Inflammatory Bowel Disease in Latin America: A Systematic Review

Abstract

Background: Inflammatory bowel disease (IBD) is the name given to two inflammatory diseases of the colon and/or small intestine: Crohn disease (CD) and ulcerative colitis (UC). There is no information summarizing the complete body of evidence about IBD in developing regions, including Latin America. Objectives: To estimate the burden of IBD in Latin America. Methods: We conducted a systematic review searching published and unpublished studies on major international and regional databases from January 2000 to September 2015. Outcomes considered were incidence, prevalence, mortality, hospitalization attributable, treatment patterns, comparative effectiveness, patient-reported outcomes, and adherence to treatment. Pairs of reviewers independently selected, extracted, and assessed the risk of bias of the studies. Discrepancies were solved by consensus. Results: We retrieved 3445 references, finally including 25 studies. Only 19% of the observational studies had a low risk of bias for participant selection and 60% were based on registries. The incidence ranged from 0.74 to 6.76/100,000 person-years for UC and from 0.24 to 3.5/100,000 person-years for CD. The prevalence rate ranged from 0.99 to 44.3/100,000 inhabitants for UC and 0.24 to 16.7/100,000 inhabitants for CD. Mortality rates ranged from 0.60 to 1.02 for UC and from 0.23 to 0.40 for CD. Patient-reported outcomes showed a decrease in quality of life associated with depression and anxiety and correlated with the time of diagnosis. The most frequently used medication in the studies was mesalazine. Conclusions: The burden of IBD in Latin America seems to be important, but there is a considerable gap of high-quality evidence in the region.