Incidence Of Pediatric Inflammatory Bowel Disease Research Articles

Epidemiology of pediatric inflammatory bowel disease: A systematic review of international trends

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. 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. 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. 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.

Incidence trends of pediatric inflammatory bowel disease in Finland, 1987–2003, a nationwide study

The present study aimed to characterize the incidence of pediatric inflammatory bowel disease (IBD) in Finland and determine its temporal trends. The patients' data were based on the database of the Social Insurance Institution. New cases diagnosed with IBD at the age <18 years in Finland between years 1987-2003 were included. Annual incidence rates were calculated per 100,000 pediatric populations (with 95% confidence intervals [CI]). The country is divided into 21 hospital districts and regional differences were evaluated accordingly. The incidence of pediatric IBD increased from 5 per 100,000 in 1987 to 15 per 100,000 in 2003. The average rate of increase was 6.5% per year (95% CI 5.4%-7.5%). The trends were comparable for boys and girls, also by age group. Information on disease subtype was available from 1992 and during this 12-year period the incidence of Crohn's disease (CD) increased from 2-5 per 100,000 and that of ulcerative colitis (UC) from 4-9 per 100,000. Our results demonstrate a very high incidence rate for childhood IBD and in particular UC in Finland. Furthermore, a rapid increase took place nationwide in the incidence of both CD and UC during the past two decades.

Changing pattern in incidence and management of paediatric inflammatory bowel disease in southwest of England from 1997 to 2007: Abstract G111 Table 1

<h3>Introduction</h3> In 1997, a national prospective survey (British Paediatric Surveillance Unit (BPSU)) of childhood (&lt;16 years) inflammatory bowel disease (IBD) in the UK provided the best international prospective incidence data of a large IBD cohort; it documented a national incidence of 5.2 /100 000. 33 children were from the South West (SW) region. It is not possible to repeat the national study because the numbers are large. Hence a regional audit was designed. <h3>Aims</h3> (1) To document the current incidence of IBD and analyse the changes compared to the BPSU survey; (2) whether children are being diagnosed in concordance with ESPGHAN9s Porto criterion and receiving appropriate treatment in line with best practice (BSPGHAN Guidelines on management of IBD, 2008). <h3>Methodology</h3> Data were collected from 13 paediatric centres in the South West using international diagnosis codes (ICD10) identifying newly diagnosed cases of IBD including Crohn9s disease (CD), ulcerative colitis (UC) and indeterminate colitis (IC). Patient details were correlated with departmental database. The population data were obtained from the office of National Statistics. This project is approved by the local audit committee. <h3>Results</h3> All 13 centres responded. There were 51 newly diagnosed children with IBD during 2007 compared with 33 in 1997. 45 cases were diagnosed at the regional centre and were on the database; 6/51 from two centres were not. The details of the incidence figures are given in the following table 1. 43 cases were analysed in detail. 17.6% of cases had an input by an adult surgeon. Time interval from symptoms to referral to a paediatric gastroenterologist is a mean of 9.9 months (1–58 months) and time interval from symptoms to treatment is 13.8 months. 97% of CD and IC cases had barium meal studies. 39/43 (90.6%) had full colonoscopy. Upper GI involvement was seen in 35% and pancolitis in 27%. 70% of CD cases were treated with diet. <h3>Conclusion</h3> There is a definite increase in the incidence of paediatric IBD in the SW England. The increase is not only in the number of CD but more significantly in UC. The IC incidence remains stable. There is a significant delay in time period from onset of symptoms to referral to a paediatric gastroenterologist.

