Inflammatory bowel disease in Iran: a review of 448 cases

Background – Ulcerative colitis (UC) and Crohn''s disease (CD) are chronic inflammatory bowel diseases of unknown etiology. Inflammatory bowel disease (IBD) was believed to be infrequent in Iran; however, unofficial reports have confessed the continuing rise in IBD. Here, we present our experience with 448 patients with IBD referred during a 10-year period, 1992 – 2002.Methods – Demographic and clinical features, extraintestinal manifestations, extension of disease, and complications of 401 patients with UC and 47 with CD were assessed retrospectively. The diagnosis was based on Lennard Jones criteria. The exact course of physicians'' visits of 250 patients with IBD was asked through a face-to-face interview. Finally, the lag time between onset of the disease and time of definite diagnosis was determined.Results – The mean (± SD) age at diagnosis was 30.5 ± 11.8 years. Male to female ratio was 0.8:1.0 for UC and 1.3:1.0 for CD. Eighty-three percent of CD and 84.5% of UC patients were nonsmokers. Patients with UC chiefly presented with rectorrhagia (41.9%) or bloody diarrhea (31%), whereas those with CD complained of abdominal pain (47.5%) or diarrhea (27.5%). Of the patients, 14.1% had noted IBD in their family. Among UC patients, proctosigmoid was revealed to be affected in 51.9%. However, left-sided colitis and pancolitis were reported in 30% and 18.1%, respectively. Colorectal cancer was diagnosed in 2 patients (0.4%). The mean lag time between the onset of symptoms and definite diagnosis was 13.9 and 17.7 months for UC and CD patients, respectively. A total of 32.4% of patients with IBD had at least one of the five major extraintestinal manifestations. Conclusion – The demographic and clinical features of IBD are more or less the same as other developing countries. It seems as if gradual adoption of a western lifestyle may be associated with continuing rise in IBD. Higher prevalence of infectious disease and common disorders such as hemorrhoid, and lack of attention to the increased incidence of IBD in Iran are possible reasons for delayed diagnosis of IBD.