Although there is little epidemiological data from developing countries, the incidence and prevalence of inflammatory bowel disease (IBD) are increasing, indicating its appearance as a global disease. A retrospective chart review of all patients diagnosed with IBD was carried out. Sixty four patients with IBD were identified. Data collected include: patients’ characteristics, clinical presentation, endoscopic findings, histopathologies, and medical treatment. The age at diagnosis was between 20–30 years in both UC and CD. The female to male ratio was 2.67 for UC patients while it was 0.71 in CD patients. Patients with UC presented mainly with hematochezia (81.8%), where those with CD complained of abdominal pain (83.3%). 13.6% of UC patients and16.7% of CD patients reported extra intestinal manifestations. The most involved part was left colon in UC (40.9%) and ileocolitis in CD patients (54.1%).  The demographic and clinical presentation of IBD is the same as other developing countries. While IBD is no longer a rare disease in Jordan, the epidemiological profile of IBD in Jordan is still unknown. Concerns with the etiology and the role of an increasingly westernized life style may be associated with the continuing rise in IBD and warrants further studies.  

 
Keywords: Inflammatory Bowel Disease; Ulcerative Colitis; Crohn’s Disease. 

Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the large and small intestine.  IBD includes both ulcerative colitis (UC) and Crohn’s disease (CD). Both conditions are life long and follow an unpredictable relapsing and remitting course. Ulcerative colitis only affects the colon (large intestine), while Crohn’s disease can affect the entire digestive system, from the mouth to the anus [1-3]. The onset of the disease is usually between 15 and 30 years, but both younger and older individuals may be affected [4-5]. The exact cause of IBD remains unknown; however multiple systemic factors influence the progression of IBD, including genetic, environmental and immunologic factors [4-8]. Recent studies showed that there is an increased incidence of IBD because of exogenous infections, use of antibiotics and diet changes. Medical treatment options have rapidly expanded in recent years. Current medical therapy is facilitative and supportive rather than curative. The principles of medical treatment are approximately the same for ulcerative colitis and Crohn's disease. Treatment emphasizes, besides drugs, the individuality of the therapeutic response [9].  Ulcerative colitis and Crohn's disease are more common in developed countries than developing countries, however, according to recent studies; the incidence of IBD is increasing in developing countries [11-12].  In comparison to Western countries, there are limited data regarding the epidemiology, clinical features and causes of IBD in these regions [8, 13-14].   In Jordan, UC and CD is not rare and occurs among all age groups, with a peak incidence in the second and third decades [15].  Jordan has demonstrated an increasing incidence of IBD, particularly UC. IBD is a more well-defined disease in the industrialized countries. The incidence of the disease is very well described in western countries. Very little is known about the disease in Jordan. There are reports of increasing IBD frequency in developing countries. As Jordan is now a country with different ethnicities, additional studies that emphasize epidemiologic and clinical features of IBD are needed to explain its pattern in Jordan. What is very clear about IBD is that, IBD patients often report symptoms referable to the gastrointestinal tract, without objective indication of current disease activity. This leaves both the patient and physician with a major problem, where treatment would involve strong immune-modulating agents that are associated with strong side effects, high financial cost, and difficulty in accomplishing effective symptom relief. The present study has assessed IBD cases from a gastrointestinal clinic in Central Jordan with the intent to report the epidemiologic and clinical features of IBD.

A retrospective chart review of all patients diagnosed with IBD was used to collect study data.

All patients diagnosed with IBD that who were referred to a referral hospital affiliated gastrointestinal clinic, between 2007 and 2010 were included. IBD diagnosis was based on the typical clinical symptoms, laboratory data, endoscopic findings and histological confirmation of UC or CD. All information regarding demographics, family history of IBD, major extra-intestinal manifestations, extent of IBD, treatment details, need for surgical treatment, and co-existence of other diseases were obtained by the investigators. Study was approved by local Ethics Committee at the hospital.

3. Statistical analysis

All statistical analyses were performed using SPSS version 17 (SPSS Inc., Chicago IL.). Measured values were expressed as frequencies and percentages.

Table 7 shows histopathology and endoscopic procedures done for patients.

The following drugs were used: Asacol (mesalazine) in 53 (75.7%) patient, Imuran (azathioprine) in 27 (38.6%), Steroid in 45 (64.3%), Infliximab in 2 (2.9%), see table 8.

The aim of our study is to determine the epidemiologic profile and clinical features of Jordanian patients with IBD. Most previous reports from Jordan have discussed an increasing rate of UC and rarity of CD [15].  However, in this study, a higher rate of CD was

Observed among the 64 patients who referred to the gastroenterology clinic in Amman over a period from 2007 - 2010. In comparison with previous studies, the UC to CD ratio was lower. The ratio of female to male patients was 2.67 in UC and was 0.71 in CD in our study, which showed female gender dominance for IBD that is incongruent with studies in some Asian countries [16-18]. In Western countries, UC tends to be slightly more common in males, whereas CD is marginally more common in females. Differences in

 
Sample sizes and the numbers of patients in each group (UC and CD) possibly account for this inconsistency;

Future studies should employ larger sample sizes. In this study the mean age at onset for UC and CD were relatively similar. The age at onset of IBD was between 20 - 30 years of age, which is consistent with the first peak in western countries. Our study did not show a second peak between the ages of 50 – 70 years, this is most likely due to hesitancy and delay in performing diagnostic endoscopies on older patients by both physicians and patients. Those patients may be labeled by their physicians with other diagnosis like infectious colitis, hemorrhoids, or anal fissures. 

It was found that 22.7% of UC and 6.3 % of CD patients had positive family histories of IBD. This proportion for UC was higher than reports from some Western countries and Asia. Reports from various countries in this regard are inconsistent; therefore more genetic studies are required to reveal a definite familial tendency in IBD. There was a predominance of left-sided colitis in this study. These findings are in agreement with previous reports from studies; however, pancolitis was much less frequent. Pancolitis was more frequent in patients who developed UC at a younger age. This finding agreed with the results of a study by Wiercinska-Drapalo et al. [19].  Colon involvement in CD patients was more frequent in the current study, which confirmed the results of a study by Aghazadeh et al. [20], however this was in contrast to results from other studies [21]. In accordance with several reports, 75.7% of patients had Asacol (mesalazine) prescribed, whereas approximately 33.0% took Imuran [azathioprine] and 64.3% received steroids.

Among extra-intestinal manifestations, oral ulcers and spondyloarthropathy were predominant in both UC and CD patients in our study which contrasted with previous reports [22]. Primary sclerosing cholangitis was the main extra-intestinal complication in a study by Yazdanbod etal. study [23].  In support of other reports, the predominant clinical presentation in our patients was abdominal pain. Other frequent symptoms among UC patients were rectal bleeding and diarrhea. Diarrhea and weight loss were common problems in patients with CD.

This paper demonstrated the similarities and differences of demographic and clinical characteristics of IBD patients in Jordan compared to studies conducted in other countries. The limitations of the current study included a limited number of patients with UC. In conclusion, the occurrence of CD was much higher than UC. The age of onset for IBD was mostly before 40 years, with a predominance of female patients. The most common clinical form of UC was left-sided colitis and colon involvement in patients with CD. Mostly, the pattern of IBD was mild to moderate, with fewer patients who underwent surgery. We believe that we are only reporting the tip of the iceberg and the actual disease characteristics are yet to be explored. The variety of disease appearance has altered over the years requiring more attentiveness by primary care physicians and gastroenterologists to better diagnose IBD. A campaign is needed to inform the public about this increasing worldwide problem across all age groups specifically with modern dietary changes of our food.

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