P1260 Demographics and Clinical Characteristics of Inflammatory Bowel Disease in the Middle East and North Africa : A Multi-Nation Cross-sectional (MIRAGE) Study
Authors: Shehab M , Azzam N , Al-Bawardy B , Abid S , Bashandi A , AlShihri R , Mukhtar M , Saadah O , Alharbi O , Al-Darmaki A , Al Harthi S , Al-Ejji K , Ayash A , Al sahli A , Khamees N , Salem O E , Mohamed E A , Maher M , Daba G , Helal A , Alnassar M , Alfadhli A , Mosli M 
Published: January 2025

Abstract

Background
Although inflammatory bowel disease (IBD) is more prevalent in Western countries, its incidence and prevalence have risen markedly in Asia and the Middle East [1,2]. Data on IBD patients from the Middle East and North Africa (MENA) region remain limited. This study aims to evaluate the demographic, clinical, and treatment patterns of IBD patients in the MENA region through the Middle East and North Africa IBD Research and Geographic Epidemiology (MIRAGE) study.

Methods
A cross-sectional, multi-national study was conducted at 10 IBD centers across six countries in the MENA region from January 1, 2022, to July 1, 2024. The primary objective was to assess IBD demographics, prevalence, and subtypes according to the Montreal classification. The secondary objective was to evaluate current IBD treatment strategies in the region. Categorical variable differences were analyzed using the Chi-squared test or Fisher’s exact test as appropriate.

Results
A total of 5,540 patients with inflammatory bowel disease (IBD) were included in the study. Of these, 2,824 (50.9%) were diagnosed with ulcerative colitis (UC), 2,602 (46.9%) with Crohn’s disease (CD), and 114 (2.0%) with IBD unclassified (IBD-U). In terms of gender distribution, 2,663 (48.1%) were male, and 2,877 (51.9%) were female. A total of 481 patients (8.7%) reported being smokers. Among the UC patients, disease extent was categorized as follows: 517 (18.3%) had E1 (proctitis), 1,123 (39.8%) had E2 (left-sided colitis), and 1,190 (42.1%) had E3 (pancolitis). For CD patients, disease location was distributed as: L1 (ileal) in 784 patients (30.13%), L2 (colonic) in 287 patients (11.02%), and L3 (ileocolonic) in 1,210 patients (46.50%). Disease behavior among CD patients included B1 (non-stricturing, non-penetrating) in 1,324 patients (50.9%), B2 (stricturing) in 693 patients (26.6%), and B3 (penetrating) in 647 patients (24.9%). Perianal disease was present in 708 CD patients (27.2%). Across the entire IBD cohort, 1,018 patients (18.38%) had undergone prior IBD-related surgeries, and 1,960 patients (35.38%) had experience with biologic therapies. (Table 1). The highest CD-to-UC ratio was observed in the Kingdom of Saudi Arabia (63% CD/35% UC), while the lowest ratio was seen in Oman (18% CD/80% UC) (Figure 1).

Conclusion
This study offers valuable insights into the demographic characteristics, clinical profiles, and treatment approaches for IBD patients in the MENA region, highlighting the rising prevalence of IBD in the region and the increasing utilization of advanced therapies.

References
1.Hammer T, Langholz E. The epidemiology of inflammatory bowel disease: balance between East and West? A narrative review. Digestive Medicine Research. 2020 Dec 30;3.
2.Adam H, Alqassas M, Saadah OI, Mosli M. Extraintestinal manifestations of inflammatory bowel disease in middle eastern patients. Journal of Epidemiology and Global Health. 2020 Dec;10(4):298-303.