Crohn's & colitis 360 · 2026
Clinical characterization and healthcare burden of difficult-to-treat inflammatory bowel disease in Latin America: a real-world registry-based study.
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Yamamoto-Furusho Jesus K, Fróes Renata, Flores Cristina, Balderramo Domingo, Lasa Juan Sebastian, Gomes Tárcia Nogueira Ferreira, Martínez Sócrates Bautista, Veitia Guillermo, Iade-Vergara Beatriz, Nathaly Parra-Holguín Norma, Ferreira Amanda Yaeza, Fernandes Milene, Vicente Vera, Juliao-Baños Fabian
Аннотация
BACKGROUND: Inflammatory bowel disease (IBD) is increasing across Latin America (LATAM). We aimed to determine the frequency and characteristics of difficult-to-treat IBD (DTT-IBD) in this region, using international consensus criteria.
METHODS: A retrospective study using data from IBD registries across 11 LATAM countries: the EPILATAM-IBD study (9 countries), the Brazilian national IBD registry, and 2 Argentinian single-center registries. Adults with ulcerative colitis (UC), Crohn's disease (CD), or unclassified IBD were included. DTT-IBD was defined as meeting at least one of the following criteria: failure of ≥2 advanced mechanisms of action, chronic antibiotic-refractory pouchitis, CD recurrence after ≥2 resections, or complex perianal CD. Comparisons between DTT and non-DTT groups were performed using Mann-Whitney and Chi-square/Fisher exact tests (P < .05).
RESULTS: Among 5699 patients with complete data [40% CD, median disease duration 9 years (Q1-Q3: 5-15)], 747 (13%) met DTT-IBD criteria. DTT prevalence was higher with CD (30%) than among patients with UC (2%). Complex perianal disease predominated in DTT-CD (91%), whereas failure of ≥2 advanced mechanisms of action predominated in DTT-UC (93%). Compared to non-DTT patients, those with DTT-IBD were younger at symptom onset [median age 24 (19-34) years] and IBD diagnosis [26 (21-37) years], and had longer time to diagnosis (P-value<.001). DTT-CD was associated with penetrating behavior (39%) and ileocolonic disease (46%); DTT-UC with extensive colitis (83%).
CONCLUSIONS: DTT-IBD affected 13% of patients treated in LATAM, with nearly one-third of individuals with CD presenting more severe phenotypic features. These findings highlight the need for comprehensive IBD care strategies in this complex patient population.
METHODS: A retrospective study using data from IBD registries across 11 LATAM countries: the EPILATAM-IBD study (9 countries), the Brazilian national IBD registry, and 2 Argentinian single-center registries. Adults with ulcerative colitis (UC), Crohn's disease (CD), or unclassified IBD were included. DTT-IBD was defined as meeting at least one of the following criteria: failure of ≥2 advanced mechanisms of action, chronic antibiotic-refractory pouchitis, CD recurrence after ≥2 resections, or complex perianal CD. Comparisons between DTT and non-DTT groups were performed using Mann-Whitney and Chi-square/Fisher exact tests (P < .05).
RESULTS: Among 5699 patients with complete data [40% CD, median disease duration 9 years (Q1-Q3: 5-15)], 747 (13%) met DTT-IBD criteria. DTT prevalence was higher with CD (30%) than among patients with UC (2%). Complex perianal disease predominated in DTT-CD (91%), whereas failure of ≥2 advanced mechanisms of action predominated in DTT-UC (93%). Compared to non-DTT patients, those with DTT-IBD were younger at symptom onset [median age 24 (19-34) years] and IBD diagnosis [26 (21-37) years], and had longer time to diagnosis (P-value<.001). DTT-CD was associated with penetrating behavior (39%) and ileocolonic disease (46%); DTT-UC with extensive colitis (83%).
CONCLUSIONS: DTT-IBD affected 13% of patients treated in LATAM, with nearly one-third of individuals with CD presenting more severe phenotypic features. These findings highlight the need for comprehensive IBD care strategies in this complex patient population.