Clinical characteristics and phenotypes of inflammatory bowel disease in Northern Central America: initial results from the Northern Central America Inflammatory Bowel Disease Registry
Eleazar E Montalvan-Sanchez, Michael Dougherty, Dalton Norwood, Aida Rodriguez-Murillo, Kathya Jimenez, Daniela M Montalvan-Sanchez, Luis A Najera, Blanca A Avalos-Quijano, Oscar G Avelar-Escobar, Marco A Calix-Cerrato, Gustavo A Ramos-Aguilar, Daniel Guifarro, Jeffrey Freidenson, Candida Leiva, Douglas Morgan, Deborah Proctor, Alexander N LevyAbstract
Background
Inflammatory bowel disease (IBD), encompassing ulcerative colitis (UC), Crohn’s disease (CD), and IBD unclassified (IBDU), affects over 7 million people worldwide. While incidence has plateaued in higher-income countries, it continues to rise in lower- and middle-income regions, including Latin America. Data from northern Central America remain scarce.
Aim
To characterize the clinical and phenotypic profile of IBD in Honduras, El Salvador, and Guatemala.
Methods
The Inflammatory Bowel Disease in Northern Central America Research and Epidemiological Study (IBD-NCARES) was a multinational, multicenter descriptive study spanning 15 years. Cases were identified using ICD-10 codes and confirmed by chart review. Sociodemographic, behavioral, and clinical variables were collected.
Results
Among 277 patients, UC was the predominant subtype (57.8%), highest in Honduras (71.4%). CD accounted for 11.9% of cases, with greater frequency in Honduras (25.7%). IBDU was frequent in El Salvador (40.3%) and Guatemala (38.2%) compared with Honduras (2.9%). Delayed diagnosis (>1 year) occurred in 35% of UC and 60.6% of CD patients. Complicated CD was observed in 54.5% (B2 30.3%; B3 24.2%). Extraintestinal manifestations included vascular (18.2%) and hepatic/pancreatic (9.1%) complications. Most patients received 5-aminosalicylates or systemic steroids. Only 5.1% of the overall cohort received advanced therapies.
Conclusion
This first multinational study of IBD in northern Central America highlights UC predominance, high rates of IBDU (likely inflated by incomplete diagnostics), frequent diagnostic delay, and limited use of advanced therapies. These findings underscore the need for regional registries, improved diagnostic capacity, and expanded therapeutic resources.