Characteristics and Trends in the Incidence of Inflammatory Bowel Disease in Korean Children: A Single-Center Experience

Inflammatory bowel disease (IBD) is rare in Asian children and few reports on pediatric IBD have appeared. We, therefore, investigated the incidence trends and clinical characteristics of pediatric IBD in Korea. We enrolled 48 children with Crohn's disease (CD) and 14 children with ulcerative colitis (UC) from 1996 to 2007. Trends in annual enrollment and clinical characteristics were retrospectively evaluated by medical record review. During the 12 years of observation, the number of new enrollments gradually increased. CD showed male predominance (33 boys, 15 girls), but more females presented with UC (4 boys, 10 girls). A relevant family history was observed in 3 (4.9%) of the 61 unrelated families. The most common presenting symptom was abdominal pain (67%) in CD and hematochezia (93%) in UC. Growth delay was observed in 10% of CD patients, but not in any of the UC patients. In CD, colonic involvement occurred in 87% of patients, ileal involvement in 87%, and both the small bowel and colon were affected in 75%. With UC, pancolitis occurred in 43% of patients, left-sided colitis in 36%, and proctitis in 21%, including all three patients with appendiceal orifice inflammation. The most frequent disease behavior was inflammatory in 85% of patients, but perianal fistula was noted in 50% of CD patients. This study showed that the incidence of pediatric IBD has been rapidly increasing in Korea in recent years. Relevant family history is less prevalent and phenotypic expression differs from what is seen in Western countries.

The incidence of inflammatory bowel disease in the pediatric population of Southwestern Ontario

Purpose Despite a rising worldwide incidence of inflammatory bowel disease (IBD), few data exist on Canadian children. We reviewed the incidence of IBD in all children 17 years or younger in Southwestern Ontario. Materials and Methods A chart review from 1997 to 2006 revealed 123 children with IBD. Patients were divided into 2 groups according to year of diagnosis: group 1 = 1997 to 2001 and group 2 = 2002 to 2006. Our catchment population was determined from census data. Results Sex (group 1 = 52% females; group 2 = 45% females, P = .42) and age (group 1 = 12.4 ± 3.6 years; group 2 = 12.9 ± 3.5 years; P = .43) were similar between groups. Although the overall incidence of IBD decreased (group 1 = 14.3 cases/100,000; group 2 = 12.4 cases/100,000), the incidence of Crohn's disease nearly doubled (group 1 = 3.5 cases/100,000; group 2 = 6.01 cases/100,000) while the incidence of ulcerative colitis decreased substantially (group 1 = 10.6 cases/100,000; group 2 = 6.01 cases/100,000). The incidence of indeterminate colitis was 0.2 cases/100,000 for group 1 and 0.4 cases/100,000 for group 2. The rate of surgical intervention decreased over time, with 43% of patients requiring surgery in group 1 and 31% in group 2 ( P = .17). Conclusion Despite a slight decrease in pediatric IBD incidence in Southwestern Ontario, the incidence of Crohn's disease has nearly doubled over the last decade. Reasons for this remain unclear, although given the relatively short time interval, environmental factors, rather than genetic changes, seem more likely.

M2042 The Role of Pregnane X Receptor (PXR/NR1i2) Gene Variants in Inflammatory Bowel Disease

M2042 The Role of Pregnane X Receptor (PXR/NR1i2) Gene Variants in Inflammatory Bowel Disease

