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Master Thesis

Épidémiologie des MICI en Guadeloupe : étude rétrospective descriptive de 2007 à 2019

Abstract : Context: IBDs have long been considered as diseases specific to the population living in the Northern Hemisphere. However, this North-South gradient tends to disappear with the increase in their incidence and the extension of their distribution worldwide. No recent data are available for the Guadeloupean population, whose lifestyle has changed considerably in recent years. Objective: The aim of our study is to demonstrate the existence of a similar evolution of IBDs in Guadeloupe compared to the global trend and to analyze the epidemiological characteristics of this population. Method: First, we have collected from the General Social Security Fund of the Health Insurance of Guadeloupe (CGSS) the new attestations of long-term affections (ALD) prescribed for an IBD from 2007 to 2019 and all the ALD in progress on 31st of 2019. Secondly, we conducted a retrospective descriptive monocentric study from the 1st of January 1 2007 to the 31st of December 2019, including all patients hospitalized for suspected or diagnosed IBD in the hepato-gastroenterology department of the CHU of Pointe-à-Pitre. Results: There were 476 new ALDs delivered for IBD between 2007 and 2019, including 184 patients with Crohn's disease (CD) and 244 patients with ulcerative colitis (UC). The rate of new ALDs delivered confirms an increase in the number of IBDs, with a maximum rate of 5.6/105 hab for CD and 8.1/105 hab for UC. There were a total of 506 ALDs, old or new, in progress on the 31st of December 2019, which makes it possible to estimate by extrapolation a prevalence of IBDs of approximately 159/105 per inhabitant. We included 134 patients hospitalized in the hepato-gastroenterology department: 75 MC and 59 UC. The median age at diagnosis was 25.5 years old [9-66] for CD and 36.5 years old [9-89] for UC (p=0.001). Sex ratio F/H was 1.42 and 0.84 respectively. In CD, the early forms (median age at diagnosis <40 years) are more extensive, with ileocolic localization (p=0.03), and more associated with the prescription of anti-TNFα (p=0.0003). There are more smokers than in the general population with no aggravating effect on evolution. There is no significant association between the early form and family history (p= 0.62) or extra-digestive disease (p= 0.27). In UC, the localization is mainly pancolic with no difference according to the median diagnostic age (p= 1). There is no protective effect of smoking or appendectomy which is paradoxically associated with more pancolic forms (p= 0.015). The presence of a family history of UC (p= 0.04) or extra-digestive disease are risk factors for early UC (p= 0.02). In the comparative study of CD and UC, there is more use of anti-TNFα (p=0.0003) or surgery in CD (p=0.02). There is no significant difference in the occurrence of cancer (p=0.08), death (p=0.44) or co-morbidities (p=0.08). Our population includes 96 patients (75%) of Afro-Caribbean origin, 25 of Caucasian origin (19%), 8 of Indian origin (6%), with no significant difference in characteristics between each group. Conclusion: We confirm the increase in the number of IBDs in Guadeloupe, whose incidence rates seem to be similar to those in France. The characteristics of our population show notable differences in comparison with patients living in France, but similarities with patients living in the Caribbean. Therefore this study tends to demonstrate that the evolution of IBD is not related to the origin of the ancestors but to the lifestyle and environment. A prospective study integrating a national cohort would be necessary to refine the epidemiological characteristics of IBD in Guadeloupe.
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https://dumas.ccsd.cnrs.fr/dumas-03350884
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Submitted on : Tuesday, September 21, 2021 - 4:31:55 PM
Last modification on : Wednesday, February 16, 2022 - 4:04:47 PM

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Claire Thomas. Épidémiologie des MICI en Guadeloupe : étude rétrospective descriptive de 2007 à 2019. Hépatologie et Gastroentérologie. 2020. ⟨dumas-03350884⟩

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