Oriana M. Damas

Phenotypic Manifestations of Inflammatory Bowel Disease Differ Between Hispanics and Non-Hispanic Whites: Results of a Large Cohort Study

OBJECTIVES:Hispanics are the fastest growing minority in the United States, yet few studies have examined the phenotypes of inflammatory bowel disease (IBD) in this population. No studies compare IBD presentation between foreign and US-born Hispanics. Our aim was to compare phenotypic characteristics of IBD between Hispanics and non-Hispanic Whites (NHWs), as well as between US-born and foreign-born Hispanics.METHODS:We retrospectively identified cohorts of adult IBD patients from 1998 to 2009 and compared ethnic variation in phenotype, including disease type (Crohns disease or ulcerative colitis (UC)), extra-intestinal manifestations (EIMs), Montreal classification, surgeries, hospitalizations, and medication prescription.RESULTS:A total of 325 patients were included; 208 were Hispanics. Foreign-born Hispanics, accounting for 68% of the total, were diagnosed at an older age than US-born Hispanics and NHWs (45 vs. 25 and 27, respectively, P<0.05). Foreign-born Hispanics manifested more UC than US-born Hispanics or NHWs (59.9% vs. 41% and 28.2%, respectively, P<0.05). No difference was noted in the prevalence of EIMs between Hispanics and NHWs. More upper gastrointestinal tract Crohns was observed in NHWs (12.5% vs. 3.9%, P<0.05). The incidence density rate of IBD-related surgeries in NHWs was higher than in Hispanics (22.9 vs. 7.3 surgeries/100 person-years, P<0.01, hazard ratio: 0.3, 95% confidence interval: 0.14–0.5). Hispanic patients had fewer prescriptions for biologics and immunomodulators than NHWs (22.2% vs. 55.6%, P<0.01 and 35.7% vs. 53.8%, P<0.01, respectively).CONCLUSIONS:This study demonstrates differences in IBD presentation among NHW, US-born Hispanic, and foreign-born Hispanic groups. Further investigation to identify environmental and genetic differences between ethnic groups affected by IBD is warranted.

Treating Inflammatory Bowel Disease in Pregnancy: The Issues We Face Today.

Many women of childbearing age are living with inflammatory bowel disease [IBD], yet there are limited studies on the use of IBD medications in pregnancy. In this review, we provide a comprehensive update on the safety of these medications during pregnancy, particularly thiopurines and biologicals. Antibiotics, steroids, and aminosalicylates are relatively low risk for use in pregnancy, and growing evidence supports the safety of immunomodulators and anti-tumour necrosis factor agents as well. Available studies on infliximab, adalimumab, and certolizumab pegol show no increase in adverse events during pregnancy or perinatally. Similarly, studies on lactation demonstrate that concentrations of subcutaneous anti-tumour necrosis factor biologicals are undetectable, and levels of thiopurines and infliximab are negligible in breast milk. Less is known about anti-integrins in pregnancy [eg natalizumab and vedolizumab] but currently available data suggest they may be safe as well. Although more studies are needed to examine the long-term effects of these medications on offspring, the available data provide reassuring information for providers caring for women of childbearing age.

Inflammatory bowel disease is presenting sooner after immigration in more recent US immigrants from Cuba

Despite a rising incidence of inflammatory bowel disease (IBD) in Hispanics in the United States, there are no studies examining the relationship between immigrant generation and IBD onset among Hispanics.

Hispanic Americans and Non-Hispanic White Americans Have a Similar Inflammatory Bowel Disease Phenotype: A Systematic Review with Meta-Analysis

BackgroundInflammatory bowel disease (IBD) is a devastating immune-mediated disease on the rise in Hispanics living in the USA. Prior observational studies comparing IBD characteristics between Hispanics and non-Hispanic whites (NHW) have yielded mixed results.AimsWe performed a meta-analysis of observational studies examining IBD phenotype in Hispanics compared to NHW.MethodsWe conducted a systematic search of US-based studies comparing IBD subtype (Ulcerative Colitis: UC or Crohn’s disease: CD) and phenotype (disease location and behavior) between Hispanics and NHW. We evaluated differences in age at IBD diagnosis, the presence of family history and smoking history. A random effects model was chosen “a priori.” Categorical and continuous variables were analyzed using odds ratio (OR) or standard mean difference (SMD), respectively.ResultsSeven studies were included with 687 Hispanics and 1586 NHW. UC was more common in Hispanics compared to NHW (OR 2.07, CI 1.13–3.79, p = 0.02). Location of disease was similar between Hispanics and NHW except for the presence of upper gastrointestinal CD, which was less common in Hispanics (OR 0.58, CI 0.32–1.06, p = 0.07). Hispanics were less likely to smoke (OR 0.48, CI 0.26–0.89, p = 0.02) or have a family history of IBD (OR 0.35, CI 0.22–0.55, p < 0.001). CD behavior classified by Montreal classification and age at IBD diagnosis were similar between Hispanics and NHW.ConclusionUC was more common among US Hispanics compared to NHW. Age at IBD diagnosis is similar for both Hispanics and NHW. For CD, disease behavior is similar, but Hispanics show a trend for less upper gastrointestinal involvement. A family history of IBD and smoking history were less common in Hispanics.

