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Wang Y, Pan CW, Huang Y, Zheng X, Li S, He M, Hashash JG, Farraye FA, Ehrlich AC. Global Epidemiology and Geographic Variations of Pediatric-Onset Inflammatory Bowel Disease: A Comprehensive Analysis of the Global Burden of Disease Study 1990 to 2019. Inflamm Bowel Dis 2024:izae093. [PMID: 38676392 DOI: 10.1093/ibd/izae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND An increasing incidence of pediatric-onset inflammatory bowel disease (PIBD) has been reported in many countries. However, the global burden and distribution of this disease remain less understood. We aimed to examine the global epidemiology and trends of PIBD from 1990 to 2019. METHODS Data from the 2019 Global Burden of Disease Study, covering 204 countries, were analyzed. We assessed key measures like incidence, prevalence, mortality, and disability-adjusted life years (DALYs) using linear regression to calculate annual percentage changes and assess trends. RESULTS Between 1990 and 2019, the PIBD incidence rate increased and the DALY rate and mortality rate declined. The incidence rate was notably elevated in the high Socio-demographic Index (SDI) quintile, reaching 6.3 per 100 000 person-years, corresponding to 13 914 new cases in 2019. Incidence and prevalence of PIBD positively correlated with the SDI, while higher death and DALY burdens were observed in lower-SDI countries. In 2019, the top 5 countries with the highest PIBD incidence rates were Canada (19.9 per 100 000 population), Denmark (12.4 per 100 000 population), Hungary (8.5 per 100 000 population), Austria (8.1 per 100 000 population), and the United States (7.4 per 100 000 population). Several countries experienced significant increases in incidence rates from 1990 to 2019, led by Taiwan (annual percent change 4.2%), followed by China (2.8%), Japan (2.1%), Australia (1.8%), and Hungary (1.6%). DISCUSSION PIBD incidence has significantly increased since 1990. High-SDI countries face higher incidence, while lower-SDI countries experience higher mortality and DALY burdens. The study underscores the need for ongoing monitoring and research to address this emerging public health issue.
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Affiliation(s)
- Yichen Wang
- Division of Hospital Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chun-Wei Pan
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Yuting Huang
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Xin Zheng
- Division of Gastroenterology and Hepatology, Loma Linda University Health, Loma Linda, CA, USA
| | - Si Li
- Department of Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Mingyue He
- Department of Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Jana G Hashash
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Adam C Ehrlich
- Section of Gastroenterology and Hepatology, Temple University Hospital, Philadelphia, PA, USA
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Weidner J, Glauche I, Manuwald U, Kern I, Reinecke I, Bathelt F, Amin M, Dong F, Rothe U, Kugler J. Correlation of Socioeconomic and Environmental Factors With Incidence of Crohn Disease in Children and Adolescents: Systematic Review and Meta-Regression. JMIR Public Health Surveill 2024; 10:e48682. [PMID: 38526534 PMCID: PMC11002755 DOI: 10.2196/48682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 12/28/2023] [Accepted: 01/23/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND The worldwide incidence of Crohn disease (CD) in childhood and adolescence has an increasing trend, with significant differences between different geographic regions and individual countries. This includes an increase in the incidence of CD in countries and geographic regions where CD was not previously prevalent. In response to the increasing incidence, the pediatric care landscape is facing growing challenges. OBJECTIVE This systematic review and meta-analysis were undertaken to comprehensively delineate the incidence rates of CD in pediatric populations across different countries and to explore potential influencing factors. METHODS We performed a systematic review of PubMed and Embase (via Ovid) for studies from January 1, 1970, to December 31, 2019. In addition, a manual search was performed in relevant and previously published reviews. The results were evaluated quantitatively. For this purpose, random effects meta-analyses and meta-regressions were performed to investigate the overall incidence rate and possible factors influencing the incidence. RESULTS A qualitative synthesis of 74 studies was performed, with 72 studies included in the meta-analyses and 52 in the meta-regressions. The results of our meta-analysis showed significant heterogeneity between the individual studies, which cannot be explained by a sample effect alone. Our findings showed geographical differences in incidence rates, which increased with increasing distance from the equator, although no global temporal trend was apparent. The meta-regression analysis also identified geographic location, UV index, and Human Development Index as significant moderators associated with CD incidence. CONCLUSIONS Our results suggest that pediatric CD incidence has increased in many countries since 1970 but varies widely with geographic location, which may pose challenges to the respective health care systems. We identified geographic, environmental, and socioeconomic factors that contribute to the observed heterogeneity in incidence rates. These results can serve as a basis for future research. To this end, implementations of internationally standardized and interoperable registries combined with the dissemination of health data through federated networks based on a common data model, such as the Observational Medical Outcomes Partnership, would be beneficial. This would deepen the understanding of CD and promote evidence-based approaches to preventive and interventional strategies as well as inform public health policies aimed at addressing the increasing burden of CD in children and adolescents. TRIAL REGISTRATION PROSPERO International prospective register of systematic reviews CRD42020168644; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=168644. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2020-037669.
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Affiliation(s)
- Jens Weidner
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ingmar Glauche
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ulf Manuwald
- Faculty of Applied Social Sciences, University of Applied Sciences (FHD), Dresden, Germany
| | - Ivana Kern
- Institute and Policlinic for Occupational and Social Medicine, Department of Health Sciences/Public Health, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ines Reinecke
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Franziska Bathelt
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
- Thiem-Research GmbH, Cottbus, Germany
| | - Makan Amin
- Institute and Policlinic for Occupational and Social Medicine, Department of Health Sciences/Public Health, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
- Department for Trauma Surgery and Orthopaedics, Park-Klinik Weissensee, Berlin, Germany
| | - Fan Dong
- Institute and Policlinic for Occupational and Social Medicine, Department of Health Sciences/Public Health, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | | | - Joachim Kugler
- Institute and Policlinic for Occupational and Social Medicine, Department of Health Sciences/Public Health, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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Östensson M, Björkqvist O, Guo A, Størdal K, Halfvarson J, Mårild K, Ludvigsson J. Epidemiology, validation, and clinical characteristics of inflammatory bowel disease: the ABIS birth cohort study. BMC Gastroenterol 2023; 23:199. [PMID: 37291531 DOI: 10.1186/s12876-023-02840-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Birth cohort studies with linked register-based data on inflammatory bowel disease (IBD) provide opportunities to prospectively study early-life determinants of the disease. However, register-based data often lack information on clinical characteristics and rely on diagnostic algorithms. Within the All Babies in Southeast Sweden (ABIS) cohort, we examined the validity of a register-based definition of IBD, its incidence, and clinical and therapeutic characteristics at diagnosis. METHODS We followed 16,223 children from birth (1997-1999) until the end of 2020 for the diagnosis of IBD as defined by a minimum of two diagnostic codes for IBD in the Swedish National Patient Register (NPR). We described the incidence and cumulative incidence of IBD. Through a medical record review of cases diagnosed by the end of 2017, we examined the positive predictive value (PPV) for IBD and described its clinical characteristics and treatment. RESULTS By 2020, at an average age of 22.2 years, 113 participants (0.74%, 95% confidence interval [CI] = 0.61-0.89) had a register-based diagnosis of IBD, corresponding to an incidence of 31.3 per 100,000 person-years of follow-up; the incidence for Crohn's disease (CD) was 11.1 per 100,000 person-years and 15.8 for ulcerative colitis (UC). Of 77 participants with a register-based definition of IBD by the end of 2017, medical records were identified for 61 participants, of whom 57 had true IBD (PPV = 93%; 95%CI = 0.87-1.00). While oral 5-aminosalicylic acid treatment was equally common in newly diagnosed CD and UC patients, biologics were more often used for newly diagnosed CD. The median faecal calprotectin levels were 1206 mg/kg at diagnosis and 93 mg/kg at the last follow-up (P < 0.001). CONCLUSIONS In this population-based sample of Swedish children and young adults the cumulative IBD incidence was 0.74. The validity of register-based definition of IBD was high and supports using such data to identify IBD patients in cohort studies.