Incidence of inflammatory bowel disease in finnish children, 1987–2003

The incidence of inflammatory bowel disease (IBD) has been increasing in Western countries. In younger people, Crohn's disease (CD) predominates over ulcerative colitis (UC), but the finding is not universal. The present study aimed to characterize not only the incidence but also the clinical picture of IBD from 1987 to 2003 in a large pediatric population in Finland. Data were collected from the patient discharge and medical records at the 2 largest university hospitals in Finland. The study population covered a total of 619,340 children, representing 56% of the children <18 years old in the country. All of the cases diagnosed with IBD from 1987 to 2003 were reviewed. Clinical, endoscopic, and histological data were collected. Incidence rates were estimated based on statistical assumptions. A total of 604 cases with IBD were diagnosed during the 17-year period. All of the patients had undergone endoscopy. The diagnosis was CD in 203 (34%) cases, UC in 317 (52%) cases, and indeterminate colitis (IC) in 83 (14%) cases. The mean annual incidence rate increased from 3.9/100,000 (95% confidence interval [CI] 2.5-5.8) in 1987 to 7.0/100,000 (CI 5.0-9.4) in 2003 (P < 0.001). The majority of cases were 12 to <15 years old (n = 200, 33%). Of the patients, 5.1% were <3 years old and 14% were <6 years old. IC was most common in young children; 29% of all IBD patients <3 years of age had IC. Of the patients, 97% had been followed up until the age 18 in the hospitals after initial diagnosis (median follow-up 3.1 years). Of the patients, 45.2% were initially treated with steroids, whereas 17.8% received immunosuppressive agents at the end of the follow-up. Operations had been performed in 21% of the cases before age 18. The median time interval from the diagnosis to the first operation was 1.8 (range 7.8) years. The incidence of pediatric IBD almost doubled in Finland from 1987 to 2003. Surgical intervention was common early in the disease course.

Inflammatory bowel diseases in pediatric and adolescent patients: Clinical, therapeutic, and psychosocial considerations

Inflammatory bowel diseases (Crohn’s disease and ulcerative colitis) primarily affect young adults, but in 15%–25% of cases, the initial disease starts in childhood. Many aspects of inflammatory bowel disease, including initial evaluation, nutritional support, medical and surgical intervention, and the direction of future research, are encountered in both adult and pediatric patients. However, it is important to delineate issues specific to pediatric patients, especially growth velocity impairment, derangements in and treatment of abnormal bone mineralization, and transitional care issues; the lack of extensive randomized, controlled pediatric therapeutic trials is also a concern. This article reviews the epidemiology of pediatric inflammatory bowel disease incidence and prevalence worldwide, clinical issues (including impairments of growth velocity and bone density), diagnostic and therapeutic interventions, and psychosocial issues unique to pediatric patients. Future research directions defined by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and opportunities provided by existing pediatric research databases are highlighted.

The Incidence of Pediatric Inflammatory Bowel Disease in the Netherlands: 1999–2001

ABSTRACTBackgroundThe incidence of inflammatory bowel disease (IBD) seems to be rising. Incidence studies could provide more insight into geographical differences and thereby lead to the identification of etiological factors. The aim of this study was to prospectively assess the incidence of pediatric IBD in the Netherlands from 1999 to 2001, using both an active physician case‐reporting registry and a nationwide pathology database.MethodsAll pediatricians in the Netherlands were sent monthly identification cards to be returned if they had diagnosed a new case of IBD in a pediatric patient. Follow‐up questionnaires were sent to physicians reporting new cases of IBD. The pathology database contains reports from all cytologic and histologic diagnoses made in the Netherlands. Two independent raters searched the database for new IBD cases. Cases identified from the pathology database were labeled as “probable IBD” and “possible IBD.” Cases were cross‐checked across databases on the basis of gender, date of birth, date of biopsy, and place of residence. Age‐specific incidence rates were calculated for the Dutch population for the year 2000.ResultsFive hundred forty‐six probable cases of IBD were identified; 217 cases were labeled as possible. The incidence rate was 5.2 new cases per 100,000 children (&lt;18 years) per year. An increase in incidence with age was observed. Only 24% of the cases were ascertained through the clinical registry.ConclusionThe incidence of IBD cases in the Netherlands is comparable with that reported in other European countries. Epidemiological studies using case reporting by physicians may be underestimates of true incidence rates.

The incidence of pediatric inflammatory bowel disease in the Netherlands: 1999-2001.

