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Specificities of inflammatory bowel disease in childhood
1IBD Program, University of Toronto, The Hospital for Sick Children, 555 University Avenue, Toronto, Ont. M5G 1X8, Canada. anne.griffiths@sickkids.ca
Insights
Paediatric Crohn's disease incidence is rising, unlike stable ulcerative colitis rates. Genetic susceptibility and diverse symptoms, including growth impairment in Crohn's disease, are key concerns for pediatric inflammatory bowel disease.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease (IBD) Epidemiology
Background:
- Paediatric ulcerative colitis (UC) incidence remains stable, while paediatric Crohn's disease (CD) has increased.
- Both UC and CD incidence rise from middle childhood through adolescence, with CD showing a male preponderance in early onset.
- Familiality suggests significant genetic susceptibility in pediatric inflammatory bowel disease (IBD).
Purpose of the Study:
- To summarize current trends and characteristics of paediatric ulcerative colitis and Crohn's disease.
- To highlight differences in incidence, gender distribution, and symptomatology between UC and CD in children.
- To discuss factors influencing disease presentation and potential therapeutic advancements.
Main Methods:
- Review of epidemiological trends in paediatric IBD.
- Analysis of clinical presentation, including gender distribution and disease extent.
- Discussion of genetic and environmental factors in disease pathogenesis.
Main Results:
- Paediatric CD incidence is increasing, whereas UC incidence is stable.
- Early-onset CD shows a male predominance; paediatric UC has an equal gender distribution.
- Childhood UC is typically extensive; paediatric CD varies in localization. Growth impairment is a frequent complication of paediatric CD.
Conclusions:
- Significant increase in paediatric Crohn's disease necessitates further research into contributing factors.
- Understanding genetic susceptibility is crucial for pediatric IBD pathogenesis.
- Advancements in immunomodulatory and biologic therapies offer potential to reduce the prevalence of chronic intestinal inflammation and its complications.
Abstract:
In parallel with overall population trends, the incidence of paediatric ulcerative colitis (UC) has remained stable, whereas that of paediatric Crohn's disease (CD) has increased in recent decades. Still rare among preschool children, the incidence of both UC and CD rises steadily from middle childhood through adolescence. There is an unexplained preponderance of males with early-onset CD, and an equal gender distribution in paediatric UC. Observations on the familiality of paediatric inflammatory bowel disease (IBD) suggest that genetic susceptibility is particularly important to disease pathogenesis in young patients. In comparison to adult-onset disease, childhood UC is usually extensive but the anatomic localization of paediatric CD varies, as in adults. UC manifests uniformly as bloody diarrhea whereas the symptomatology of paediatric CD is much more diverse. Linear growth impairment frequently complicates chronic intestinal inflammation in paediatric CD. Key contributing factors have been defined; better immunomodulatory therapy and emerging biologic agents will potentially reduce its prevalence.
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