Phenotypic Differences and Clinical Outcomes of South Asian Children With IBD: A Singapore-Malaysia Study From the Asian PIBD Registry Network

James Guoxian Huang; Kee Seang Chew; Veena Logarajah; Way Seah Lee; Marion Margaret Aw

doi:10.1111/jgh.17020

Phenotypic Differences and Clinical Outcomes of South Asian Children With IBD: A Singapore-Malaysia Study From the Asian PIBD Registry Network

J Gastroenterol Hepatol. 2025 May 27. doi: 10.1111/jgh.17020. Online ahead of print.

Authors

James Guoxian Huang^{1

2}, Kee Seang Chew³, Veena Logarajah⁴, Way Seah Lee^{3

5}, Marion Margaret Aw^{1

2}

Affiliations

¹ Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
² Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore.
³ Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
⁴ Gastroenterology, Hepatology and Nutrition Service, Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore.
⁵ Tunku Abdul Rahman University, Kampar, Perak, Malaysia.

PMID: 40421670
DOI: 10.1111/jgh.17020

Abstract

Background and aim: Existing literature largely contrasts pediatric inflammatory bowel disease (PIBD) phenotypic differences and outcomes of South Asians (SAs) with Caucasians. No published comparative data exist between SAs and non-SAs within Asia-Pacific. We aim to validate these comparisons within Asia-Pacific, comparing SAs ("Indian," "Bangladeshi," "Nepali," "Pakistani," "Sri Lankan (Sinhalese/Tamil)," and "Maldivian") with their non-SA ("Chinese," "Malay," "Eurasian", or "Others") counterparts in the multiethnic populations of Singapore and Malaysia.

Methods: Clinical data from three centers in Singapore and Malaysia were compared, at baseline, 1-year (1YFU) and 5-year (5YFU) post-diagnosis, between SAs and non-SAs.

Results: Baseline, 1YFU, and 5YFU data were analyzed in 366, 260 (71.0%), and 127 (34.7%) patients, respectively. Compared with non-SAs, SAs were significantly older (10.2 vs. 9.1 years, p = 0.013), had less very early-onset disease (15.5% vs. 33.0%, p = 0.001), a shorter time from symptom onset to diagnosis (5.9 vs. 8.9 months, p = 0.024), less growth retardation (5.9% vs. 14.0%, p = 0.035), and less comorbid liver diseases (1.4% vs. 9.4%, p = 0.002). SAs with Crohn's disease had more symptomatic perianal disease (18.3% vs. 9.4%, p = 0.016) and less isolated ileal L1 disease (10.2% vs. 20.7%, p = 0.057). No significant differences in induction therapies, maintenance immunosuppression or remission rates at 1YFU were noted, but at 5YFU, SAs had significantly lower rates of clinical remission (SA = 68.3% vs. non-SA = 84.9%, p = 0.036), steroid-free remission (SA = 53.7% vs. non-SA = 73.3%, p = 0.043), and mucosal healing (calprotectin < 300 ug/g, 0.0% vs. 80.0%, p = 0.048).

Conclusions: We report unique phenotypic differences in SA and non-SA children with IBD. SAs had poorer long-term clinical outcomes, although short-term outcomes and therapy usage patterns were comparable.

Keywords: South Asian; children; ethnicity; inflammatory bowel disease; pediatric.