***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND A system-wide , multi-ethnicity study on Crohn 's disease ( CD ) of the pouch , including Indian American ( IA ) patients has not been conducted . AIM To compare the frequency of subsequent development of CD of the pouch for African-American ( AA ) , Hispanic-American ( HA ) , IA and Caucasian patients with ulcerative ( UC ) undergoing ileal-pouch anal anastomosis ( IPAA ) .  METHODS In this historical cohort study from our Pouch Registry , patients with restorative proctocolectomy and IPAA for IBD with identifiable , self-declared racial background ( i.e. AA , HA , IA or Caucasian ) were included . Univariable and multivariable analyses were performed to identify risk factors for CD of the pouch . RESULTS The study included 235 patients : AA ( N=26 ) , HA ( N=37 ) , IA ( N=22 ) and r and omly selected Caucasian ( N=150 ) controls . Greater number of HA and Caucasians had a history of smoking than IA ( 27.3 % and 27.0 % vs. 0 ; p=0.007 ) . Caucasians and HA were also more likely to have a family history of IBD than IA or AA ( 25 % vs. 27 % vs. 5 % vs. 4 % ; p=0.016 . ) IA less frequently had extensive colitis before colectomy than Caucasians ( 71.4 % vs. 94.0 % ; p=0.004 ) and more frequently required anti-TNF biologics than HA ( 22.7 % vs. 0 ; p=0.016 ) . On multivariable logistic regression analysis , AA ( odds ratio [OR]=10.1 , 95 % confidence interval [ CI ] : 1.03 , 1365.8 , p=0.004 ) and Caucasians ( OR=11.1 , 95 % CI : 1.4 , 1427.2 , p=0.015 ) had a higher risk of developing CD of the pouch than IA . However , the event-free survival was not significantly different between the groups on Cox regression analysis , presumably due to the sample size . CONCLUSION Racial background may be associated with different risk for the development of CD of the pouch for patients with IBD undergoing IPAA PURPOSE Common belief based on clinical experience suggests that Crohn ’s disease is more severe among black patients , although little data exists on the effect of race on Crohn ’s disease . We compared multiple variables among black patients with Crohn ’s disease requiring surgery to those of white patients presenting to a university colorectal surgery unit during a five-year period . METHODS A total of 345 patients required surgery for Crohn ’s disease between June 1998 and September 2003 . The following data were abstract ed from patient charts and a prospect ively maintained data base : age at diagnosis ; age at first Crohn ’s disease surgery ; presenting symptoms ; incidence , number and location of fistulas at presentation ; number of Crohn ’s disease operations ; and family history of inflammatory bowel disease . Data regarding medical insurance coverage also were obtained . Complete data were evaluable on 178 patients . Patient variables were analyzed using the chi-squared , Fisher exact , and Student t-tests . RESULTS Mean age at diagnosis was 28 years for white males , 20 years for black males , 30 years for white females , and 28 years for black females ( all p > 0.05 ) . Thirty-seven percent of white females presented with obstructive symptoms vs. 12 percent of black females . ( P = 0.011 ) . Sixty-five percent of black females presented with inflammatory symptoms compared with 28 percent of white females ( P = 0.001 ) . Of females presenting with fistulas , 15 percent of black patients had a rectovaginal fistula compared with 5 percent of white patients . Seventeen percent of black males and 21 percent of white males had intra-abdominal fistulas . None of these differences were statistically significant . The incidence of fistulas at presentation , mean number of fistulas , total number of operations , and family history of inflammatory bowel disease did not differ . CONCLUSIONS Contrary to expectations , Crohn ’s disease does not seem to be more severe among black patients , who had an earlier age of diagnosis , although this was not statistically significant . Overall , there was no difference in disease presentation . White females were more likely to present with obstructive symptoms compared with black females , who more often presented with inflammatory symptoms . Among patients with fistulas , the incidence of rectovaginal fistulas was higher in black females compared with white females , and white males were somewhat more likely to have intra-abdominal fistulas than black males . Although there was no demonstrated difference in incidence and mean number of fistulas at presentation , the number of operations for Crohn ’s disease , or family history of inflammatory bowel disease among blacks and whites , there are differences in presenting symptoms among these population Background : Inflammatory bowel disease ( IBD ) is increasingly diagnosed in ethnic and racial minorities .  