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Affiliation(s)
- Malin Östensson
- Bioinformatics and Data Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olle Björkqvist
- Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Annie Guo
- Department of Paediatrics, Institute of Clinical Science, University of Gothenburg, Gothenburg, Sweden
| | - Ketil Størdal
- Department of Paediatric Research, Faculty of Medicine, University of Oslo, Oslo, Norway
- Children's Centre, Oslo University Hospital, Oslo, Norway
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karl Mårild
- Department of Paediatrics, Institute of Clinical Science, University of Gothenburg, Gothenburg, Sweden.
- Department of Paediatrics, Queen Silvia Children's Hospital, 416 78, Gothenburg, Sweden.
| | - Johnny Ludvigsson
- Crown Princess Victoria Children's Hospital, Region Östergötland, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Division of Paediatrics, Linköping University, Linköping, Sweden
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Dorn-Rasmussen M, Lo B, Zhao M, Kaplan GG, Malham M, Wewer V, Burisch J. The Incidence and Prevalence of Paediatric- and Adult-Onset Inflammatory Bowel Disease in Denmark During a 37-Year Period: A Nationwide Cohort Study (1980-2017). J Crohns Colitis 2023; 17:259-268. [PMID: 36125076 DOI: 10.1093/ecco-jcc/jjac138] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Incidence rates of inflammatory bowel disease [IBD] reported from developed countries are rising, with some levelling out. The aim of this study was to assess the disease burden of IBD by estimating the incidence and prevalence across age groups and projecting these to 2030 in a high-incidence country. METHODS Using an algorithm [incorporating ICD codes, medications and histopathology], patients [n = 69 862] diagnosed with Crohn's disease [CD] or ulcerative colitis [UC] between 1980 and 2017 were identified in the Danish National Patient Registry and included in a nationwide cohort. RESULTS From 1980 to 2017 the overall incidence of CD increased from 5.1 [95% CI: 4.5-5.8] to 15.6 [95% CI: 14.6-16.6] per 100 000, while the incidence of UC increased from 6.2 [95% CI: 5.5-6.9] to 27.2 [95% CI: 25.9-28.6] per 100 000. For paediatric-onset CD [pCD], the incidence increased from 1.9 [95% CI: 1.2-2.8] to 9.9 [95% CI: 8.1-11.8] per 100 000 and from 1.8 [95% CI: 1.2-2.8] to 8.7 [95% CI: 7.1- 10.5] per 100 000 for paediatric-onset UC [pUC]. In 2017, the prevalence of CD and UC was 293 [95% CI: 288-297] and 523 [95% CI: 517-528] per 100 000. For pCD and pUC, the prevalence was 35 [95% CI: 31-38] and 28 [95% CI: 26-32] per 100 000. CONCLUSIONS The incidence of paediatric- and adult-onset IBD in Denmark continues to increase and is among the highest in the world.
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Affiliation(s)
- Maria Dorn-Rasmussen
- Department of Paediatric and Adolescence Medicine, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Bobby Lo
- Gastrounit, Medical Division, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Mirabella Zhao
- Gastrounit, Medical Division, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Gilaad G Kaplan
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Mikkel Malham
- Department of Paediatric and Adolescence Medicine, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Vibeke Wewer
- Department of Paediatric and Adolescence Medicine, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Johan Burisch
- Gastrounit, Medical Division, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
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Larrosa-Haro A, Abundis-Castro L, Contreras MB, Gallo MJ, Peña-Quintana L, Targa Ferreira CH, Nacif PA, Vázquez-Frías R, Bravo S, Muñoz-Urribarri AB, Mejía-Castro M, Orsi M, Amil-Díaz J, Busoni V, Cohen-Sabban J, Martin-Capri FJ, Zablah R, Rodríguez-Guerrero MG, Sdepanian VL. Epidemiologic trend of pediatric inflammatory bowel disease in Latin America: The Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) Working Group. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 86:328-334. [PMID: 34518143 DOI: 10.1016/j.rgmxen.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 07/25/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND AIMS The primary aim was to explore the epidemiologic trend of pediatric inflammatory bowel disease in Latin America, and the secondary aims were to obtain an overview of the diagnostic/therapeutic focus of the members of the LASPGHAN and examine the relation of case frequency to year, during the study period. MATERIALS AND METHODS Latin American pediatric gastroenterologists participated in an online survey, conducted through the SurveyMonkey platform, that investigated the yearly frequency of new inflammatory bowel disease patients within the time frame of 2005-2016, their disease variety, the gastrointestinal segments affected, and the diagnostic and treatment methods utilized. The correlation of new case frequency with each study year was evaluated. RESULTS A total of 607 patients were studied. The diagnoses were ulcerative colitis in 475 (78.3%) cases, Crohn's disease in 104 (17.1%), and inflammatory bowel disease D unclassified in 28 (4.6%). The trend in ulcerative colitis was a lineal increase in the frequency of new cases related to each study year, with a significant correlation coefficient. Pancolitis was found in 67.6% of the patients. The diagnostic methods included clinical data, endoscopy, and biopsies in more than 99% of the cases, and imaging studies were indicated selectively. Drug regimens were limited to 5-aminosalicylic acid derivatives, azathioprine, 6-mercaptopurine, infliximab, and adalimumab. CONCLUSIONS Pediatric inflammatory bowel disease in Latin America appears to have increased during the years included in the study period, with a predominance of moderate or severe ulcerative colitis. That lineal trend suggests the predictive likelihood of a gradual increase in the coming years, with possible epidemiologic and clinical implications.
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Affiliation(s)
- A Larrosa-Haro
- Instituto de Nutrición Humana, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico.
