During the twentieth century, inflammatory bowel disease (IBD) was considered a disease of early industrialized regions in North America, Europe and Oceania¹. At the turn of the twenty-first century, IBD incidence increased in newly industrialized and emerging regions in Africa, Asia and Latin America, while the prevalence in early industrialized regions continued to grow steadily^2,3,4. Changes in the incidence and prevalence denote the evolution of IBD across four epidemiologic stages: stage 1 (emergence), characterized by low incidence and prevalence; stage 2 (acceleration in incidence), marked by rapidly rising incidence and low prevalence; and stage 3 (compounding prevalence), where the incidence decelerates, plateaus or declines while the prevalence steadily increases. A fourth stage (prevalence equilibrium) has been proposed in which the prevalence slope plateaus due to demographic shifts in an ageing IBD population, but it has not yet been evidenced. To date, these stages have remained theoretical, lacking specific numerical indicators to define transition points. Here, using real-world data from 522 population-based studies encompassing 82 global regions and spanning more than a century (1920–2024), we show spatiotemporal transitions across stages 1–3 and model stage 4 progression. Understanding the evolution of IBD across epidemiologic stages enables healthcare systems to better anticipate the future worldwide burden of IBD.

Background/Aims: There has been a paucity of published data on the epidemiology of inflammatory bowel disease (IBD) in Central Asia and Kazakhstan. Therefore, we aimed to study IBD prevalence and patient awareness among adults in Kazakhstan. Methods: The cross-sectional study was carried out among subjects of both sexes aged 18 years and older using IBD Alert Questionnaire (CalproQuest), single fecal calprotectin test, and endoscopy with biopsy to verify IBD from January to December 2017, across regions of Kazakhstan. All participants were included in the study after providing informed consent.Results: Out of 115,556 subjects, there were 128 confirmed IBD cases, in which 36 Crohn’s disease (CD) and 92 ulcerative colitis (UC) cases identified. The age and sex-adjusted IBD prevalence were 113.9 (95% confidence interval [CI], 69.0–158.9) per 100,000 population. The age- and sex-adjusted prevalence for UC were 84.4 (95% CI, 44.8–123.9) and for CD were 29.5 (95% CI, 8.2–50.9) per 100,000 population.Conclusions: This is the first report on the prevalence of IBD with a verified diagnosis in the Central Asia and could be used to better plan and allocate healthcare resources for IBD management program.

Background: The analysis of data obtained from real world clinical practice of management of patients with inflammatory bowel diseases (IBD) is an effective tool to improve medical care for this patient category. Studies of the kind are rare in Russia, which hinders a critical assessment of the current situation and optimization of the established approaches.Aim: To study real world practice of medical treatment of patients with moderate and severe IBD in the Russian Federation, Republic of Belarus and Republic of Kazakhstan.Materials and methods: We analyzed intermediate results from the INTENT study (NCT03532932), which is a multinational, multicenter, retrospective and prospective, non-interventional observation trial being performed in the Russian Federation, Republic of Belarus and Republic of Kazakhstan. The retrospective analysis included data from 706 patients above 18 years of age with confirmed diagnosis of moderate/severe ulcerative colitis (UC) and Crohn's disease (CD) made at least 2 years before the study entry, with acute exacerbations of the disease at the study entry or within the last 2 years. Data were collected during routine management; at the study entry the patients were treated with a standard regimen including 5-aminosalicylic acid (5-ASA) agents, glucocorticosteroids (GCS) and immunosuppressants (IS), as well as genetically engineered biological agents (GEBA).Results: Among 706 IBD patients, 465 had UC and 241 had CD. The male to female ratios in both groups were similar. Mean age of the UC patients was