Epidemiology of inflammatory bowel disease in the Middle East and North Africa: a multinational, tertiary care registry (MIRAGE) study.

Abstract

Background and aims: Inflammatory bowel disease (IBD) is increasing in the Middle East and North Africa (MENA), yet region-specific evidence on phenotype and treatment patterns remains limited. We aimed to characterize IBD epidemiology, clinical phenotypes, and therapy use across MENA centers.

Methods: This was a multicenter cross-sectional study across 13 centers in seven MENA countries. Adults with ulcerative colitis (UC), Crohn's disease (CD), or IBD-unclassified (IBD-U) were included. Demographics, Montreal phenotype/behavior, smoking status, disease duration, perianal disease, and therapies were collected. Descriptive statistics and between-group comparisons were performed.

Results: We analyzed 10 340 patients (52% UC, 45% CD, 3% IBD-U). Mean age was 39.79 ± 14.4 years in UC and 34.57 ± 12.9 years in CD (P < .0001). UC patients were slightly more often female (51.6%), while CD patients were male-predominant (59.0%). Current smoking was more common in CD than in UC (12.0% vs 5.6%). Mean disease duration was 9.73 ± 7.5 years, longest in Jordan (14.1 years) and shortest in Qatar (2.45 years; P < .001). Biologic exposure differed by subtype (P < .001), with the highest rate in CD (57.9%). In UC, extensive colitis (E3) was the most common phenotype. In CD, ileocolonic involvement (L3) predominated with mainly non-stricturing, non-penetrating behavior (B1). Perianal disease affected approximately 13% overall, with rates varying by country, highest in UAE and lowest in Egypt and Qatar.

Conclusion: This multi-country hospital-based registry study helps define contemporary IBD patterns in MENA: slight UC predominance, high rates of extensive UC and ileocolonic B1 CD, and heterogeneous biologic use. Our data provide insights into regional IBD epidemiological trends and treatment adoption.