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Disease presentation and clinical course in black and white children with inflammatory bowel disease
Alexandra P Eidelwein1, Richard Thompson, Kristin Fiorino
1Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, MD 21287-2631, USA.
Insights
Pediatric inflammatory bowel disease (IBD) shows racial differences. Black children with IBD experienced more severe disease, including malnutrition and complicated Crohn disease, requiring more aggressive treatment.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Genetics
Background:
- Inflammatory bowel disease (IBD) affects children worldwide.
- Understanding racial and ethnic variations in IBD presentation and course is crucial for equitable care.
Purpose of the Study:
- To compare disease presentation, phenotype, and clinical course between Black and White children diagnosed with IBD.
- To identify potential disparities in IBD management and outcomes based on race.
Main Methods:
- Retrospective review of medical records for 245 pediatric IBD patients over 10 years at a tertiary care center.
- Analysis of demographic data, clinical presentation, disease distribution, extraintestinal manifestations, and treatment outcomes.
- Comparison of disease characteristics and clinical course between Black and White patient cohorts.
Main Results:
- No significant differences were observed in IBD anatomic distribution, symptom presentation, or extraintestinal manifestations between racial groups.
- White children had a higher prevalence of family history of IBD.
- Black children with Crohn disease presented with higher erythrocyte sedimentation rates, lower BMI z-scores, and a greater proportion experienced complicated disease behavior (stricturing and penetrating).
- African American children required more corticosteroids and infliximab, and had lower hemoglobin levels at 12 months post-diagnosis.
Conclusions:
- Racial differences exist in the prevalence of family history and disease phenotype among pediatric IBD patients.
- Black children with IBD, particularly Crohn disease, exhibit a more severe phenotype and disease course, necessitating more intensive treatment strategies.
- Further research is warranted to elucidate the underlying mechanisms driving these observed racial disparities in pediatric IBD.
Objectives:
To compare the disease presentation, disease phenotype, and clinical course between black and white children with inflammatory bowel disease (IBD).
Patients And Methods:
A 10-year retrospective review was undertaken of the medical records of 245 pediatric patients with IBD studied at a tertiary care center.
Results:
In this patient population 24% were black and 76% were white. There were no differences between black and white patients in terms of anatomic distribution of IBD, symptom presentation, and extraintestinal manifestations. A family history of IBD (36.4% vs 17.5%; P = 0.006) was more common in white children. Mean erythrocyte sedimentation rate of black patients with Crohn disease was higher at diagnosis compared with whites (P < 0.001) and a greater proportion of African Americans presented with a body mass index z-score less than -2 (P < 0.009). At 12 months following diagnosis 22.5% of African American children had a hemoglobin level lower than 10 g/dL compared with 4.3% of whites (P = 0.001). African Americans had evidence of more complicating stricturing and penetrating Crohn disease behavior (51.3% vs 27.4%; P = 0.006). African Americans received significantly more corticosteroids and infliximab to treat their IBD compared with whites (P < 0.04).
Conclusions:
This study suggests that for pediatric IBD, there may be racial differences in prevalence of family history and in disease phenotype.
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