| | - L Abundis-Castro
- Banco de Leche Humana, Secretaría de Salud del Estado de Sonora, Sonora, Mexico
| | - M B Contreras
- Servicio de Atención Médica Integral para la Comunidad Juan P. Garrahan, Hospital de Pediatría, Buenos Aires, Argentina
| | - M J Gallo
- Servicio de Gastroenterología, Hepatología y Trasplante Hepatointestinal Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - L Peña-Quintana
- Unidad de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Universitario Materno Infantil, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | - C H Targa Ferreira
- Departamento de Pediatría, Universidad Federal de Ciencias, Porto Alegre, Brazil
| | - P A Nacif
- Servicio de Gastroenterología, Centro Hospitalario Pereira Rossel (CHPR), Montevideo, Uruguay
| | - R Vázquez-Frías
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - S Bravo
- Hospital de Niños Víctor J. Vilela, Rosario (Santa Fe), Argentina
| | | | - M Mejía-Castro
- Centro de Gastroenterología Endoscopia y Nutrición Pediátrica, Managua, Nicaragua
| | - M Orsi
- Servicio de Gastroenterología, Hepatología y Trasplante Hepatointestinal Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Amil-Díaz
- Departamento de Pediatría Médica, Hospital de Sao Joao, Oporto, Portugal
| | - V Busoni
- Servicio de Gastroenterología, Hepatología y Trasplante Hepatointestinal Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Cohen-Sabban
- Servicio de Gastroenterología, Hepatología y Trasplante Hepatointestinal Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - F J Martin-Capri
- Servicio de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Sant Joan de Déu, Esplugues de Llobregat (Barcelona), Spain
| | - R Zablah
- Servicio de Gastroenterología Pediátrica, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador
| | - M G Rodríguez-Guerrero
- Servicio de Gastroenterología Pediátrica, Hospital de Niños José Manuel de los Ríos, Caracas, Venezuela
| | - V L Sdepanian
- Departamento de Pediatría, Universidad Federal de São Paulo, São Paulo, Brazil
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6
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Larrosa-Haro A, Abundis-Castro L, Contreras MB, Gallo MJ, Peña-Quintana L, Targa Ferreira CH, Nacif PA, Vázquez-Frías R, Bravo S, Muñoz-Urribarri AB, Mejía-Castro M, Orsi M, Amil-Díaz J, Busoni V, Cohen-Sabban J, Martin-Capri FJ, Zablah R, Rodríguez-Guerrero MG, Sdepanian VL. Epidemiologic trend of pediatric inflammatory bowel disease in Latin America: The Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) Working Group. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2020; 86:S0375-0906(20)30120-8. [PMID: 33223251 DOI: 10.1016/j.rgmx.2020.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/09/2020] [Accepted: 07/25/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES The primary aim was to explore the epidemiologic trend of pediatric inflammatory bowel disease in Latin America, and the secondary aims were to obtain an overview of the diagnostic/therapeutic focus of the members of the LASPGHAN and examine the relation of case frequency to year, during the study period. MATERIALS AND METHODS Latin American pediatric gastroenterologists participated in an online survey, conducted through the SurveyMonkey platform, that investigated the yearly frequency of new inflammatory bowel disease patients within the time frame of 2005 to 2016, their disease variety, the gastrointestinal segments affected, and the diagnostic and treatment methods utilized. The correlation of new case frequency with each study year was evaluated. RESULTS A total of 607 patients were studied. The diagnoses were ulcerative colitis in 475 (78.3%) cases, Crohn's disease in 104 (17.1%), and inflammatory bowel disease D unclassified in 28 (4.6%). The trend in ulcerative colitis was a lineal increase in the frequency of new cases related to each study year, with a significant correlation coefficient. Pancolitis was found in 67.6% of the patients. The diagnostic methods included clinical data, endoscopy, and biopsies in more than 99% of the cases, and imaging studies were indicated selectively. Drug regimens were limited to 5-aminosalicylic acid derivatives, azathioprine, 6-mercaptopurine, infliximab, and adalimumab. CONCLUSIONS Pediatric inflammatory bowel disease in Latin America appears to have increased during the years included in the study period, with a predominance of moderate or severe ulcerative colitis. That lineal trend suggests the predictive likelihood of a gradual increase in the coming years, with possible epidemiologic and clinical implications.
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Affiliation(s)
- A Larrosa-Haro
- Instituto de Nutrición Humana, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México.
| | - L Abundis-Castro
- Banco de Leche Humana, Secretaría de Salud del Estado de Sonora, Sonora, México
| | - M B Contreras
- Servicio de Atención Médica Integral para la Comunidad Juan P. Garrahan, Hospital de Pediatría, Buenos Aires, Argentina
| | - M J Gallo
- Servicio de Gastroenterología, Hepatología y Trasplante Hepatointestinal Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - L Peña-Quintana
- Unidad de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Universitario Materno Infantil, Universidad de Las Palmas de Gran Canaria, Las Palmas, España
| | - C H Targa Ferreira
- Departamento de Pediatría, Universidad Federal de Ciencias, Porto Alegre, Brasil
| | - P A Nacif
- Servicio de Gastroenterología, Centro Hospitalario Pereira Rossel (CHPR), Montevideo, Uruguay
| | - R Vázquez-Frías
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - S Bravo
- Hospital de Niños Víctor J. Vilela, Rosario (Santa Fe), Argentina
| | | | - M Mejía-Castro
- Centro de Gastroenterología Endoscopia y Nutrición Pediátrica, Managua, Nicaragua
| | - M Orsi
- Servicio de Gastroenterología, Hepatología y Trasplante Hepatointestinal Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Amil-Díaz
- Departamento de Pediatría Médica, Hospital de Sao Joao, Oporto, Portugal
| | - V Busoni
- Servicio de Gastroenterología, Hepatología y Trasplante Hepatointestinal Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Cohen-Sabban
- Servicio de Gastroenterología, Hepatología y Trasplante Hepatointestinal Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - F J Martin-Capri
- Servicio de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Sant Joan de Déu, Esplugues de Llobregat (Barcelona), España
| | - R Zablah
- Servicio de Gastroenterología Pediátrica, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador
| | - M G Rodríguez-Guerrero
- Servicio de Gastroenterología Pediátrica, Hospital de Niños José Manuel de los Ríos, Caracas, Venezuela
| | - V L Sdepanian
- Departamento de Pediatría, Universidad Federal de São Paulo, São Paulo, Brasil
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7
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Roberts SE, Thorne K, Thapar N, Broekaert I, Benninga MA, Dolinsek J, Mas E, Miele E, Orel R, Pienar C, Ribes-Koninckx C, Thomson M, Tzivinikos C, Morrison-Rees S, John A, Williams JG. A Systematic Review and Meta-analysis of Paediatric Inflammatory Bowel Disease Incidence and Prevalence Across Europe. J Crohns Colitis 2020; 14:1119-1148. [PMID: 32115645 DOI: 10.1093/ecco-jcc/jjaa037] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease [IBD] is often one of the most devastating and debilitating chronic gastrointestinal disorders in children and adolescents. The main objectives here were to systematically review the incidence and prevalence of paediatric IBD across all 51 European states. METHODS We undertook a systematic review and meta-analysis based on PubMed, CINAHL, the Cochrane Library, searches of reference lists, grey literature and websites, covering the period from 1970 to 2018. RESULTS Incidence rates for both paediatric Crohn's disease [CD] and ulcerative colitis [UC] were higher in northern Europe than in other European regions. There have been large increases in the incidence of both paediatric CD and UC over the last 50 years, which appear widespread across Europe. The largest increases for CD have been reported from Sweden, Wales, England, the Czech Republic, Denmark and Hungary, and for UC from the Czech Republic, Ireland, Sweden and Hungary. Incidence rates for paediatric CD have increased up to 9 or 10 per 100 000 population in parts of Europe, including Scandinavia, while rates for paediatric UC are often slightly lower than for CD. Prevalence reported for CD ranged from 8.2 per 100 000 to approximately 60 and, for UC, from 8.3 to approximately 30. CONCLUSIONS The incidence of paediatric IBD continues to increase throughout Europe. There is stronger evidence of a north-south than an east-west gradient in incidence across Europe. Further prospective studies are needed, preferably multinational and based on IBD registries, using standardized definitions, methodology and timescales.
