The Changing Landscape of Inflammatory Bowel Disease: East Meets West.

76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 Tporary diseases of modern societies. Ulcerative colitis emerged in the Western world in the 19th century with “regional ileitis” entering the medical vernacular in the 1930s. Throughout the 20th century, the incidence of Crohn’s disease and ulcerative colitis exponentially increased in the Western world including North America, Europe, Australia, and New Zealand, and predominantly, among white individuals of European descent. The 21st century ushered in a new era with the advent of IBD in newly industrialized countries throughout the world. As societies in newly industrialized countries have adopted practices of the Western world, diseases of the Western world, such as IBD, have emerged. The rise of IBD in Asia has been documented by the AsiaPacific Crohn’s and Colitis Epidemiology Study (ACCESS) Group. This consortium developed population-based inception cohorts of patients with ulcerative colitis and Crohn’s disease in Asia (China, Hong Kong, Indonesia, Sri Lanka, Macau, Malaysia, Singapore, and Thailand) and a control country of the Western world (Australia) between 2011 and 2013. The first publication from ACCESS in 2013 reported that the incidence of IBD in Asia was 1.4 per 100,000. Although this incidence was a fraction of the incidence reported in Australia (24 per 100,000), the publication confirmed the presence of IBD in multiple countries across Asia. A fundamental question stemmed from this study: is a patient diagnosed with IBD in Asia similar to an individual diagnosed in North America or Australia? In other words, is the pathogenesis of IBD in Asia unique such that patients living in Asia will collectively experience a different natural history, response to drugs, and need for surgery? This question was addressed in this issue of Gastroenterology by Ng et al. Using standardized operating procedures and infrastructure, patients with Crohn’s disease and ulcerative colitis who were diagnosed between 2011 and 2013 were followed prospectively to characterize the evolution of phenotype, drug use, and prognosis (eg, surgery) during the first 18 months (median period) of diagnosis. For the most part, prescription of immunomodulators and anti-tumor necrosis factor, and need for surgery were relatively similar for Asia and Australia. Although Crohn’s disease and ulcerative colitis are heterogeneous diseases with multiple different phenotypes, the