Ileal pouch – anal anastomosis ( IPAA ) has become the treatment of choice for ulcerative colitis ( UC ) patients requiring surgery . Few studies have characterized the natural history of IPAA and the pouch outcomes in the Hispanic American population . Methods : Ethnicity was design ated by self‐report and the Hispanics who had IPAA for UC were identified from a prospect ively maintained data base . Demographics , clinical characteristics , and pouch outcomes were compared between Hispanic and a sample of Non‐Hispanic whites ( 1:4 ratio ) r and omly selected from the same data base . Exclusion criteria were patients with a preoperative diagnosis of Crohn 's disease or familial adenomatous polyposis , and patients of other ethnic groups . Results : Thirty‐six Hispanics with IPAA were identified . Hispanic patients were younger at UC diagnosis 23.1 ± 13.1 vs. 30.4 ± 12.6 yrs and at colectomy 31.9 ± 13.9 vs. 38.8 ± 13.8 yrs than controls .  The interval between diagnosis and colectomy was comparable between the two groups . There were more uninsured in the Hispanic group than controls ( 13.9 % vs. 2.8 % ) . There were no significant differences in gender distribution , family history of IBD , smoking history , extent of UC , fulminant colitis , pouch configuration , stage of pouch , presence of extraintestinal manifestations , or concurrent autoimmune disorders . Pouch‐related disorders and pouch failure were also similar . Conclusions : There appeared to be some difference in the preoperative characteristics of patients who underwent  colectomy for UC between Hispanics and non‐Hispanic whites , but outcomes after the restorative proctocolectomy with IPAA were comparable . Further studies are needed to characterize the natural history of UC and IPAA in the Hispanic population and the associated biosocioeconomic factors . ( Inflamm Bowel Dis 2011 ; OBJECTIVE : There are few estimates of the incidence and prevalence of inflammatory bowel disease in North American communities . We sought to estimate the incidence and prevalence of inflammatory bowel disease ( IBD ) , including Crohn 's disease ( CD ) , and ulcerative colitis ( UC ) , among 3.2 million members of Kaiser Permanente , Northern California , for the period 1996–2002 . METHODS : All health plan members who had one or more diagnoses of CD ( ICD-9 code 555 ) or UC ( ICD-9 code 556 ) on computerized records during the period 1996–2002 and with at least 12 months of membership were identified as possible IBD cases ( N = 12,059 ) . We r and omly sample d 24 % of these for chart review to confirm the diagnosis and obtain the initial diagnosis date . Incidence rates and the point prevalence on December 31 , 2002 were st and ardized to the 2000 U. S. Census . RESULTS : The annual incidence rate per 100,000 persons was 6.3 for CD ( 95 % confidence interval [ CI ] , 5.6–7.0 ) and 12.0 for UC ( CI , 11.0–13.0 ) . The point prevalence per 100,000 on December 31 , 2002 was 96.3 for CD ( 95 % CI , 89.6–103.0 ) and 155.8 for UC ( 95 % CI , 146.6–164.9 ) , increasing to 100.3 and 205.8 per 100,000 , respectively , when hospital discharge data from 1985 to 1995 were included . The age-specific incidence of CD was bimodal , while UC incidence rose in early adulthood and remained elevated with advancing age . CONCLUSIONS : The incidence we estimated for CD was similar to the previous U. S. estimate . Our incidence estimate for UC was much higher than the previous U.S. estimate , but similar to that of recent Canadian and European studies . The prevalence we estimated for CD was somewhat lower than previous estimates The epidemiology of inflammatory bowel disease is described among the more than 1.5 million members of the Kaiser Permanente Medical Care Program ( KPMCP ) in northern California . We review ed a 20 % r and om sample of the medical records of 2,067 persons first admitted to hospital in the period 1971 through 1982 with codes indicating inflammatory bowel disease . We also examined all new outpatient cases for a 1-year period from records at the Oakl and KPMCP facility . Criteria used to establish valid cases adhered to st and ards used in previous studies but were revised to reflect current diagnostic methods . The disadvantages of using hospital discharge data have been identified and quantified . In this population , only 21 % of ambulatory patients with inflammatory bowel disease were admitted to hospital in a 3 1/2-year period . There was no difference in the incidence of the disorder by sex or between whites and blacks , but it was rare in Asians . A bimodal age distribution was suggested for Crohn 's disease but not for ulcerative colitis . During the 12 years of this study , rates of hospital admissions for ulcerative colitis decreased and for Crohn 's disease were slightly increased 
    Output:
    
The incidence and prevalence of IBD is increasing among minorities .
There is less of a genetic influence in the pathogenesis of IBD among African Americans ; however , novel variants have been identified .
There is a predilection for pancolonic ulcerative colitis among Hispanics and Asians .
Crohn 's disease-related hospitalizations are increasing in Asians , whereas African Americans are more likely to use the emergency department .
No major differences are seen in disease location and behavior , upper gastrointestinal tract , and perianal involvement and extraintestinal manifestations among races and ethnic groups .
Medication utilization seems to be similar .
Differences in surgery are likely explained by health insurance status .