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Affiliation(s)
- S E Roberts
- Medical School, Swansea University, Swansea, Wales, UK
| | - K Thorne
- Medical School, Swansea University, Swansea, Wales, UK
| | - N Thapar
- Neurogastroenterology and Motility Unit, Department of Gastroenterology, Great Ormond Street Hospital, London, UK
- Stem Cells and Regenerative Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
- Prince Abdullah Ben Khalid Celiac Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
| | - I Broekaert
- Department of Paediatrics, University Children's Hospital, University of Cologne, Cologne, Germany
| | - M A Benninga
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, The Netherlands
| | - J Dolinsek
- Department of Pediatrics, University Medical Center Maribor, Maribor, Slovenia
| | - E Mas
- Unité de Gastroentérologie, Hépatologie, Nutrition, Diabétologie et Maladies Héréditaires, du Métabolisme, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
- IRSD, Université de Toulouse, INSERM, INRA, ENVT, UPS, Toulouse, France
| | - E Miele
- Department of Translational Medical Science, Section of Pediatrics, University of Naples 'Federico II', Naples, Italy
| | - R Orel
- Department of Gastroenterology, Hepatology and Nutrition, Children's Hospital, University Medical Centre, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - C Pienar
- Department of Pediatrics, 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - C Ribes-Koninckx
- Department of Paediatric Gastroenterology, Hepatology & Nutrition, La FE University Hospital, Valencia, Spain
| | - M Thomson
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, UK
| | - C Tzivinikos
- Department of Paediatric Gastroenterology, Al Jalila Children's Specialty Hospital, Dubai, UAE
| | | | - A John
- Medical School, Swansea University, Swansea, Wales, UK
| | - J G Williams
- Medical School, Swansea University, Swansea, Wales, UK
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Extraintestinal Manifestations Are Associated With Disease Severity in Pediatric Onset Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2020; 71:40-45. [PMID: 32187141 DOI: 10.1097/mpg.0000000000002707] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The aim of this study was to investigate a possible association between extraintestinal manifestations (EIM) and a more severe disease course in pediatric onset inflammatory bowel disease (pIBD). METHODS This study compares the disease course of pIBD patients (IBD diagnosis <15 years of age) with and without EIM in a population-based cohort from Denmark. Patients diagnosed with pIBD between 1998 and 2008 were included in the study and followed until December 31, 2014. Data on phenotype, treatment, relapses, and the temporal relationship between IBD relapses and activity of EIM were collected at end of follow-up by manual revision of patient charts. RESULTS Of 333 pIBD patients, 14 (4.2%) had EIM at time of diagnosis and 47 (14.1%) developed EIM during follow-up. Median follow-up time was 9.6 years for patients with EIM and 8.8 years for patients without. In ulcerative colitis, EIM were associated with an increased risk of biological treatment and surgery (hazard ratio: 2.6; 95% confidence interval [CI]: 1.3-5.5, P = 0.008 and 2.9 [95% CI: 1.1-7.7, P = 0.03], respectively). In Crohn disease, EIM were associated with an increased relapse rate (1.3 [95% CI: 1.1-1.5], P = 0.001). Lastly, we found a positive temporal relationship between relapse of IBD and EIM activity. CONCLUSION The presence of EIM is associated with a more severe disease course in pIBD. This should be considered when deciding treatment options, as a more aggressive treatment approach could be warranted in patients with EIM. However, prospective studies are needed to fully evaluate this.
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Sýkora J, Pomahačová R, Kreslová M, Cvalínová D, Štych P, Schwarz J. Current global trends in the incidence of pediatric-onset inflammatory bowel disease. World J Gastroenterol 2018; 24:2741-2763. [PMID: 29991879 PMCID: PMC6034144 DOI: 10.3748/wjg.v24.i25.2741] [Citation(s) in RCA: 230] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/01/2018] [Accepted: 06/25/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To perform a comprehensive review and provide an up-to-date synopsis of the incidence and trends of inflammatory bowel disease (IBD). METHODS We systematically searched the MEDLINE (source PubMed), EMBASE and Cochrane Library databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (period: 1985-2018) to identify studies reporting population-based data on the incidence of pediatric-onset (< 19 years at diagnosis) IBD in full manuscripts. Two authors carried out screening and data extraction. Choropleth interactive maps and temporal trends were used to illustrate the international differences and incidences of and changes in IBD and subtypes. RESULTS In total, one hundred forty studies reporting data from 38 countries were considered in this review. The highest annual pediatric incidences of IBD were 23/100000 person-years in Europe, 15.2/100000 in North America, and 11.4/100000 in Asia/the Middle East and Oceania. The highest annual incidences of Crohn's disease (CD) were 13.9/100000 in North America and 12.3/100000 in Europe. The highest annual incidences of ulcerative colitis (UC) were 15.0/100000 in Europe and 10.6/100000 in North America. The highest annual incidences of IBD-unclassified (IBD-U) were 3.6/100000 in Europe and 2.1/100000 in North America. In the time-trend analyses, 67% of CD, 46% of UC and 11% of IBD-U studies reported an increasing incidence (P < 0.05). The risk of IBD is increasing among first-generation of migrant populations. CONCLUSION Globally, the incidence of IBD varies greatly by geographical areas. The steadily increasing incidence of pediatric IBD over time indicates its emergence as a global disease, suggesting that studies should investigate the environmental risk factors among pediatric cohorts.
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Affiliation(s)
- Josef Sýkora
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Faculty Hospital, Pilsen 304 60, Czech Republic
| | - Renáta Pomahačová
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Faculty Hospital, Pilsen 304 60, Czech Republic
| | - Marcela Kreslová
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Faculty Hospital, Pilsen 304 60, Czech Republic
| | - Dominika Cvalínová
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Faculty Hospital, Pilsen 304 60, Czech Republic
| | - Přemysl Štych
- Department of Applied Geoinformatics and Cartography, Charles University in Prague, Faculty of Science, Prague 128 43, Czech Republic
| | - Jan Schwarz
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Faculty Hospital, Pilsen 304 60, Czech Republic
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Abstract
Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are lifelong conditions that often begin in childhood. The implications of IBD are of particular importance in children because of the potential negative effects on growth, development, psychosocial function, and overall wellbeing. The key management strategy is to achieve sustained control of intestinal inflammation and monitor for potential complications of the disease and side effects of therapies. Overall, the evidence on the management of IBD in children is less extensive than in adults, but good quality multicenter studies and various guidelines and society consensus statements are available. This review summarizes the evidence on the pathophysiology, diagnosis, and approaches to management of children and adolescents with IBD.
