Emerging inflammatory bowel disease in saudi outpatients: A report of 693 cases.

[kiny]

http://www.ncbi.nlm.nih.gov/pubmed/23319033

Emerging inflammatory bowel disease in saudi outpatients: A report of 693 cases.

Gastroenterology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

2013 Jan

Background/Aim:

Inflammatory bowel disease (IBD) is a chronic disease of unknown etiology and considered traditionally as a disease of the western world. Recently, rising trends have been observed in countries previously known to have a low prevalence and incidence. The aim of this study is to collect epidemiological data on IBD outpatients and to add data from the Kingdom of Saudi Arabia (KSA) to the available IBD literature.

Patients and Methods:

The medical records of 693 Saudi patients with IBD over a period of 17 years, between 1993 and 2009, were reviewed. The demographic and clinical data and methods of diagnosis were retrieved.

Results:

The total number of patients in this cohort was 693. It constituted 238 (34.3%) ulcerative colitis (UC) and 455 (65.7%) Crohn's disease (CD) patients. UC was steady throughout the years, whereas only 1.2 CD patients were diagnosed per year in the first 11 years, and 73.7 per year in the last six years. The median age of UC patients was 34 years, ranging from 10 to 80 years with a peak between 21 and 40 years and in CD it was 27 years, ranging from 11 to 73 years with a peak between 11 and 30 years. There was a male preponderance of 1.5:1 and 2:1, respectively. The rest of the data is discussed in this study.

Conclusion:

IBD is no longer a rare disease in KSA. UC is in a steady state, whereas CD is increasing significantly and far outnumbering UC.

 

[kiny]

Does anyone still think this increase is caused by better detection methods. It's a 70 times increase in crohn's disease in 10 years time. Even if their numbers would be completely off it would still be an exponential increase.

Genes, hygiene theory, bla bla bla.....good luck explaining those increases with that ~ it's something else.

 

[Mark in Seattle]

I've read a study or two similar to this recently - time trends that show UC as the first IBD to develop in an area, and it trends up, and it is is then followed by CD trending up, and then UC tends to level or decline while CD continues to trend higher. To me, intuitively, this pattern which I believe is somewhat consistent across geographies (correct me if I'm wrong) strikes me a a situation where an environmental variable comes into a particular geography and the folks who are predisposed to UC will perhaps then develop disease as a result of a comparatively smaller exposure (smaller in terms of quantity or perhaps smaller in terms of time duration), and as the exposure builds in the population, those who are predisposed to developing CD will go on to do so as the environmental variable builds in their body over greater time or greater quantity relative to UC folks. I might therefore expect a shorter incubation period for UC'ers compared to CD'ers. Does that sound consistent with the literature?

 

[sashaz]

That or there is a major change in their diets in the last few years. Have they just introduced restuarants like kfc/mcdonalds and pizzas now and they didnt have access to it before?

 

[mnsun]

Here's my obligatory MMR conspiracy connection:

Looking at Saudi vaccination schedules for measles and MMR, you find interesting statistics which may relate to the spike in Crohn’s. In particular, there was an “elimination phase” (of measles mumps & rubella) from 1998-2000 where 96% of school going children were given MMR doses, once in 1998 and in lower age groups in 2000—regardless of whether they had already received the previous schedule: measles vaccine (one dose at 6 mo) and MMR vaccine(one dose at 12 mo), which was the schedule from 1990 till 98. (This elimination phase made all preparatory and secondary children get one MMR dose in 1998. The 2000 dose was given to all primary and 1st year preparatory children.)

Therefore, (if I’m not mistaken) the net effect was that most kids would have been given, likely, one single measles vacc IN ADDITION TO two MMR vaccs FOR THE FIRST TIME IN SAUDI history, once the “elimination phase” was through. Not sure what ages attend preparatory/primary/secondary, but 12-14 years later, it probably is the median age for developing Crohns nowadays.

FYI: Later on, the use of two MMR-dose schedules, (like here in the states and elsewhere) with the first dose at 12 months and the second dose at pre-school age, was implemented in 2001.
http://applications.emro.who.int/imemrf/Ann_Saudi_Med/2005_25_4_324.pdf

Of interest may also be the fact that Japan banned the triple MMR vaccine in 1993. I haven’t found relevant statistics on Crohn’s rates in Japan… Not sure if there is a ?15-20? year lag which would show a resultant drop in Crohn’s, or not, since I’m not sure if they really ascribe to the causal dietary factors etc… They instead use separate measles, mumps and rubella jabs, not MMR single jabs, so they in essence still get two measles shots—just not the especially dangerous MMRs.
http://www.dailymail.co.uk/health/article-17509/Why-Japan-banned-MMR-vaccine.html

 

[wild_one353]

Here's my obligatory MMR conspiracy connection:

Looking at Saudi vaccination schedules for measles and MMR, you find interesting statistics which may relate to the spike in Crohn’s. In particular, there was an “elimination phase” (of measles mumps & rubella) from 1998-2000 where 96% of school going children were given MMR doses, once in 1998 and in lower age groups in 2000—regardless of whether they had already received the previous schedule: measles vaccine (one dose at 6 mo) and MMR vaccine(one dose at 12 mo), which was the schedule from 1990 till 98. (This elimination phase made all preparatory and secondary children get one MMR dose in 1998. The 2000 dose was given to all primary and 1st year preparatory children.)

Therefore, (if I’m not mistaken) the net effect was that most kids would have been given, likely, one single measles vacc IN ADDITION TO two MMR vaccs FOR THE FIRST TIME IN SAUDI history, once the “elimination phase” was through. Not sure what ages attend preparatory/primary/secondary, but 12-14 years later, it probably is the median age for developing Crohns nowadays.

FYI: Later on, the use of two MMR-dose schedules, (like here in the states and elsewhere) with the first dose at 12 months and the second dose at pre-school age, was implemented in 2001.
http://applications.emro.who.int/imemrf/Ann_Saudi_Med/2005_25_4_324.pdf

Of interest may also be the fact that Japan banned the triple MMR vaccine in 1993. I haven’t found relevant statistics on Crohn’s rates in Japan… Not sure if there is a ?15-20? year lag which would show a resultant drop in Crohn’s, or not, since I’m not sure if they really ascribe to the causal dietary factors etc… They instead use separate measles, mumps and rubella jabs, not MMR single jabs, so they in essence still get two measles shots—just not the especially dangerous MMRs.
http://www.dailymail.co.uk/health/article-17509/Why-Japan-banned-MMR-vaccine.html

quote from the saudi arabia study:

The median age of UC patients was 34 years, ranging from 10 to 80 years with a peak between 21 and 40 years and in CD it was 27 years, ranging from 11 to 73 years with a peak between 11 and 30 years.

not sure the age ranges in the study match up with the vaccination ages and timing. The study was from records up until 2009, and they said within the past six years the crohns rates had dramatically increased, that would put some increase in potential causative event/agent in the range of 2002-2003, but still may have been earlier, but probably around this time something changed in saudi arabia. it was affecting all people of all ages.

These "facts" seem to somewhat contradict the vaccination theory. what do you think?

 

[wild_one353]

That or there is a major change in their diets in the last few years. Have they just introduced restuarants like kfc/mcdonalds and pizzas now and they didnt have access to it before?

This idea should be explored. there were some political changes that may connect these events, in terms of economic changes. dont have anymore time at the moment to explore this tho.