| Inflammatory bowel disease (IBD) consists of two diseases including ulcerative colitis (UC) and Crohn’s disease (CD). The incidence of IBD is much higher in western countries comparing to the Asian countries especially in Thailand. The incidence of UC in Thailand is quite low and seems less aggressive than in western countries. Over the past two decades, the evolution of UC management in Thailand impacts a reduction in hospitalization and colectomy as demonstrated by a cohort from two main university hospitals in Bangkok. Of 291 patients in that cohort between 2000 and 2018, an increase of both oral and topical mesalamine was noted and the early use of thiopurine was also observed. Comparing the patients treated in the 2000s and 2010s, only 1% of patients for each group required a biologic agent. The 3-year achieving mucosal healing rate increased from 15% to 46% (p<0.01). The 5-year UC-related hospitalization decreased from 30% to 21% (p<0.05). The 5-year colectomy rate decreased from 6% to 2% (p<0.05). Regarding CD, a cohort of 182 patients from the two aforementioned hospitals between 2000 and 2017 was analyzed. The mean age of Thai patients was 46 which seems older than the cohorts from western and other Asian countries. The majority of patients had an inflammatory phenotype at diagnosis. Stricturing and penetrating diseases were observed equally at approximately 10% of patients. Perianal disease and extraintestinal manifestations were noted in nearly 12% of patients. Diagnosis of CD remains challenging in our country as the time from onset of symptoms to diagnosis was 12 months possibly due to unawareness and difficulty in the differential diagnosis between CD and intestinal tuberculosis. The overall 1-year and 5-year rate of surgery was 25.3% and 30.4% in this cohort. With a significant trend to early initiation of immunomodulators and biologics in the later period, the 1-year and 5-year cumulative rate of surgery after diagnosis was only 2.2% and 11%. To improve the outcomes of CD treatment in Thailand, our physicians need more awareness to recognize the disease which results in early diagnosis, long-term complications prevention, and reduction in the rate of surgery both before and after the diagnosis. |