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Affiliation(s)
- Stephanie B Oliveira
- Cincinnati Children's Hospital Medical Center Ringgold standard institution, Cincinnati, OH, USA
| | - Iona M Monteiro
- Rutgers New Jersey Medical School Ringgold standard institution - Pediatrics, Newark, NJ 07103-2714, USA
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11
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Ludvigsson JF, Büsch K, Olén O, Askling J, Smedby KE, Ekbom A, Lindberg E, Neovius M. Prevalence of paediatric inflammatory bowel disease in Sweden: a nationwide population-based register study. BMC Gastroenterol 2017; 17:23. [PMID: 28143594 PMCID: PMC5282815 DOI: 10.1186/s12876-017-0578-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 01/18/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND We evaluated the impact of different case definition algorithms on the prevalence of paediatric inflammatory bowel disease (IBD), Crohn's disease (CD) and ulcerative colitis (UC) and to compare the occurrence of certain diseases compared to matched controls. METHODS Paediatric patients (<18 years) were identified via ICD codes for UC and CD in Swedish registers between 1993 and 2010 (n = 1432). Prevalence was defined as ≥2 IBD-related visits. Prevalence of treated children in 2010 was defined as ≥2 IBD-related visits with one visit and ≥1 dispensed IBD-related drug prescription in 2010. To test the robustness of the estimates, prevalence was also calculated according to alternative case definitions. The presence of rheumatic, hepatobiliary, pancreatic, and dermatologic diseases were compared with age-/sex-/county-of-residence-matched general population controls. RESULTS The IBD prevalence was 75/100,000 (CD: 29/100,000; UC: 30/100,000; patients with IBD-U: 16/100,000). Prevalence of treated disease in 2010 was 62/100,000 (CD: 23/100,000; UC: 25/100,000; patients with IBD-U: 13/100,000). When age restrictions were employed, the prevalence estimate decreased (<17y: 61/100,000, <16y: 49/100,000 and <15y: 38/100,000). Compared to general population controls (n = 8583), children with IBD had a higher prevalence of dermatologic (4.7% vs. 0.6%), hepatobiliary (including primary sclerosing cholangitis) (5.5% vs. 0.1%), pancreatic (1.7% vs. 0%) and rheumatic diseases (7.2% vs. 1.2%; all P < 0.01). CONCLUSIONS The overall prevalence of paediatric IBD in Sweden was similar to that in earlier regional cohorts. IBD patients had a higher prevalence of comorbid conditions than matched general population controls.
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Affiliation(s)
- J F Ludvigsson
- Department of Paediatrics, Örebro University Hospital, Örebro, Sweden. .,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
| | - K Büsch
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - O Olén
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.,Department of paediatric gastroenterology and nutrition, Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - J Askling
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.,Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - K E Smedby
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - A Ekbom
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - E Lindberg
- Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
| | - M Neovius
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
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Larsen MD, Baldal ME, Nielsen RG, Nielsen J, Lund K, Nørgård BM. The incidence of Crohn's disease and ulcerative colitis since 1995 in Danish children and adolescents <17 years - based on nationwide registry data. Scand J Gastroenterol 2016; 51:1100-5. [PMID: 27160395 DOI: 10.3109/00365521.2016.1172340] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Worldwide the incidence of pediatric Crohn's disease (CD) and ulcerative colitis (UC) is suspected to be increasing. Based on unselected nationwide register data the aim of this study is to examine the change in incidence of CD and UC in children and adolescents in Denmark. MATERIALS AND METHODS All children and adolescents <17 years with a diagnosis of CD or UC registered in the Danish National Patient Registry from 1 January 1995 to 31 December 2013 were included. Using a Poisson regression model we estimated the incidence rate ratio (IRR) for the annual change in the incidence adjusted for gender and age. The cumulative incidence was described using Kaplan-Meier survival analyses. RESULTS The IRR for CD was 1.052 (95% CI: 1.039-1.065), and for UC the IRR was 1.022 (95% CI: 1.011-1.033), adjusted for age and gender. The incidence rate of CD increased during the study period to 10.0 (95% CI: 7.5-13.2) per 100,000 person years for girls and 9.4 (95% CI: 7.0-13.2) for boys, in 2013. Similar, the incidence of UC increased to 7.2 (95% CI: 5.0-9.9) per 100,000 person years for girls and 6.2 (95% CI: 4.3-8.7) for boys. CONCLUSIONS In a period of 19 years from 1995 to 2013 we found an increasing incidence for pediatric UC and CD, especially pronounced for CD.
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Affiliation(s)
- Michael Due Larsen
- a Research Unit of Clinical Epidemiology , Institute of Clinical Research, University of Southern Denmark , Odense , Denmark ;,b Center for Clinical Epidemiology , Odense University Hospital , Odense , Denmark
| | - Mira Eggebrecht Baldal
- a Research Unit of Clinical Epidemiology , Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Rasmus Gaardskær Nielsen
- c Hans Christian Andersen Children's Hospital, Odense University Hospital, and Research Unit of Pediatric , Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Jan Nielsen
- a Research Unit of Clinical Epidemiology , Institute of Clinical Research, University of Southern Denmark , Odense , Denmark ;,b Center for Clinical Epidemiology , Odense University Hospital , Odense , Denmark
| | - Ken Lund
- b Center for Clinical Epidemiology , Odense University Hospital , Odense , Denmark
| | - Bente Mertz Nørgård
- a Research Unit of Clinical Epidemiology , Institute of Clinical Research, University of Southern Denmark , Odense , Denmark ;,b Center for Clinical Epidemiology , Odense University Hospital , Odense , Denmark
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13
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Malmborg P, Hildebrand H. The emerging global epidemic of paediatric inflammatory bowel disease--causes and consequences. J Intern Med 2016; 279:241-58. [PMID: 26355194 DOI: 10.1111/joim.12413] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Two decades ago, paediatric inflammatory bowel disease (IBD) drew only modest interest from the international paediatric community. Since then, dramatically globally increasing incidence rates have made childhood-onset IBD a priority for most paediatric gastroenterologists. The emerging pandemia of paediatric IBD has fuelled a quest to identify the recent changes in early life exposures that could explain the increasing risk for IBD amongst today's children. Treatment of children with IBD should aim for symptom control but should also target restoration of growth and prevention of pubertal delay. The paediatric IBD phenotype seems to be characterized by more extensive disease location, and some comparative studies have suggested that childhood-onset IBD also represents a more severe phenotype than the adult-onset IBD form. In this review, we analyse recent global incidence trends of paediatric IBD. We present an update on the known and suggested risk factors that could explain the emerging global epidemia of paediatric IBD. We also draw attention to differences in treatment between children and adults with IBD. Finally, we highlight latest follow-up studies that question the proposed dynamic and aggressive nature of childhood-onset IBD.
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Affiliation(s)
- P Malmborg
- Department of Women's and Children's Health, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - H Hildebrand
- Department of Women's and Children's Health, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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14
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Holmes EA, Xiang F, Lucas RM. Variation in incidence of pediatric Crohn's disease in relation to latitude and ambient ultraviolet radiation: a systematic review and analysis. Inflamm Bowel Dis 2015; 21:809-17. [PMID: 25789921 DOI: 10.1097/mib.0000000000000320] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pediatric Crohn's disease (CD) is a lifelong, debilitating, and costly disease. In previous studies, CD incidence increased with higher geographic latitude in the Northern Hemisphere. This may indicate a role for lower vitamin D status as a risk factor for CD. Analysis of worldwide incidence of pediatric CD has not been previously reported. METHODS We undertook a systematic review of population-based studies reporting incidence of pediatric CD and published between 2003 and 2013. Included studies had well-defined diagnostic criteria for CD, evidence of high case ascertainment, reported incidence according to age group, and provided a specific location. Average daily ambient ultraviolet radiation (UVR) for each location was derived from satellite data. Negative binomial regression was used to assess the association between pediatric CD incidence and latitude and ambient UVR, adjusting for the study year. RESULTS Twenty-eight articles provided 39 incidence data points. Incidence of pediatric CD increased with higher latitude, and in association with a greater number of months where the average daily UVR was lower than a previously published threshold of 1.488 kJ/m. Incidence of pediatric CD increased over calendar time. CONCLUSIONS After applying rigorous quality assessment criteria, and including only population-based studies, there was a modest increase in incidence of pediatric CD with higher latitude and greater number of months with low ambient UVR. Reporting using nonconsistent diagnostic criteria and age groups, with poorly defined geographic locations, makes it difficult to compare data across different studies.
