{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T01:38:27Z","timestamp":1778636307933,"version":"3.51.4"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2020,3,2]],"date-time":"2020-03-02T00:00:00Z","timestamp":1583107200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11,19]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>South Asians have recently been identified as having a rapidly rising incidence and prevalence of inflammatory bowel disease (IBD) throughout the world. However, longitudinal phenotypic studies of South Asians living in the United States remain scarce.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively studied 171 South Asian patients with IBD treated at 2 US tertiary centers who presented between 2000 and 2016. South Asian IBD patients were randomly matched in a 1:2 ratio with sex and IBD subtype\u2013matched (ulcerative colitis [UC] vs Crohn disease [CD]) white control patients (n = 342). Demographic and phenotypic characteristics were evaluated and compared between the 2 groups. Odds ratios (OR), logistic regression, and survival analysis were performed using R studio and STATA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>81 South Asian patients and 162 white patients had CD, and 90 South Asians and 180 white patients had UC. Among the CD group, South Asian patients were diagnosed at a median older age (age 28) than white patients (21 years; P &amp;lt; 0.003). Fistulizing disease (24.1% vs 8.6%; P &amp;lt; 0.002), perianal disease (20.3% vs 2.5%; P &amp;lt; 0.005), and presentation of rectal pain (16.2% vs 2.9%; P &amp;lt; 0.001) were more common among South Asian patients with CD than among white patients. After adjusting for covariates, South Asian patients with CD were less likely to be placed on thiopurines (OR = 0.36; P &amp;lt; 0.007) or to receive more than 1 biologic (OR = 0.42; P &amp;lt; 0.040). South Asian patients with UC were less likely to have proctitis (10% vs 22.2%; P &amp;lt; 0.022) and more likely to have primary sclerosing cholangitis (n = 7 vs n = 2; P &amp;lt; 0.007). South Asian patients born in the United States or those who had migrated before age 5 were younger at the age of IBD diagnosis (age 18.9 vs 32.4; P &amp;lt; 0.0005).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We found unique demographic and phenotypic characteristics among South Asian patients, including more penetrating disease in those with CD and less proctitis among those with UC, along with altered medication use patterns. Distinct environmental exposures and a potentially unique genetic profile of South Asian patients may confer this variable phenotypic expression, influencing management of this increasingly at-risk population.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ibd\/izaa029","type":"journal-article","created":{"date-parts":[[2020,3,2]],"date-time":"2020-03-02T08:00:30Z","timestamp":1583136030000},"page":"1933-1942","source":"Crossref","is-referenced-by-count":33,"title":["South Asian Patients With Inflammatory Bowel Disease in the United States Demonstrate More Fistulizing and Perianal Crohn Phenotype"],"prefix":"10.1093","volume":"26","author":[{"given":"Sushrut","family":"Jangi","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, University of California San Diego, San Diego, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Ruan","sequence":"additional","affiliation":[{"name":"Division of Pediatrics, Children\u2019s Hospital of Pennsylvania, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua","family":"Korzenik","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Punyanganie","family":"de Silva","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,3,2]]},"reference":[{"key":"2020111909563776900_CIT0001","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1053\/j.gastro.2011.01.055","article-title":"Epidemiology and natural history of inflammatory bowel diseases","volume":"140","author":"Cosnes","year":"2011","journal-title":"Gastroenterology."},{"key":"2020111909563776900_CIT0002","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.bpg.2014.04.003","article-title":"Epidemiology of inflammatory bowel disease: focus on Asia","volume":"28","author":"Ng","year":"2014;","journal-title":"Best Pract Res Clin Gastroenterol."},{"key":"2020111909563776900_CIT0003","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1111\/j.1751-2980.2010.00429.x","article-title":"Inflammatory bowel disease in the Asia-Pacific area: a comparison with developed countries and regional differences","volume":"11","author":"Ahuja","year":"2010","journal-title":"J Dig Dis."},{"key":"2020111909563776900_CIT0004","article-title":"Ramakrishnan K, Ahmad F. State of Asian Americans and Pacific Islander series: a multifaceted portrait of a growing population. Center for American Progress. 2014. cdn.americanprogress.org."},{"key":"2020111909563776900_CIT0005","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1136\/gut.33.5.687","article-title":"Epidemiological study of ulcerative proctocolitis in Indian migrants and the indigenous population of Leicestershire","volume":"33","author":"Probert","year":"1992","journal-title":"Gut."},{"key":"2020111909563776900_CIT0006","first-page":"125","article-title":"Epidemiology of Crohn\u2019s disease in Indian migrants and the indigenous population in Leicestershire","volume":"82","author":"Jayanthi","year":"1992","journal-title":"Q J Med."},{"key":"2020111909563776900_CIT0007","doi-asserted-by":"crossref","first-page":"2918","DOI":"10.1111\/j.1572-0241.1999.01438.x","article-title":"The effects of migration on ulcerative colitis: a three-year prospective study among Europeans and first- and second-generation South Asians in Leicester (1991\u20131994)","volume":"94","author":"Carr","year":"1999","journal-title":"Am J Gastroenterol."},{"key":"2020111909563776900_CIT0008","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1111\/j.1572-0241.2007.01562_3.x","article-title":"Inflammatory bowel disease in the South Asian population of northwest England","volume":"103","author":"Rashid","year":"2008","journal-title":"Am J Gastroenterol."