76,173,174 It is not clear if the variation in surgical rates for CD across Asia is due to differences in disease severity or in clinical practice. A study from Hong Kong showed a cumulative surgical rate of 29% at 10 years,24 whereas a much higher rate of 58.3% at 10 years was reported in China.72 From Korea, cumulative surgical rates were 11.9–15.5% at one year, 25% at 5 years and 32.8% at 10 to 15 years.77,172 Eighteen percent of surgical patients from one study required a second resection, with cumulative rate of re-operation

of 2.9% after 1 year, 19.9% after 5 years, and 30.8% after 10 years.77 Japanese studies have reported cumulative rates at 5 years of 25.9–44.4% and 10 years of 46.3–80.1%,76,173,174 which are comparable to Western data of cumulative surgical rates of 37.9% (Norway)168 and 65% (Copenhagen) at 10 years.90 Regarding risk factors for surgery, multivariate analyses from China selleck compound have found stricturing and penetrating behaviour,72,172 and smoking habit,72 to be independently associated with increased risk of surgery, whereas female gender and ileal disease were independent risk factors for surgery in Japan.175 Extra-intestinal manifestations.  In the West, check details the prevalence of extra-intestinal manifestations (EIM) (Table 5) in IBD is approximately 25–40%,178–181 although comparisons between studies are difficult due to different diagnostic criteria. Previous reviews of IBD in Asia

have surmised lower EIM in Asian countries compared to the West.45,182 Studies in China and Hong Kong have demonstrated that joint manifestations in IBD were seen in 2.7–7.9% of patients.24,70,73,81 In India, up to one quarter of patients have joint manifestation.137 Primary sclerosing cholangitis (PSC) associated with UC is less prevalent in Asia (0–1.7%)56,70,81,84,137,176,183 compared with the West (2–7%).184 A recent Korean study of 1849 UC patients demonstrated

the cumulative probability of PSC after diagnosis was 0.71% after 1–5 years, 1.42% after 10 years, 2.59% after 15 years, and 3.35% after 20–25 years.176 In the West the likelihood of having IBD in patients diagnosed with PSC was 62–76%.185–188 上海皓元医药股份有限公司 In contrast, 20% of PSC patients in Japan and 50% in India had IBD.189 A case series of 10 patients with PSC in Singapore revealed that only 20% were associated with symptomatic IBD.190 Studies comparing different ethnicities within the one country have found differing EIM between ethnic groups. In Malaysia, there was a higher prevalence of EIM among the Indians compared with Malays (P = 0.04) and Chinese (P = 0.002).56 In Singapore the frequency of EIM was higher in Indians (14%) than Chinese (6%).55 The use of corticosteroids for UC and CD is variable in studies from Asia. A recent questionnaire, designed according to European and US Guidelines of IBD, was distributed to IBD specialists throughout Asia with the aim of assessing IBD management practices.