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Affiliation(s)
- Elizabeth A Holmes
- *National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia; and †Telethon Kids Institute, University of Western Australia, Perth, Australia
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15
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Zhulina Y, Udumyan R, Henriksson I, Tysk C, Montgomery S, Halfvarson J. Temporal trends in non-stricturing and non-penetrating behaviour at diagnosis of Crohn's disease in Örebro, Sweden: a population-based retrospective study. J Crohns Colitis 2014; 8:1653-60. [PMID: 25113899 DOI: 10.1016/j.crohns.2014.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/01/2014] [Accepted: 07/19/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM The incidence of Crohn's disease (CD) is continuing to rise in several countries and in others it appears to have already levelled off after a period of increase. We updated our previous population-based study, by re-extraction of all information on patients diagnosed with CD between 1963 and 2010. Our aim was to assess temporal trends in incidence, prevalence and disease phenotype at diagnosis. METHODS Patients of all ages with a potential diagnosis of CD were identified retrospectively by evaluation of medical notes of all current and previous patients at the colitis clinic, Örebro University Hospital amended by computerised search in the inpatient, outpatient, primary care and histopathological records. Diagnosis was confirmed by subsequent evaluation of medical notes. Disease phenotype was defined according to the Montreal classification. RESULTS The incidence increased over time, especially among Crohn's disease, A1 and A3. SaTScan model revealed a statistically significant high incidence during 1991-2010 (p=0.0001). The median age at diagnosis increased from 28 (3-79) years to 37 (5-87) years (p=0.0002). The point prevalence increased from 21/10(5) (14-32) in 1965 to 267/10(5) (244-291) in 2010. Non-stricturing and non-penetrating disease at diagnosis increased from 12.5% in 1963-1965 to 82.3% in 2006-2010 (p<0.0001). CONCLUSION The incidence of CD increased over time, although it seemed to be plateauing during the most recent decades. A striking increase in non-stricturing, non-penetrating disease at diagnosis was observed, suggesting earlier diagnosis or phenotypic change. The observed point prevalence in 2010 is among the highest reported.
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Affiliation(s)
- Yaroslava Zhulina
- Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
| | - Ruzan Udumyan
- Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital, Örebro, Sweden.
| | - Ida Henriksson
- Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
| | - Curt Tysk
- Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital, Örebro, Sweden.
| | - Jonas Halfvarson
- Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
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Abstract
BACKGROUND Pediatric inflammatory bowel disease (IBD) is increasingly recognized in developing countries; however, the incidence and trend over time have not been reported. METHODS This retrospective study included children diagnosed with IBD in gastroenterology centers in the Kingdom of Saudi Arabia between 2003 and 2012. The date of birth, date and age at diagnosis, gender, and final diagnosis were collected on special forms. Clinical, laboratory, imaging, endoscopy, and histopathology results were reviewed to confirm the final diagnosis. Descriptive statistics were used to compare ulcerative colitis and Crohn's disease in different age groups, and significance was assessed by the chi-square test. Incidence rates and trend over time were analyzed with the assumption of Poisson distribution. The incidence rate over time was compared in 2 periods (2003-2007 and 2008-2012). A P value of <0.05 and 95% confidence intervals were used to assess the significance and precision of the estimates. RESULTS A total of 340 Saudi Arabian children aged 0 to 14 years were diagnosed. The mean incidence rate per 100,000 individuals was 0.2, 0.27, and 0.47 for ulcerative colitis, Crohn's disease, and IBD, respectively. Except for the 0- to 4-year age group, there was a significant increase in incidence over time. CONCLUSIONS Although the incidence of pediatric IBD in Saudi Arabian children is lower than suggested in the Western literature, there is a significantly increasing trend over time. However, decreased trend in the younger age group over time is identified. Prospective studies will be important to identify the risk factors for IBD in different age groups.
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Eszter Müller K, Laszlo Lakatos P, Papp M, Veres G. Incidence and paris classification of pediatric inflammatory bowel disease. Gastroenterol Res Pract 2014; 2014:904307. [PMID: 24778643 PMCID: PMC3979067 DOI: 10.1155/2014/904307] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 02/02/2014] [Indexed: 02/06/2023] Open
Abstract
New epidemiological data suggest that the incidence of inflammatory bowel disease (IBD) is increasing. As a result the burden of disease accounts for more strains to the health care system. The clinical variability queries whether disease characteristics are related to clinical outcome. Our aim was to delineate the latest results of incidence trends in pediatric IBD and to compare the first experiences with Paris Classification. Incidence of pediatric IBD has been increasing in Western Europe and in Eastern Europe. To better characterize IBD, Paris Classification was introduced and validated recently. Ileocolonic involvement is the most characteristic disease location in Crohn's disease (CD) based on applying Paris Classification. The rate of perianal disease and complicated behaviour in CD was similar. It is of interest that CD patients with colonic involvement were less likely to have stricturing disease compared with patients with ileal involvement. In addition, pancolitis dominated in ulcerative colitis (UC). However, most countries lack prospective, nationwide epidemiological studies to estimate incidence trends. This review emphasizes the importance of nationwide registries that enroll all pediatric IBD cases serving reliable data for "everyday practice." These first reports have shown that Paris Classification is a useful tool to determine the pediatric IBD phenotype.
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Affiliation(s)
- Katalin Eszter Müller
- 1st Department of Pediatrics, Semmelweis University, 53 Bókay Street, Budapest 1083, Hungary
| | - Peter Laszlo Lakatos
- 1st Department of Medicine, Semmelweis University, Korányi S. Street 26A, Budapest 1083, Hungary
| | - Maria Papp
- 2nd Department of Medicine, University of Debrecen, Nagyerdei Körút 98, Debrecen 4032, Hungary
| | - Gabor Veres
- 1st Department of Pediatrics, Semmelweis University, 53 Bókay Street, Budapest 1083, Hungary
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Gulinaer A, Sang W, Shi XL, Zhang W, Li XX. Clinical and pathologic characteristics of inflammatory bowel disease. Shijie Huaren Xiaohua Zazhi 2014; 22:1027-1032. [DOI: 10.11569/wcjd.v22.i7.1027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical and pathological characteristics of inflammatory bowel disease to raise the early diagnosis of this disease.
METHODS: One hundred and twenty-two cases of inflammatory bowel disease including 101 cases of ulcerative colitis and 21 cases of Crohn's disease were analyzed.
RESULTS: Non-necrotizing granuloma, fissure ulcer and chronic inflammation were morphological features of Crohn's disease. Massive inflammatory cell infiltration in the lamina propria, destroyed glands and reduced secretion, and polyangitis were the hallmarks of ulcerative colitis.
CONCLUSION: The diagnosis of inflammatory bowel disease should be made based on endoscopic, macroscopic and clinical findings. Awareness of the clinical and pathologic features of inflammatory bowel disease can help make an early diagnosis of this disease.