higher than that of the CD patients (41.8 [95% confidence interval (CI) 40.6–43.0] years vs 35.6 [95% CI 33.9–37.3] years, p = 0.0001). The same difference was noted for the mean age of disease manifestation (34.5 [95% CI 33.29–35.61] vs 29.7 [95% CI 28.03–31.3] years, p = 0.0001) and for mean duration of disease from the time of diagnosis to the study entry (7.3 [95% CI 6.77–7.9] for UC and 5.9 [95% CI 5.3–6.59] years for CD, p = 0.0027). The proportion of patients with familial history of IBD was low (3.2 and 0.8%, respectively, p = 0.0672). The number of smokers with CD was more than 2-fold higher than those with UC (11.2% vs 5%, p < 0.001). 58.1% of the patients in the UC group and 47.0% of those from the CD group were employed (р < 0.05). 36.6% of the UC patients and 56.0% of the CD patients had the legal disability status due to underlying disease (p < 0.005). The relapsing course of the disease was noted in 72.9% with UC and 60.6% with CD, while in the rest of the patients the disease had the continuous course. The degree of UC involvement corresponded to pancolitis in 58.9% of the cases, to left-sided colitis in 33.1%, and to proctitis in 8%. The distribution of CD location was as follows: ileocolitis 54.8%, terminal ileitis 23.7%, colitis 20.3%, isolated upper gastrointestinal tract involvement 1.2%. The prevalence of complicated UC was 12.9%, and that of the complicated CD 57.4% (р = 0.0001). There were no difference in the rate of extraintestinal manifestations between UC and CD (23.4 and 28.2%, respectively, p = 0.1705). UC and CD groups differed by their treatment patterns. In the UC group, 5-ASA + GCS regimens were given to 25.4% of the patients, whereas in the CD group, to 3.7% (р ≤ 0.0001). The second frequent regimens were: 5-ASA with subsequent IS ± GCS (17.9% in UC, 22.8% in CD, p = 0.1331); standard regimen (any 5-ASA agent, IS or GCS, but not GEBA) with subsequent treatment withdrawal or its reduction to GCS monotherapy (14.8% in UC, 5% in CD, р = 0.0001); 5-ASA with a subsequent combination with IS, then any tumor necrosis factor-α inhibitor (iTNF-α) as the basic treatment with continuation of 5-ASA and/or IS (22% in CD vs 13.5% in UC, р = 0.0052); treatment initiation from iTNF-α combined with any standard agent without any subsequent modification (24.1% in CD and 13.6% in UC, р = 0.0007). Less frequent the following treatment regimens were used: initial treatment with 5-ASA and subsequent iTNF-α with continuation of 5-ASA (4.5% in UC and 2.5% in CD, р = 0.2181); initial treatment with iTNF-α in combination with any standard agent with subsequent GEBA withdrawal and continuation of a standard regimen or its withdrawal (4.3% in UC and 7.5% in CD, р = 0.0812). The cumulative frequency of GEBA administration at various stages of treatment for CD (66.4%) was significantly higher than for UC (39.4%). Vedolizumab for CD was administered more frequently than for UC (10.4 and 3.4%, respectively, p = 0.0003). The analysis of habitual GCS use revealed a number of negative trends, namely, half of the IBD patients received more than 2 GCS courses within 2 years, and in some cases the number of GCS courses amounted to 5–8. Mean duration of a GCS course in most regimens for UC and CD was in the range of 91 to 209 days, which is significantly higher than the recommended treatment duration of 12 weeks (83 days).Conclusion: With a number of its demographic characteristics and clinical particulars, the study cohort of patients with IBD is compatible to global trends: the male to female ratio, mean patients’ age, young age at disease manifestation, smoking status, prevalence of extraintestinal manifestations and the location of CD. It is of note that 5-ASA is included into almost all treatment regimens for CD, which does not meet the treatment strategy recommended in the guidelines. Frequent administration and long duration of GCS therapy also is in contradiction with the guidelines. Of significant concern is rather rare and late administration of GEBA, especially for UC. We believe that the identified pitfalls are associated both with low awareness of doctors on the current strategies of IBD management and with low patients' compliance to treatment.