},{"key":"2020111909563776900_CIT0009","doi-asserted-by":"crossref","first-page":"1\u20137","DOI":"10.1155\/2016\/8723949","article-title":"Colectomy rates for ulcerative colitis differ between ethnic groups: results from a 15-year nationwide cohort study","volume":"2016","author":"Misra","year":"2016","journal-title":"Can J Gastroenterol Hepatol."},{"key":"2020111909563776900_CIT0010","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1159\/000484347","article-title":"Asians have more perianal Crohn disease and ocular manifestations compared with white Americans","volume":"2","author":"Kochar","year":"2018","journal-title":"Inflamm Intest Dis."},{"key":"2020111909563776900_CIT0011","first-page":"201","article-title":"Common NOD2 mutations are absent in patients with Crohn\u2019s disease in India","volume":"27","author":"Pugazhendhi","year":"2008","journal-title":"Indian J Gastroenterol."},{"key":"2020111909563776900_CIT0012","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1111\/j.1440-1746.2010.06533.x","article-title":"Common variants in NOD2 and IL23R are not associated with inflammatory bowel disease in Indians","volume":"26","author":"Mahurkar","year":"2011","journal-title":"J Gastroenterol Hepatol."},{"key":"2020111909563776900_CIT0013","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1111\/j.1365-2036.2007.03524.x","article-title":"Evidence of allelic heterogeneity for associations between the NOD2\/CARD15 gene and ulcerative colitis among North Indians","volume":"26","author":"Juyal","year":"2007","journal-title":"Aliment Pharmacol Ther."},{"key":"2020111909563776900_CIT0014","first-page":"237","article-title":"A clinical review of recent findings in the epidemiology of inflammatory bowel disease","volume":"5","author":"Ponder","year":"2013","journal-title":"Clin Epidemiol."},{"key":"2020111909563776900_CIT0015","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1038\/ajg.2011.85","article-title":"Differences in inflammatory bowel disease phenotype between South Asians and Northern Europeans living in North West London, UK","volume":"106","author":"Walker","year":"2011","journal-title":"Am J Gastroenterol."},{"key":"2020111909563776900_CIT0016","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1097\/MIB.0000000000000651","article-title":"Pediatric inflammatory bowel disease among South Asians living in British Columbia, Canada: a distinct clinical phenotype","volume":"22","author":"Carroll","year":"2016","journal-title":"Inflamm Bowel Dis."},{"key":"2020111909563776900_CIT0017","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1007\/s00535-012-0655-3","article-title":"Reply to the letter by A. M. Bianco et al. regarding \u201cEffects of family history on IBD characteristics in Japanese patients.\u201d","volume":"48","author":"Kuwahara","year":"2013","journal-title":"J Gastroenterol."},{"key":"2020111909563776900_CIT0018","doi-asserted-by":"crossref","first-page":"17120","DOI":"10.3748\/wjg.v20.i45.17120","article-title":"Similar clinical characteristics of familial and sporadic inflammatory bowel disease in South Korea","volume":"20","author":"Chung","year":"2014","journal-title":"World J Gastroenterol."},{"key":"2020111909563776900_CIT0019","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1093\/ecco-jcc\/jjw063","article-title":"Influence of a positive family history on the clinical course of inflammatory bowel disease","volume":"10","author":"Hwang","year":"2016","journal-title":"J Crohn\u2019s Colitis"},{"key":"2020111909563776900_CIT0020","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.cgh.2017.05.047","article-title":"Ethnicity influences phenotype and outcomes in inflammatory bowel disease: a systematic review and meta-analysis of population-based studies","volume":"16","author":"Shi","year":"2018","journal-title":"Clin Gastroenterol Hepatol."},{"key":"2020111909563776900_CIT0021","doi-asserted-by":"crossref","first-page":"17","DOI":"10.5009\/gnl16510","article-title":"Inflammatory bowel disease and primary sclerosing cholangitis: a review of the phenotype and associated specific features","volume":"12","author":"Palmela","year":"2018","journal-title":"Gut Liver."},{"key":"2020111909563776900_CIT0022","doi-asserted-by":"crossref","first-page":"99","DOI":"10.2147\/CLEP.S37357","article-title":"Gallbladder cancer: epidemiology and outcome","volume":"6","author":"Shaffer","year":"2014","journal-title":"Clin Epidemiol."},{"key":"2020111909563776900_CIT0023","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1365-2249.2010.04139.x","article-title":"The \u201chygiene hypothesis\u201d for autoimmune and allergic diseases: an update","volume":"160","author":"Okada","year":"2010","journal-title":"Clin Exp Immunol."},{"key":"2020111909563776900_CIT0024","first-page":"26050","article-title":"The composition of the gut microbiota throughout life, with an emphasis on early life","volume":"26","author":"Rodr\u00edguez","year":"2015","journal-title":"Microb Ecol Heal Dis."},{"key":"2020111909563776900_CIT0025","doi-asserted-by":"crossref","first-page":"489","DOI":"10.2147\/PPA.S153741","article-title":"UK-South Asian patients\u2019 experiences of and satisfaction toward receiving information about biologics in rheumatoid arthritis","volume":"12","author":"Kumar","year":"2018","journal-title":"Patient Pref Adherence."}],"container-title":["Inflammatory Bowel Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ibdjournal\/article-pdf\/26\/12\/1933\/34398021\/izaa029.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ibdjournal\/article-pdf\/26\/12\/1933\/34398021\/izaa029.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T22:48:22Z","timestamp":1614638902000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ibdjournal\/article\/26\/12\/1933\/5771121"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,2]]},"references-count":25,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,3,2]]},"published-print":{"date-parts":[[2020,11,19]]}},"URL":"https:\/\/doi.org\/10.1093\/ibd\/izaa029","relation":{},"ISSN":["1078-0998","1536-4844"],"issn-type":[{"value":"1078-0998","type":"print"},{"value":"1536-4844","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,12]]},"published":{"date-parts":[[2020,3,2]]}}}