Inflammatory bowel disease among first generation immigrants in Israel:A nationwide epi-Israeli Inflammatory Bowel Disease Research Nucleus study

BACKGROUND Israel has a high rate of Jewish immigration and a high prevalence of inflammatory bowel disease(IBD).AIM To compare IBD prevalence in first-generation immigrants vs Israel-born Jews.METHODS Patients with a diagnosis of IBD as of June 2020 were included from the validated epi-IIRN(Israeli IBD Research Nucleus)cohort that includes 98%of the Israeli population.We stratified the immigration cohort by IBD risk according to country of origin,time period of immigration,and age group as of June 2020.RESULTS A total of 33544 patients were ascertained,of whom 18524(55%)had Crohn’s disease(CD)and 15020(45%)had ulcerative colitis(UC);28394(85%)were Israel-born and 5150(15%)were immigrants.UC was more prevalent in immigrants(2717;53%)than in non-immigrants(12303,43%,P<0.001),especially in the<1990 immigration period.After adjusting for age,longer duration in Israel was associated with a higher point prevalence rate in June 2020(high-risk origin:Immigration<1990:645.9/100000,≥1990:613.2/100000,P=0.043;intermediate/low-risk origin:<1990:540.5/100000,≥1990:192.0/100000,P<0.001).The prevalence was higher in patients immigrating from countries with high risk for IBD(561.4/100000)than those originating from intermediate-/low-risk countries(514.3/100000;P<0.001);non-immigrant prevalence was 528.9/100000.CONCLUSION Lending support to the environmental effect on IBD etiology,we found that among immigrants to Israel,the prevalence of IBD increased with longer time since immigration,and was related to the risk of IBD in the country of origin.The UC rate was higher than that of CD only in those immigrating in earlier time periods.

Helicobacter pylori infection in patients with selective immunoglobulin E deficiency

AIM: To investigate the prevalence and clinical characteristics of Helicobacter pylori(H.pylori)-infected dyspeptic patients with selective immunoglobulin E deficiency(IgE d).METHODS: All individuals who underwent serum totalimmunoglobulin E(Ig E) measurement at the Leumit Healthcare Services(Israel) in 2012 were identified in an electronic database search(n = 18487).From these,selected case group subjects were ≥ 12 years of age and had serum total Ig E < 2 k IU/L(n = 158).The control group was selected from a random sampling of the remaining subjects ≥ 12 years of age to obtain a case-control ratio of 1:20(n = 3160).Dyspeptic diseases,diagnosed no more than 5 years before serum total Ig E testing,were identified and retrieved from the electronic database using specific International Classification of Diseases diagnostic codes.Results of C13-urea breath tests were used to identify subjects infected with H.pylori.Categorical variables between case and control subjects were analyzed using Fisher's exact tests,whereas continuous variables were analyzed using χ2 tests.RESULTS: Dyspepsia was present in 27.2%(43/158) of case subjects and 22.7%(718/3160) of controls.Of these,significantly more case subjects(32/43,74.4%) than controls(223/718,31.1%) were positive for H.pylori(P < 0.01).Esophagogastroduodenoscopy was performed in 19 case and 94 control subjects,revealing that gastritis was more prevalent in IgE d case subjects than in controls(57.9% vs 29.8%,P < 0.05).Furthermore,a significantly greater proportion of case subjects presented with peptic duodenal ulcers(63.2% vs 15.9%,P < 0.01).Histopathologic examination showed marked chronic inflammation,lymphoid follicle formation and prominent germinal centers,with polymorphonuclear cell infiltration of gastric glands,that was similar in case and control biopsy tissues.Finally,Ig Ed case subjects that underwent esophagogastroduodenoscopy were more likely to exhibit treatment-refractory H.pylori infections that require second-line triple antibiotic therapy(47.4% vs 11.7%,P < 0.01).CONCLUSION: IgE d is associated with higher rates ofH.pylori-associated gastritis and peptic duodenal ulcers.