The incidence of inflammatory bowel disease (IBD) seems to be rising. Incidence studies could provide more insight into geographical differences and thereby lead to the identification of etiological factors. The aim of this study was to prospectively assess the incidence of pediatric IBD in the Netherlands from 1999 to 2001, using both an active physician case-reporting registry and a nationwide pathology database. All pediatricians in the Netherlands were sent monthly identification cards to be returned if they had diagnosed a new case of IBD in a pediatric patient. Follow-up questionnaires were sent to physicians reporting new cases of IBD. The pathology database contains reports from all cytologic and histologic diagnoses made in the Netherlands. Two independent raters searched the database for new IBD cases. Cases identified from the pathology database were labeled as "probable IBD" and "possible IBD." Cases were cross-checked across databases on the basis of gender, date of birth, date of biopsy, and place of residence. Age-specific incidence rates were calculated for the Dutch population for the year 2000. Five hundred forty-six probable cases of IBD were identified; 217 cases were labeled as possible. The incidence rate was 5.2 new cases per 100000 children (<18 years) per year. An increase in incidence with age was observed. Only 24% of the cases were ascertained through the clinical registry. The incidence of IBD cases in the Netherlands is comparable with that reported in other European countries. Epidemiological studies using case reporting by physicians may be underestimates of true incidence rates.

Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in wisconsin: a statewide population-based study

ObjectiveTo define epidemiologic and clinical characteristics of newly diagnosed pediatric inflammatory bowel disease (IBD) in a large population-based model. Study designAll pediatric gastroenterologists providing care for Wisconsin children voluntarily identified all new cases of IBD during a 2-year period. Demographic and clinical data were sent to a central registry prospectively for analysis. ResultsThe incidence of IBD in Wisconsin children was 7.05 per 100,000, whereas the incidence for Crohn's disease was 4.56, more than twice the rate of ulcerative colitis (2.14). An equal IBD incidence occurred among all ethnic groups, and children from sparsely and densely populated counties were equally affected. The majority (89%) of new IBD diagnoses were nonfamilial. ConclusionsThis study provides novel, prospective, and comprehensive information on pediatric IBD incidence within the United States. The surprisingly high incidence of pediatric IBD, the predominance of Crohn's disease over ulcerative colitis, the low frequency of patients with a family history, the equal distribution of IBD among all racial and ethnic groups, and the lack of a modulatory effect of urbanization on IBD incidence collectively suggest that the clinical spectrum of IBD is still evolving and point to environmental factors contributing to the pathogenesis.

INTERIM RESULTS OF THE BRITISH PAEDIATRIC SURVEILLANCE UNIT'S 1998/9 SURVEY OF THE INCIDENCE OF INFLAMMATORY BOWEL DISEASE

93 INTRODUCTION: No national prospective epidemiological study of paediatric Inflammatory Bowel Disease (IBD) has previously been undertaken in the United Kingdom or Republic of Ireland. To date, all the European data on the incidence of paediatric IBD has either been retrospectively collected or prospectively collected from regions within a country. METHODS: The British Paediatric Surveillance Unit (BPSU) co-ordinates a well established surveillance system via a monthly reporting card that is sent to all Paediatricians and other doctors involved in the care of children. The unit operates in both the United Kingdom and Republic of Ireland. Commencing in June 1998, and finishing in July 1999, all respondents have been asked to prospectively report new cases of IBD that they care for. A detailed postal questionnaire relating to diagnosis and initial management has been sent to those that notify cases. RESULTS: 92% of doctors have returned their reporting cards each month and there have been 332 IBD notifications from June to October inclusive. 235 questionnaires have been returned, 70 of these are not valid for a variety of reasons or are duplicates, and 97 have not been returned to date. There were thus between 165 and 262 new cases of IBD during the initial 5 month period of the study. The latter figure assumes that all the questionnaires still to be returned are valid cases and the former that none are. An initial breakdown of disease type, age and gender is: (Table)TableCONCLUSIONS: These interim figures suggest that the incidence of IBD in the United Kingdom and Republic of Ireland amongst children aged < 16 years is 3.0-4.8 cases / 100,000 / year. Experience gained from this study may be useful for those wishing to undertake similar studies within Europe.