Background & aims: Kazakhstan has implemented comprehensive programs to reduce the incidence of Hepatitis B and Hepatitis C. This study aims to assess seroprevalence and risk factors for HBsAg and anti-HCV positivity in three large regions of Kazakhstan. Methods: A cross-sectional study was conducted in three regions geographically remote from each other. Participants were randomly selected using a two-stage stratified cluster sampling and were surveyed by a questionnaire based on the WHO STEP survey instrument. Blood samples were collected for HBsAg and anti-HCV testing. Results: A total of 4,620 participants were enrolled. The seroprevalence was 5.5% (95%CI: 3.6%-8.4%) for HBsAg and 5.1% (95%CI: 3.5%-7.5%) for anti-HCV antibodies. Both were more prevalent in the western and northern regions than in the southern. A history of blood transfusion was significantly associated with anti-HCV presence, with odds ratios (ORs) of 2.10 (95%CI: 1.37–3.21) and was borderline associated with HBsAg 1.39 (95%CI: 0.92–2.10), respectively. Having a family member with viral hepatitis was also borderline associated (2.09 (95%CI: 0.97–4.50)) with anti-HCV positivity. Conclusions: This study found a high-intermediate level of endemicity for HBsAg and a high level of endemicity for anti-HCV antibodies in three large regions of Kazakhstan. We found that history of surgery was not associated with HbsAg neither with anti-HCV seropositivity rates. Blood transfusion was associated with anti-HCV seropositivity, however, to investigate effectiveness of the introduced comprehensive preventive measures in health care settings, there is a need to conduct further epidemiological studies.

Background: By analyzing small bowel capsule endoscopy (SBCE) performed in two large hospitals in Kazakhstan, we aimed to explore the characteristics of patients representative of Central Asia and the technical characteristics of SBCE.Methods: SBCE cases were retrospectively analyzed. A descriptive analysis was conducted on the patients’ demographic data, diagnosis, and clinical symptoms. The results of SBCE, such as the lesions found, transit time and retention rate in the stomach and small bowel, and bowel visualization quality, were analyzed. Complications related to SBCE were investigated.Results: SBCE was performed in 123 patients. Abdominal pain (81.3%) and chronic diarrhea (66.7%) were the most common symptoms, followed by weight loss (25.2%) and gastrointestinal bleeding (15.4%). The most common disease was Crohn’s disease (52.0%). Definite lesions, such as ulcers, polyps, and bleeding, were identified in 55.3% of patients. SBCE was successfully completed in all cases except for 11 (9.1%). The average small bowel transit time was 4 hours and 28 minutes. Excellent visualization (>75% of mucosa) was reported in 82.5% of patients. No patients experienced complications.Conclusions: SBCE performed in Kazakhstan showed a high diagnostic yield with high-quality patient selection and no complications.

