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Inflammatory bowel disease in children and adolescents in Sweden, 1984-1995
E Lindberg1, B Lindquist, L Holmquist
1Department of Paediatrics, Orebro Medical Centre Hospital, Sweden.
Insights
The incidence of ulcerative colitis (UC) in Swedish children increased significantly between 1984-1995, while Crohn's disease (CD) incidence remained stable. Surgery rates for pediatric inflammatory bowel disease (IBD) also decreased during this period.
Area of Science:
- Pediatric Gastroenterology
- Epidemiology
- Inflammatory Bowel Disease (IBD) Research
Background:
- Investigating temporal trends in pediatric inflammatory bowel disease (IBD) incidence and morbidity in Sweden.
- Examining changes from 1984 through 1995 to understand disease evolution.
Purpose of the Study:
- To determine if the incidence and morbidity of IBD in children have changed over an 11-year period.
- To analyze trends in specific IBD subtypes like ulcerative colitis (UC) and Crohn's disease (CD).
Main Methods:
- Prospective study including children aged 15 or younger with a confirmed IBD diagnosis.
- Covered 56.5% of Sweden's pediatric population, encompassing ulcerative colitis (UC), Crohn's disease (CD), indeterminate colitis (IC), and probable Crohn's disease (PCD).
Main Results:
- Overall IBD incidence rose from 4.6 to 7.0 per 100,000 children annually.
- Ulcerative colitis (UC) incidence significantly increased (8% yearly rise), while Crohn's disease (CD) incidence remained stable.
- Surgical intervention rates decreased substantially, from 17.3% to 4.6% over the study period.
Conclusions:
- Swedish pediatric ulcerative colitis (UC) incidence has increased, contrasting with stable Crohn's disease (CD) rates.
- A notable proportion of pediatric IBD cases were classified as indeterminate colitis (IC) or probable Crohn's disease (PCD).
- IBD diagnosis typically occurred in older children (≥11 years), with a decrease in surgical procedures observed.
Background:
A prospective study of inflammatory bowel disease (IBD) in Sweden was performed to investigate whether the incidence and morbidity have changed from 1984 through 1995.
Methods:
Children 15 years of age or less with IBD were included--i.e., those with a definite diagnosis of ulcerative colitis (UC) and Crohn's disease (CD) and those classified as having indeterminate colitis (IC) and probable Crohn's disease (PCD). The study covered 56.5% of the pediatric population of Sweden.
Results:
The diagnosis of IBD was made in 639 children, which corresponds to a mean annual incidence of 5.8 per 100,000. The incidence increased from 4.6 per 100,000 per year from 1984 through 1986 to 7.0 from 1993 through 1995. It reflected an increase in UC from 1.4 to 3.2 per 100,000 per year, which is a significant yearly percentage of increase (8%; confidence interval, 2-14%; P < 0.05). In contrast, no change occurred in the incidence of CD (1.2-1.3 per 100,000). The incidence of IC and PCD also remained fairly stable. The percentages of children who underwent surgery decreased from 17.3% in the first 6 years to 4.6% in the last 6 years (P < 0.001). Surgery was performed in 27.7% of CD and 5.3% of UC cases. The median age at diagnosis was 12.2 years for UC, 13.0 years for CD, 11.2 for IC, and 11.2 for PCD. At diagnosis, 48 children (7.5%) were 5 years of age or less, whereas most of the patients were 11 years of age or more (398 children, 62.3%).
Conclusions:
In Sweden, the incidence of UC has increased, whereas that of CD remains the same. A significant number of children were classified with IC and PCD. In most children, IBD was diagnosed when they were 11 years old or more, but some cases were detected even in those below 6 years of age. A decrease in the frequency of surgery occurred during the study.
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