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Epidemiology of Inflammatory Bowel Diseases , Where are the Iranian Cases ?


1 Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
*Corresponding author: Homayoon Vahedi, Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran, Tel.: +98-9121094160, Fax: +98-2182415400, E-mail: vahedi@ams.ac.ir.
Annals of Colorectal Research. 2013 September; 1(2): 74. , DOI: 10.17795/acr-11900
Article Type: Letter; Received: May 2, 2013; Revised: Jun 1, 2013; Accepted: Jun 17, 2013; epub: Jul 30, 2013; ppub: Sep 29, 2013

Keywords: Ulcerative colitis; Cohn's disease; inflammatory bowel disease; Iran

Dear Editor,

We have read with interest the paper “Epidemiology of Inflammatory Bowel Diseases (IBD) in Iran”(1) by Dr. Taghavi’ AR et al. and would like to make few comments on this study. According to the first published article from Fars province (Shiraz), 44 years ago the authors claimed that there was no IBD in Iran (2). The first two reports of IBD in Iran which were designed to look for all cases of IBD [both ulcerative colitis (UC) and Crohn’s disease (CD)] were published 28 years ago from Tehran and 27 years ago from Shiraz. In both surveys the authors could only find UC and they both confirmed that they did not find even a single case of CD (3, 4). The first CD case was reported 13 years ago and now CD incidence is increasing and its incidence is close to the incidence of UC (5, 6). This epidemiological pattern is similar to what reported in western countries during the first two decades after the emerge of IBD in Western world where the UC detected first, then the CD emerged 15–20 years later and today CD is almost as common as UC. The most important causes of increasing prevalence of IBD are life style changes, better hygiene, vaccination and cold chain theory rather than availability of diagnostic tools (7).

The clinical presentation of CD in Iran are in consistent with the classic presentation of the disease in western countries (3-5). The age-specific incidence curve is in agreement with many other epidemiological data (5). The percentages of extra intestinal complications are quite similar to western reports (8, 9). We have also shown that current smoking was a significant protective factor in UC, while prolonged use of OCP, appendectomy and tonsillectomy were the risk factors for CD (10) . These observations suggest that CD clinical features in Iran are similar to those previously reported in other countries. The burden of IBD in Iran and all other low and middle income countries is a great given of lifelong disease with expensive therapy which are available for the treatment these patients (11).

Acknowledgments

There is no acknowledgement.

Footnotes

Authors’ Contribution: Fatemeh Malekzadeh prepared the first draft and Homayoon Vahedi edited and confirmed the final version.
Financial Disclosure: The authors declare that there is no conflict of interest.

References


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