Genetic Characterization and Influence on Inflammatory Bowel Disease Expression in a Diverse Hispanic South Florida Cohort

OBJECTIVES: Hispanics represent an understudied inflammatory bowel disease (IBD) population. Prior studies examining genetic predisposition to IBD in Hispanics are limited. In this study, we examined whether European‐derived IBD variants confer risk in Hispanics and their influence on IBD phenotype in Hispanics compared to non‐Hispanic whites (NHW). METHODS: Self‐identified Hispanics and NHWs with IBD were included. Hispanic controls were included for our genetic analyses. We performed single‐variant testing at previously identified Crohns disease (CD) and ulcerative colitis (UC) IBD variants in Hispanic cases and controls. These risk variants were used to compute individual genetic risk scores. Genetic risk scores and phenotype associations were compared between Hispanic and NHW. RESULTS: A total of 1,115 participants were included: 698 controls and 417 IBD patients (230 Hispanics). We found evidence of association within our Hispanic cohort at 22 IBD risk loci, with ˜76% of the risk loci demonstrating over‐representation of the European risk allele; these included loci corresponding to IL23R and NOD2 genes. CD genetic risk score for Hispanics (199.67) was similar to the score for NHW (200.33), P=0.51; the same was true in UC. Genetic risk scores did not predict IBD phenotype or complications in Hispanics or NHW except for a younger age of CD onset in Hispanics (P=0.04). CONCLUSIONS: This study highlights the fundamental importance of these loci in IBD pathogenesis including in our diverse Hispanic population. Future studies looking at non‐genetic mechanisms of disease are needed to explain differences in age of presentation and phenotype between Hispanics and NHW.

Hispanics Coming to the US Adopt US Cultural Behaviors and Eat Less Healthy: Implications for Development of Inflammatory Bowel Disease

IntroductionThe incidence of inflammatory bowel disease (IBD) among US Hispanics is rising. Adoption of an American diet and/or US acculturation may help explain this rise.AimsTo measure changes in diet occurring with immigration to the USA in IBD patients and controls, and to compare US acculturation between Hispanics with versus without IBD. Last, we examine the current diet of Hispanics with IBD compared to the diet of Hispanic controls.MethodsThis was a cross-sectional study of Hispanic immigrants with and without IBD. Participants were recruited from a university-based GI clinic. All participants completed an abbreviated version of the Stephenson Multi-Group Acculturation Scale and a 24-h diet recall (the ASA-24). Diet quality was calculated using the Healthy Eating Index (HEI-2010).ResultsWe included 58 participants: 29 controls and 29 IBD patients. Most participants were Cuban or Colombian. Most participants, particularly those with IBD, reported changing their diet after immigration (72% of IBD and 57% of controls). IBD participants and controls scored similarly on US and Hispanic acculturation measures. IBD patients and controls scored equally poorly on the HEI-2010, although they differed on specific measures of poor intake. IBD patients reported a higher intake of refined grains and lower consumption of fruits, whereas controls reported higher intake of empty calories (derived from fat and alcohol).ConclusionThe majority of Hispanics change their diet upon immigration to the USA and eat poorly irrespective of the presence of IBD. Future studies should examine gene–diet interactions to better understand underlying causes of IBD in Hispanics.

Letter: Cuban immigrants to the US developing IBD have a progressive shortening of the lag between time of arrival and disease onset. Authors’ reply

SIRS, We read with great interest the report by Damas et al. on the onset of inflammatory bowel disease (IBD) in Cuban immigrants to the US. Unfortunately, the most exciting finding in the paper—the shortening of the time lag to disease onset in recent immigrants—eluded the Authors’ efforts to identify a viable cause, despite scrutiny for obvious factors such as diet and life habits. We noticed that the Authors did not examine a possible impact of psychological distress on these immigrants, despite the fact that this is a frequently analyzed variable in IBD epidemiology. In our opinion, the relevant question may be: have perceptions of an unsafe society increased in the recent US history, such as to affect the anxiety level of recent immigrants? A positive answer might be plausible given the increased rates of violent death, perhaps related to problems with mental health care. It can be postulated that people born and grown in a relatively secluded environment such as Cuba might have experienced a strongly reduced resilience to the accelerated pace at which American society has changed, not always for the best.

Editorial: migration studies to determine risk and cause of inflammatory bowel disease—authors’ reply

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