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Büsch K, Ludvigsson JF, Ekström-Smedby K, Ekbom A, Askling J, Neovius M. Nationwide prevalence of inflammatory bowel disease in Sweden: a population-based register study. Aliment Pharmacol Ther 2014; 39:57-68. [PMID: 24127738 DOI: 10.1111/apt.12528] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 07/03/2013] [Accepted: 09/21/2013] [Indexed: 01/14/2023]
Abstract
BACKGROUND Regional studies on inflammatory bowel disease (IBD) suggest an increasing prevalence over time, but no nationwide estimate has been published so far. AIM To estimate the IBD prevalence in 2010 in Sweden overall, by disease, and in specific patient segments. METHODS Patients were identified according to international classification codes for ulcerative colitis and Crohn's disease in in-patient care (1987-2010), day surgery and nonprimary out-patient care (1997-2010) in the nationwide Swedish Patient Register. RESULTS Requiring two or more diagnoses of IBD in nonprimary care, a total of 61 344 individuals with physician-diagnosed IBD were alive in Sweden in 2010 (mean age 50 years; 51% men), corresponding to a prevalence of 0.65% (95% CI, 0.65-0.66). The prevalence increased with age, and peaked in women at ages 50-59 years and in men at ages 60-69 years. Adding the requirement of IBD as main (vs. main or contributory) diagnosis code, or diagnosis from an internal medicine/gastroenterology/surgery department did not change the prevalence estimate. Prevalence of actively treated disease (defined as two or more IBD-related visits, of which one occurred in 2010, plus at least one dispensed prescription of IBD-related drugs in 2010) was 0.27% (95% CI, 0.27-0.28). CONCLUSIONS The Swedish nationwide register-based IBD prevalence was higher compared with previous Swedish and international estimates. While prevalence estimates were robust across different case definitions, once two or more visits were required, only about one-third of prevalent patients were drawing resources from specialised care in 2010.
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Affiliation(s)
- K Büsch
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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Agnarsson U, Björnsson S, Jóhansson JH, Sigurdsson L. Inflammatory bowel disease in Icelandic children 1951-2010. Population-based study involving one nation over six decades. Scand J Gastroenterol 2013; 48:1399-404. [PMID: 24164345 DOI: 10.3109/00365521.2013.845799] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM AND BACKGROUND. We describe the changes in incidence and disease location of inflammatory bowel disease (IBD) in children in one country over six decades. Iceland is an island with centralized health information. Children with IBD are cared for in only two hospitals. Iceland is therefore well suited for nationwide epidemiologic studies. MATERIAL AND METHODS. All IBD patients 16 years and younger diagnosed in Iceland from 1950-2010 were included. Patients were identified retrospectively from 1950-1989, and prospectively from 1990-2010, by reviewing pathology and charts for all patients diagnosed with IBD. Criteria for the diagnosis of ulcerative colitis (UC) were history of blood in stools for >3 weeks, characteristic endoscopic appearance of continuous inflammation of the colon, and histologic appearance of acute and chronic inflammation of the colon without granulomata. Criteria of Crohn's disease (CD) were history of abdominal pain, blood in stools, and endoscopic, radiologic, and histologic features of CD. RESULTS. One hundred and ten children were diagnosed with IBD, 61 with UC, 44 with CD, and 5 with indeterminate disease. The median age was 13.7 ± 2.6, with sex distribution varying from decade to decade. From 1980 until 2000, there was a dramatic increase in the incidence of IBD from 1.2 per 100,000 children <16 years of age to 5.6 per 100,000. However, in the past decade, the incidence has plateaued. CONCLUSION. In this population-based pediatric study, we report an increase in the incidence of IBD from 1950-2000. Incidence in Icelandic children is lower than in published studies from other Northern European countries.
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Affiliation(s)
- Ulfur Agnarsson
- Department of Pediatrics, National University Hospital of Iceland , Reykjavik , Iceland
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Petritsch W, Fuchs S, Berghold A, Bachmaier G, Högenauer C, Hauer AC, Weiglhofer U, Wenzl HH. Incidence of inflammatory bowel disease in the province of Styria, Austria, from 1997 to 2007: a population-based study. J Crohns Colitis 2013; 7:58-69. [PMID: 22542057 DOI: 10.1016/j.crohns.2012.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 03/14/2012] [Accepted: 03/15/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND The incidence of inflammatory bowel disease (IBD) varies widely between different countries. This large variation is also observed for the incidence of its main two forms, ulcerative colitis (UC) and Crohn's disease (CD). Controversy exists whether IBD incidence is increasing, especially in western countries. Currently no data are available for Austria. This study therefore aimed to evaluate for the first time the incidence of IBD over an eleven-year period in Styria, a province of Austria with a population of 1.2 million. METHODS All patients with an initial diagnosis of IBD between 1997 and 2007, who were Styrian residents, were eligible for this retrospective study. Data were acquired from electronically stored hospital discharge reports and individual reports by patients and physicians. According to population density Styria was divided into two rural and one urban area. RESULTS Throughout the study period 1527 patients with an initial diagnosis of IBD were identified. The average annual incidence was 6.7 (95% CI 6.2-7.1) per 100,000 persons per year for CD and 4.8 (95% CI 4.5-5.2) for UC. The average annual incidence increased significantly (p<0.01) for both diseases during the 11 year study period. Median age at initial diagnosis was 29 years (range 3-87) for CD and 39 years (range 3-94) for UC. At diagnosis, 8.5% of all IBD patients were <18 years of age. The incidence of both CD and UC was significantly higher in the urban area than in rural areas (CD: 8.8, 95% CI 7.8-9.8 versus 5.5, 95% CI 4.7-6.4 and 5.9, 95% CI 5.3-6.7; [p<0.001]; UC: 5.8, 95% CI 5.1-6.6 versus 4.0, 95% CI 3.4-4.7 and 4.7, 95% CI 4.1-5.4; [p=0.04]). CONCLUSION We observed an overall increase in the incidence of ulcerative colitis and Crohn's disease in a part of Austria during an eleven year period. IBD was more predominant in the largest urban area than in rural areas.
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Affiliation(s)
- W Petritsch
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Austria.
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Al-Mofarreh MA, Al-Mofleh IA. Emerging inflammatory bowel disease in saudi outpatients: a report of 693 cases. Saudi J Gastroenterol 2013; 19:16-22. [PMID: 23319033 PMCID: PMC3603484 DOI: 10.4103/1319-3767.105915] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 02/26/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND/AIM Inflammatory bowel disease (IBD) is a chronic disease of unknown etiology and considered traditionally as a disease of the western world. Recently, rising trends have been observed in countries previously known to have a low prevalence and incidence. The aim of this study is to collect epidemiological data on IBD outpatients and to add data from the Kingdom of Saudi Arabia (KSA) to the available IBD literature. PATIENTS AND METHODS The medical records of 693 Saudi patients with IBD over a period of 17 years, between 1993 and 2009, were reviewed. The demographic and clinical data and methods of diagnosis were retrieved. RESULTS The total number of patients in this cohort was 693. It constituted 238 (34.3%) ulcerative colitis (UC) and 455 (65.7%) Crohn's disease (CD) patients. UC was steady throughout the years, whereas only 1.2 CD patients were diagnosed per year in the first 11 years, and 73.7 per year in the last six years. The median age of UC patients was 34 years, ranging from 10 to 80 years with a peak between 21 and 40 years and in CD it was 27 years, ranging from 11 to 73 years with a peak between 11 and 30 years. There was a male preponderance of 1.5:1 and 2:1, respectively. The rest of the data is discussed in this study. CONCLUSION IBD is no longer a rare disease in KSA. UC is in a steady state, whereas CD is increasing significantly and far outnumbering UC.
