A questionnaire survey of pediatric inflammatory bowel disease in India.

Abstract

Inflammatory bowel disease (IBD) is not uncommon in children and is an important cause of morbidity. Since information on IBD in Indian children is sparse, the study aimed at highlighting the salient features in them. A questionnaire survey was done among 221 children and adolescents with IBD [ulcerative colitis (UC) 93 (42.1%); Crohn's disease (CD) 122 (55.2%); unclassified (IBD-U) 6 (2.7%)] across seven centers in India. The cut-off age was 18years and below. The mean age of presentation for UC and CD was 10.2 ± 4.4 and 11.0 ± 4.5years, respectively, with no gender difference. Diarrhea (69.9%, p = 0.001) and blood in the stools (90.3%, p = 0.0001) were common in UC, whereas abdominal pain (73.8%, p = 0.01), fever (39.3%, p = 0.0001), anemia (64.7%, p = 0.001), and growth failure (76.2%, p = 0.0001) were common in CD. Extraintestinal manifestations (EIM) were a feature in 23.6 % and 36.1% of UC and CD, respectively. Pancolitis (E3) was predominant in UC (70.9%) and 88% required steroids. Ileocolonic CD (L3) was common in 72.9%; 76.2% required azathioprine for maintenance. Of the children with UC, 11.8% had complications like massive hemorrhage and toxic megacolon, while 27% of CD had fistulae, perianal abscess, stricture, and perforation. Biologicals were used in 0.8% of severe UC and in 12.2% of CD. In UC, 4.3% required surgical intervention. Pediatric inflammatory bowel disease (P-IBD) in India shares similarities with adult-onset IBD. Distinctive features were growth failure and more severe forms of the disease necessitating immunomodulators.