Introduction. Coronavirus infection is an acute viral disease with a primary lesion of the upper respiratory tract, caused by an RNA-virus of the Betacoronavirus genus of the Coronaviridae family. The course of a viral infection varies from asymptomatic to a wide range of clinical manifestations, including fever, chills, gastrointestinal manifestations, pneumonia, respiratory distress, and death. Ulcerative colitis (UC) and Crohn's disease (CD) are chronic immune-mediated diseases with intestinal and systemic symptoms, which are based on an impairment of the intestinal microbiota and dysregulation of the immune system in genetically predisposed individuals. In the Kazakh population, risk factors also include irregular food intake (p=0.043; OR=3.61 [95% CI: 1.04–12.51]), consumption of fish and seafood (p=0.000; OR= 15.77 [95% CI: 4.56-54.59]), consumption of frozen processed foods (p = 0.018; OR = 4.62 [95% CI: 1.3-16.4]), diet based on meat dishes (p=0.029; OR=3.2 [95% CI: 1.13-9.2]), use of NSAIDs other than aspirin (p=0.031; OR=3.79 [1.13-12.69 ]) and smoking (p=0.008; OR=4.93 [95% CI: 1.52-15.98]). The suppression of the immune response is associated with the risk of infection with viral or bacterial pathogens, including potentially the SARS-CoV-2 virus. On the other hand, SARS-CoV-2 infection as a potential trigger factor for de novo occurrence of inflammatory bowel disease is currently being discussed. The aim of this study was to assess the characteristics of the course of COVID-19 during the treatment of inflammatory bowel diseases (IBD), risk factors and outcomes of COVID-19, as well as the activity of IBD before and after a coronavirus infection. Materials and methods. A longitudinal descriptive study included 158 patients with IBD who applied on an outpatient basis (including via remote consultation) or inpatient with SARS-Cov2 or COVID-19 infection in the academic centers of Almaty (Kazakhstan) n=54 and St. Petersburg (Russia), n= 104. The observation period was from May 2020 to May 2022. The median and interquartile range were used to describe quantitative data (age), and absolute frequencies and percentages were used for qualitative data. The Mann-Whitney U-test was used for intergroup comparison of quantitative data (age), for the remaining indicators, the likelihood ratio test (Likehood ratio test), and in the case of 2X2 tables, Fisher's exact test. Results. There was no association between IBD type/activity or drugs taken and the severity of COVID-19. However, the severity of COVID-19 affected the activity of IBD. We`ve identified the same risk factors for the development of a more severe course of COVID-19 were as in the world literature: cardiovascular pathology, arterial hypertension and chronic liver pathology. Conclusion. Thus, inflammatory bowel disease and current therapy do not affect the risk of SARS-Cov-2 infection and/or the severity of COVID-19, while infection associated with severe COVID-19 affects the activity or outcomes of IBD. Актуальность.Коронавирусная инфекция – острое вирусное заболевание с преимущественным поражением верхних дыхательных путей, вызываемое РНК-геномным вирусом рода Betacoronavirus семейства Coronaviridae. Заражение вирусом варьируется от бессимптомного до широкого спектра клинических проявлений, включая лихорадку, озноб, желудочно-кишечные проявления, пневмонию, респираторный дистресс и смерть. Язвенный колит (ЯК) и болезнь Крона (БК) – хронические иммуноопосредованные заболевания с кишечной и системной симптоматикой, в основе которых лежат нарушение микробиоты кишечника и дисрегуляция иммунной системы у генетически-предрасположенных лиц. У лиц казахской популяции к факторам риска также можно отнести нерегулярный прием пищи (р=0,043; ОШ=3,61 [95% ДИ: 1,04-12,51]), потребление рыбы и морских продуктов (р=0,000; ОШ=15,77 [95% ДИ: 4,56-54,59]), потребление замороженных полуфабрикатов (р=0,018; ОШ=4,62 [95% ДИ: 1,3-16,4]), питание, основанное на мясных блюдах (р=0,029; ОШ=3,2 [95%ДИ: 1,13-9,2]), применение НПВС, кроме аспирина (р=0,031; ОШ=3,79 [1,13-12,69]) и курение (р=0,008; ОШ=4,93 [95% ДИ: 1,52-15,98]) [25] Подавление иммунного ответа ассоциировано с риском инфицирования вирусными или бактериальными патогенами, в том числе, потенциально вирусом SARS-CoV-2. С другой стороны, в настоящее время обсуждается SARS-Cov2 в качестве триггера de-novo ВЗК случаев [22]. Цель проведенного исследования: оценить особенности течения COVID-19 на фоне терапии воспалительных заболеваний кишечника, факторы риска и исходы COVID-19, а также активность ВЗК до и после перенесенной КВИ. Материалы и методы.Продольное описательное исследование включало 158 пациентов с ВЗК, обратившихся амбулаторно (в том числе посредством...