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Affiliation(s)
| | - Ibrahim A. Al-Mofleh
- Gastroenterology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Momotani E, Ozaki H, Hori M, Yamamoto S, Kuribayashi T, Eda S, Ikegami M. Mycobacterium avium subsp. paratuberculosis lipophilic antigen causes Crohn's disease-type necrotizing colitis in Mice. SPRINGERPLUS 2012; 1:47. [PMID: 23519342 PMCID: PMC3600126 DOI: 10.1186/2193-1801-1-47] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/29/2012] [Indexed: 02/06/2023]
Abstract
Background: A 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced murine colitis model was developed to investigate the pathogenesis and to evaluate a method of treating human Crohn’s disease. This experimental model rapidly induces colitis similar to human Crohn’s disease lesion in a reproducible manner. However, natural exposure of the human digestive tract to TNBS is unrealistic. A novel animal model based on realistic data is eagerly anticipated in future research on pathogenesis of CD. Method: We evaluated the potency of Map antigen molecules in an effort to develop a novel colitis model using a more realistic source than TNBS. We prepared the Map antigen by ethanol extraction and developed a mouse model in a manner similar to that of the well-known TNBS-induced colitis in mice. In the experiment, seven days after subcutaneous (SC) injection of the antigen into normal C57BL/6 mice, the same antigen in 50% ethanol was injected into the colon by the transanal route with a fine cannula. Results: On the fifth day after the transanal injection, histopathological examination revealed full-thickness necrotizing colitis with erosion and ulcers; severe infiltration with neutrophils, lymphocytes, macrophages, and perforation. However, no change was detected with each single Map-antigen injection. Conclusion: The present results provide a novel animal model for research on CD and may be the key to clarifying the relationship between CD and Map. This is the first evidence that mycobacterium antigen induces necrotizing colitis.
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Affiliation(s)
- Eiichi Momotani
- Research Area of Pathology and Pathophysiology, National Institute of Animal Health, 3-1-5 Kan-nondai, Tsukuba, 305-0856 Japan
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Benchimol EI, Fortinsky KJ, Gozdyra P, Van den Heuvel M, Van Limbergen J, Griffiths AM. Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends. Inflamm Bowel Dis 2011; 17:423-39. [PMID: 20564651 DOI: 10.1002/ibd.21349] [Citation(s) in RCA: 668] [Impact Index Per Article: 51.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Temporal trends in the incidence of pediatric-onset inflammatory bowel disease (IBD) are controversial and a wide range of estimates have been reported worldwide. We conducted a systematic review of research describing the epidemiology of childhood-onset IBD to assess changes in incidence rates over time and to evaluate international differences. METHODS The following electronic databases were searched for articles published 1950-2009: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane IBD/Functional Bowel Disorders Group Specialised Trial Register. All included studies reported incidence or prevalence of IBD, Crohn's disease (CD) or ulcerative colitis (UC). Two authors independently completed the data extraction form for each eligible study. Choropleth maps demonstrated the international incidence of IBD, CD, and UC. Incidence of CD and UC was graphed using data from studies reporting rates in multiple time periods. RESULTS The search yielded 2209 references and review resulted in 139 included studies from 32 countries. A wide range of incidence was reported internationally; however, rates of IBD were not described in most countries. Twenty-eight studies (20.1%) used statistical analysis to assess trends over time, and 77.8% reported statistically significantly increased incidence of pediatric IBD. Of studies calculating statistical trends in CD incidence, 60% reported significantly increased incidence. Of similar UC studies, 20% reported significantly increased incidence. CONCLUSIONS Globally rising rates of pediatric IBD (due primarily to the rising incidence of CD) was demonstrated in both developed and developing nations; however, most countries lack accurate estimates. Analyzing incidence trends may help identify specific environmental and genetic risk factors for pediatric IBD.
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Paediatric inflammatory bowel disease during a 44-year period in Copenhagen County: occurrence, course and prognosis--a population-based study from the Danish Crohn Colitis Database. Eur J Gastroenterol Hepatol 2009; 21:1291-301. [PMID: 19581873 DOI: 10.1097/meg.0b013e32832a4ed6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM To describe the development in incidence, disease localization, activity, surgery and prognosis in two Danish paediatric population-based inflammatory bowel disease (IBD) cohorts comparing the time periods 1962-1987 (period I) and 1998-2006 (period II). MATERIALS AND METHODS Incident IBD patients below 15 years of age were included. Disease localization was classified according to the Montreal classification for ulcerative colitis (UC) patients and into small bowel, large bowel and small and large bowel combined for Crohn's disease (CD) patients. Disease activity and surgery in the first 2 years after diagnosis were assessed. Standardized cancer incidence rates and standardized mortality rates were calculated. RESULTS One hundred and nineteen IBD patients (77 UC and 42 CD) were included. Comparing periods II and I, the incidence rate ratios were 0.81 [95% confidence interval (CI): 0.5-1.4] and 15.6 (95% CI: 7.5-32.7) in UC and CD, respectively. The number of UC patients with extensive disease (E3) increased from period I to II (46.7 vs. 94.1%, P<0.001). No colectomies were performed in UC patients in period II compared with nine in period I (P = 0.13) within the first 2 years after diagnosis. For patients diagnosed in period I, the standardized cancer incidence rate for UC was 37.9 (95% CI: 4.6-136.7) after a median follow-up period of 26 years. CONCLUSION We found a significant 15-fold increase in the incidence of CD and a significant increase in the number of UC patients with extensive disease in period II compared with period I. After a median follow-up time of 26 years, a possible increased risk of colorectal cancer in UC patients was detected.
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Ruuska T, Wewer V, Lindgren F, Malmborg P, Lindquist M, Marthinsen L, Browaldh L, Casswall T, Kalliomäki M, Grönlund J. Granulocyte-monocyte adsorptive apheresis in pediatric inflammatory bowel disease: results, practical issues, safety, and future perspectives. Inflamm Bowel Dis 2009; 15:1049-54. [PMID: 19137602 DOI: 10.1002/ibd.20859] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The purpose of the study was to collect data on granulocyte-monocyte adsorptive apheresis (GMA) for the treatment of corticosteroid-dependent (SD) or corticosteroid-resistant (SR) inflammatory bowel disease (IBD) in children from 3 Nordic countries to evaluate its efficacy and safety and to assess practical issues. METHODS Retrospective data on 37 children treated with GMA were collected. In all, 22 children had ulcerative colitis (UC), 13 Crohn's disease (CD), and 2 had indeterminate colitis (IC). Their mean age was 13.2 years, range 5-17 years, and mean duration of disease was 2.4 years, range 1 month to 6 years. Indication for treatment in the UC group was SD in 11 cases, SR in 6 cases, and other reasons in 5 cases. The corresponding numbers in the CD group were SD in 8 cases, SR in 2 cases, and other reasons in 3 cases. In the IC group, 1 had SD and 1 was refractory to steroids, azathioprine, and infliximab. Efficacy was evaluated by severity indices: the Pediatric Ulcerative Colitis Activity Index (PUCAI) and the Pediatric Crohn's Disease Activity Index (PCDAI) and tapering of corticosteroids. RESULTS PUCAI and PCDAI decreased significantly in both groups after 3 months (P = 0.0007, P = 0.025). The dosage of corticosteroid was significantly reduced in the UC group by the end of GMA (P = 0.004) and this response continued after 3 months. Relapse was seen in 2 patients with UC and 3 patients with CD after 3 months follow-up. CONCLUSIONS GMA seems to be an effective and safe treatment in 81% of the SD or SR pediatric IBD patients, especially in those with UC.
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Affiliation(s)
- T Ruuska
- Department of Paediatrics, Tampere University Hospital, Finland.
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