Sze Zee L1, Kee Huat C1, Ruveena B1, Stanley K1, Shahreedhan S1, Wah Kheong C1, Shiaw Hooi H1, Rosmawati M1, Ida H1, Khean Lee G1, Sanjiv M1
1Gastroenterology and Hepatology Unit, Department of Medicine, University of Malaya
Background/Aims: The spectrum of gastrointestinal (GI) and liver diseases are recognised to have a geographical variation, which may be due to environmental or genetic differences. We aimed to explore this further in a specialist clinic serving a multi-ethnic Asian urban population.
Methods: A retrospective analysis of outpatient data from this institutions’ electronic medical records was conducted from January to June 2019. Clinical diagnoses of GI and liver diseases, and associated demographic information were collected.
Results: Data from 3832 adult patients (mean age 59 ± 16 years, female 51.5 %, Chinese ethnicity 53.3%) were available for analysis. The frequency of luminal GI, liver and pancreato-biliary diseases were 37.0%, 60.5% and 2.5% respectively. Amongst luminal GI diseases, 43.8% were functional gastrointestinal disorder (FGID) and 56.2% had an organic cause – with gastro-esophageal reflux disease (GERD) (46.4%), inflammatory bowel disease (IBD) (30.9%) and GI malignancy (7.4%) being the most common. A greater proportion of ethnic Indians was seen for IBD than non-IBD condition (42.6% vs 30.0%, P<0.001), but no ethnic predilection was seen for other luminal GI diseases. Amongst liver diseases, the most common aetiologies were Hepatitis B (44.4%) and non-alcoholic fatty liver disease (NAFLD) (39.3%). Cirrhosis and/or hepatocellular carcinoma (HCC) were present in 18% of liver diseases, with NAFLD as the most frequent aetiology. A greater proportion of ethnic Indians was seen for NAFLD-associated cirrhosis/ HCC than non-cirrhosis/ HCC NAFLD (24.6% vs 16.9%, p=0.008), whilst a greater proportion of ethnic Chinese had HBV-associated cirrhosis/ HCC compared with non-cirrhosis/ HCC HBV (87.7% vs 76.4% non-cirrhosis/HCC, p=0.008).
Conclusion: An ethnic predilection for GI and liver diseases within the same geographical region is evident. Genetic and cultural factors are possible causes for this epidemiological observation.
Keywords: Epidemiology, Ethnicity, Asia, Gastrointestinal disease, Chronic Liver Disease