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• Reply to Dr Andrew et al .
  Ajit Sood
  Published on: 18 April 2016
• Incidence and prevalence of ulcerative colitis in Punjab, North India
  Andrew Sawczenko
  Published on: 18 April 2016

• Published on: 18 April 2016

  Reply to Dr Andrew et al .

  • Ajit Sood, Doctor
  • Other Contributors:
    • V Midha, N Sood, A S Bhatia, and G Avasthi

  Dear Editor

  We wish to thank Dr Andrew et al . for their comments.[1]

  Their contention that we did not report data on the incidence of Crohn's disease is because of difficulty in ascertaining the diagnosis. This is all the more difficult in countries where tuberculosis is very common and has to be excluded/treated before diagnosis of crohn's disease is acceptable. However,we agree that there is a need t...

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  Dear Editor

  We wish to thank Dr Andrew et al . for their comments.[1]

  Their contention that we did not report data on the incidence of Crohn's disease is because of difficulty in ascertaining the diagnosis. This is all the more difficult in countries where tuberculosis is very common and has to be excluded/treated before diagnosis of crohn's disease is acceptable. However,we agree that there is a need to study the pattern of Crohn's disease in India as we do see these patients regularly in hospital practice nowadays. As far as data on IBD in chldren in India is concerned there is no epidemiologic data to report. A population based study in developing countries among children might be very informative but difficult to carry out.

  Reference

  (1) A Sood, V Midha, N Sood, A S Bhatia, and G Avasthi Incidence and prevalence of ulcerative colitis in Punjab, North India Gut 2003; 52: 1587-1590.

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  Conflict of Interest:
  None declared.

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• Published on: 18 April 2016

  Incidence and prevalence of ulcerative colitis in Punjab, North India

  • Andrew Sawczenko, Paediatric Gastroenterologist
  • Other Contributors:
    • Dr Chris Probert, Prof Bhupinder Sandhu

  Dear Editor

  Sood et al[1] are to be congratulated on their prospective study to determine the incidence and prevalence of ulcerative colitis in the Punjab region of India. Their study shows that ulcerative colitis may not be as rare in the Asian sub-continent as was once believed.

  We have previously reported ethnic IBD incidence data from a prospective study of over 13 million children, aged less...

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  Dear Editor

  Sood et al[1] are to be congratulated on their prospective study to determine the incidence and prevalence of ulcerative colitis in the Punjab region of India. Their study shows that ulcerative colitis may not be as rare in the Asian sub-continent as was once believed.

  We have previously reported ethnic IBD incidence data from a prospective study of over 13 million children, aged less than 16 years, encompassing the entire population of the United Kingdom and Republic of Ireland.[2] Children of South Asian [Indian, Pakistani and Bangladeshi] origin had a higher incidence rate of IBD compared to children of other ethnic groups [relative risk 1.5 (95% CI 1.1 -2.1, p = 0.01)], and that this was specifically because of a higher incidence of ulcerative colitis [relative risk 1.5 (95% CI 1.1-2.2, p = 0.03)]. In the original retrospective regional study from Leicester [3] cited by Sood et al,[1] undertaken a decade earlier, no significant difference in incidence of ulcerative colitis was found between European and Asian children, although the absolute number of cases were very small. However, Asian adults did have a higher incidence of ulcerative colitis than non-Asians. A recent report has suggested that there may be an increasing incidence of both ulcerative colitis and Crohn’s disease amongst the adult Bangladeshi population of East London.[4] We were interested that Sood et al.[1] did not report data on the incidence of Crohn’s disease, presumably because of the difficulty in determining the diagnosis but also perhaps because of the lower incidence and prevalence. In the United Kingdom national paediatric study, Asians, compared to other ethnic groups, did not have a lower incidence of Crohn’s disease and the incidence of ulcerative colitis was higher.

  With the rapid emergence of a large middle class in the Asian sub- continent we suspect that in some ‘westernised’ populations the incidence and prevalence of IBD, and specifically that of ulcerative colitis, may over-take that recorded in populations of North European descent. Studies amongst those in the paediatric age group in the Indian sub-continent might be the first to detect such temporal changes.

  References

  (1) A Sood, V Midha, N Sood, A S Bhatia, and G Avasthi Incidence and prevalence of ulcerative colitis in Punjab, North India. Gut 2003; 52: 1587-1590.

  (2) Sawczenko A, BK Sandhu, et al. (2001). "Prospective survey of childhood Inflammatory Bowel Disease in the British Isles." Lancet 357: 1093-4.

  (3) Probert CS, V Jayanthi et al. (1993). "Prevalence and family risk of ulcerative colitis and Crohn's disease: an epidemiological study among Europeans and south Asians in Leicestershire." Gut 34(11): 1547-51.

  (4) Tsironi E, RM Feakins et al. (2002). "Incidence of inflammatory bowel disease is rising but of abdominal TB is falling in Bangladeshis in East London." Gastroenterol 124(4): A212.

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  Conflict of Interest:
  None declared.

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