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Increasing incidence of Crohn's disease in Victorian children
Nopaorn Phavichitr1, Donald J S Cameron, Anthony G Catto-Smith
1Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
The incidence of Crohn's disease (CD) in Victorian children has significantly increased over three decades. Pediatric CD diagnosis now shows more colonic involvement and increased upper gastrointestinal tract disease detection.
Area of Science:
- Pediatric Gastroenterology
- Epidemiology
- Inflammatory Bowel Disease
Background:
- Crohn's disease incidence is rising in Western countries.
- No prior Australian studies documented pediatric Crohn's disease trends.
- Centralized Victorian pediatric gastroenterology services enabled this study.
Purpose of the Study:
- To investigate changes in pediatric Crohn's disease incidence in Victoria, Australia.
- To analyze shifts in disease patterns and diagnostic methods over time.
Main Methods:
- Retrospective analysis of 351 children (≤16 years) diagnosed with Crohn's disease between 1971-2001.
- Data collected from Royal Children's Hospital and Monash Medical Center, Melbourne.
- Examined incidence rates, patient demographics, clinical markers, and diagnostic procedures.
Main Results:
- Pediatric Crohn's disease incidence rose from 0.128 to 2.0 per 100,000 annually.
- Urban children showed disproportionately higher incidence rates.
- Diagnostic trends included lower erythrocyte sedimentation rate (ESR), higher albumin, increased flexible endoscopy use, and more frequent upper GI/colonic involvement detection.
Conclusions:
- Significant increase in pediatric Crohn's disease incidence observed in Victoria.
- Disease pattern shifted towards more frequent colonic involvement.
- Increased endoscopy use revealed greater upper gastrointestinal tract involvement.
Background:
The incidence of Crohn's disease has been increasing in Western communities, but there are no published studies which have examined this change in children in Australia. The centralization of pediatric gastroenterology services in Victoria provides an opportunity to examine these changes within one state.
Methods:
We undertook a retrospective study over a 31-year period of all children aged 16 years or less initially diagnosed with Crohn's disease at either the Royal Children's Hospital, or Monash Medical Center, Melbourne, Victoria.
Results:
We identified 351 patients who met the diagnostic criteria between 1971 and 2001. The incidence of Crohn's disease in children aged 16 years or less rose from 0.128 to 2.0 per 100,000 per year over the three decades (r = 0.964, P < 0.01). There was a disproportionate over-representation of children from an urban background (incidence rate ratio 1.66, 95% CI 1.28-2.16). Children currently being diagnosed had on average a lower erythrocyte sedimentation rate (ESR) and higher albumin than in previous decades. The use of flexible endoscopy has increased markedly (1970s: 60%; 1990s: 96%, P < 0.05) and the proportion of children recognized at diagnosis with upper gastrointestinal and colonic involvement has increased significantly.
Conclusion:
There has been a significant increase in the incidence of Crohn's disease in Victorian children. The pattern of disease has also changed with colonic disease now more frequent, and inflammatory indices less abnormal. The increased use of endoscopy has established the frequent involvement of the upper gastrointestinal tract.
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