, M.A.; Senanayake, Y.U.; Yang, hong; Qian, J.M.; Yu, H.H.; Li, M.F.; Zhang, J.; Ng, K.K.; Ong, D.E.; Ling, K-L; Goh, K.L.; Hilmi, I.; Pisespongsa, P.; Aniwan, S.; Limsrivilai, J.; Manatsathit, S.; Abdullah, M.; Simadibrata, M.; Gunawan, J.A.; Chong, V.H.; Tsang, S.; Chan, K.H.; Lo, F.H.; Hui, A.J.; Chow, C.M.; Kamm, M.A.; Hu, P.; Ching, J.; Chan, F.K.L.; Sung, J.J.Y.
BACKGROUND: The incidence of inflammatory bowel disease (IBD) in Asia was first reported in the 2011 ACCESS inception cohort. This study aims to validate the incidence reported in 2011 by including a second independent cohort from 8 of the participating countries in 2011 and Brunei to investigate the incidence of IBD in Asia in 2012. METHODS: Incident IBD cases diagnosed between April 1, 2012 and March 31, 2013 from 18 centres, 11 cities and 9 countries in Asia were enrolled. Data including demographics and disease phenotype were entered into a Web-based database (http://www.access-apibd.com/access/index.html). Disease location and behavior were classified according to the Montreal classification. RESULTS: A total of 325 IBD patients were identified including 189 (58%) ulcerative colitis (UC), 119 (37%) Crohn’s disease (CD), and 17 (5%) indeterminate colitis (IC). The crude overall annual incidence per 100,000 of IBD was 1.61 (95% confidence interval, CI, 1.44-1.79) in 2012 compared with 1.15 (95% CI, 1.25-1.51) in 2011. The highest incidence in Asia was in Guangzhou (3.86 per 100,000), Hong Kong (2.91 per 100,000) followed by Macau (2.60 per 100,000). Overall ratio of UC to CD in 2012 was similar to that of 2011 (1.57 vs. 1.69; p=0.211). There were more male than female patients in both years (59% vs 60%; p=0.773). Mean age of diagnosis was 40 years (±15.96) in 2011 and 42 years (±16.30; p=0.084) in 2012. Median time from symptom onset to diagnosis was 6 months (IQR 3-24) and 7 months (IQR 2-16), respectively, in 2011 and 2012 (p=0.958). Disease behavior (B1: 72.0%, B2: 9.9%, B3: 4.4%, perianal: 13.2%), location for CD (L1: 25.3%, L2: 25.3%, L3: 49.5%) and UC (E1: 30.9%, E2: 40.1%, E3: 28.9%) did not differ from previous year. Most CD patients were non-smokers (80.3%) whereas 9.9% were current smokers and 9.9% were ex-smokers. CONCLUSION: The incidence of IBD, UC to CD ratio and age of disease onset in the ACCESS 2012 cohort was not significantly different from that reported in the 2011 cohort. Disease phenotype was also similar over 2 years. The ACCESS inception cohort reflects the true incidence of IBD in Asia.
Natural history of inflammatory bowel disease in Asia: A follow-up population-based cohort study
(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2014) Ng, S.C.; Tang, W.; de Silva, H.J.; Niriella, M.A.; Senanayake, Y.U.; Ooi, C.J.; Ling, K-L; Ong, D.E.; Goh, K.L.; Hilmi, I.; Ouyang, Q.; Wang, Y-F.; Hu, P.; Chen, M.; Zeng, Z.; Zhu, Z.; Wu, K.; Wang, X.; Pisespongsa, P.; Manatsathit, S.; Aniwan, S.; Simadibrata, M.; Abdullah, M.; Tsang, S.; Wong, T.; Leung, V.; Lo, F.H.; Hui, A.R.; Chow, C.M.; Yu, H.H.; Li, M.F.; Ng, K.K.; Ching, J.; Sung, J.J.Y.; Chan, F.K.L.
BACKGROUND AND AIM: Data on the natural history of inflammatory bowel disease (IBD) in population-based setting in Asia are scarce. It is not clear if IBD disease course differs between Asian and Western cohorts. METHODS: In a population-based incident cohort from eight countries in Asia, we identified 259 IBD patients diagnosed between 2011 and 2013, including 158 ulcerative colitis (UC) and 101 Crohn's disease (CD) with a median follow up of 15 months (range, 12-31 months). The risk of disease extent and behaviour change according to the Montreal classification, and probability of medical or surgical therapy were prospectively assessed. RESULTS: Median age at diagnosis was 29 years (Interquartile range, IQR, 20-44) for CD, and 41 years (IQR, 30-54) for UC. At diagnosis, in CD, ileo-colonic disease (51%) and inflammatory behaviour (67%) were the most frequent phenotype. At one year, cumulative probability of behavior change from inflammatory to stricturing or penetrating disease was 18%, and cumulative rate of colectomy was 8%. In CD cumulative probabilities of receiving 5-aminosalicylic acid (5-ASA), corticosteroids, immune-suppressants and anti-tumor necrosis factor therapy were 61%, 43%, 66% and 10%, respectively, at one year. In UC, disease extent at diagnosis was evenly distributed including 31% with proctitis, 37% with left sided disease and 32% with extensive colitis. Disease extension occurred during follow-up in 19% of patients. Cumulative rate of colectomy at one year was 1%. In UC cumulative probabilities of receiving 5-ASA, corticosteroids and immunesuppressants were 91%, 28% and 13%, respectively at one year. There were two mortalities at maximal follow-up from lung carcinoma and severe sepsis. CONCLUSION: In this populationbased follow-up study, clinical presentation and early disease course in Asian IBD patients appear comparable to that of Western patients. Progression to complicated behavior and accelerated use of immunesuppressants is common in CD. Early surgical rate for UC in Asia remains low. Understanding the natural history of IBD in our population can help optimize therapeutic interventions. Reference: SC Ng, et al. Incidence and Phenotype of Inflammatory Bowel Disease, Based on Results from the Asia-Pacific Crohn's and Colitis Epidemiologic Study. Gastroenterology 2013; 145(1):158-165