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Paediatric inflammatory bowel disease in New Zealand
Jason Yap1, Alison Wesley, Stephen Mouat
1Paediatric Gastroenterology Service, Starship Children's Health, Auckland District Health Board, Private Bag 92024, Auckland, New Zealand.
Insights
This study tracked paediatric inflammatory bowel disease (IBD) in New Zealand, finding an incidence comparable to other countries but with unique presentation patterns and treatment preferences. Early diagnosis and management are crucial for children with IBD.
Area of Science:
- Gastroenterology
- Paediatric Medicine
- Epidemiology
Background:
- Paediatric inflammatory bowel disease (IBD) is a chronic condition affecting children.
- Understanding the epidemiology and clinical features of paediatric IBD is essential for effective healthcare planning.
Purpose of the Study:
- To determine the incidence, clinical presentation, and initial management strategies for paediatric inflammatory bowel disease (IBD) in New Zealand.
- To provide insights into the demographic and clinical characteristics of paediatric IBD in a New Zealand context.
Main Methods:
- A prospective surveillance study was conducted in New Zealand from 2002 to 2003.
- Paediatricians and healthcare professionals were surveyed monthly for new cases of paediatric IBD.
Main Results:
- The estimated incidence of paediatric IBD was 2.9 per 100,000 children annually, with Crohn's disease being more common than ulcerative colitis.
- The mean age at diagnosis was 11 years, with a significant delay from symptom onset to diagnosis.
- Abdominal pain, rectal bleeding, and diarrhoea were the most common presenting symptoms; the classic triad was rare in Crohn's disease presentations.
Conclusions:
- The incidence of paediatric IBD in New Zealand is at the lower end compared to North America and the UK.
- Crohn's disease is more prevalent than ulcerative colitis, and atypical presentations are common.
- 5-aminosalicylic acid agents and steroids were the primary initial treatments, with immunomodulators used in a quarter of cases.
Aim:
To determine the incidence, presentation, and initial management of paediatric inflammatory bowel disease in New Zealand.
Methods:
A prospective study in collaboration with the New Zealand Paediatric Surveillance Unit was undertaken between 2002-2003. Paediatricians and healthcare professionals working with children were surveyed monthly for cases of paediatric inflammatory bowel disease.
Results:
There were 52 cases(30 males); 34 (66%) Crohn's disease, 9 (17%) ulcerative colitis, and 9 (17%) inflammatory bowel disease type unclassified. The estimated incidence of paediatric inflammatory bowel disease, Crohn's disease, and ulcerative colitis were 2.9, 1.9, and 0.5 per 100,000 per year respectively. Mean age at diagnosis was 11 years with a delay of 8.4 months from clinical presentation to diagnosis. 85% were European, while no Maori or Pacific Islanders had Crohn's disease or ulcerative colitis. The most common symptoms at presentation were abdominal pain (63%), rectal bleeding (57%), diarrhoea (55%), and weight loss (43%). 39% of Crohn's disease patients had perianal disease at presentation. Only 18% of the Crohn's disease patients presented with the classic triad of symptoms-abdominal pain, weight loss, and diarrhoea. Haematological laboratory abnormalities were more common in Crohn's disease. 5-aminosalicylic acid agents were the most common initial therapy followed by systemic steroids. 25% of the paediatric inflammatory bowel disease cohort received immunomodulators.
Conclusions:
The incidence of paediatric inflammatory bowel disease in New Zealand is comparable but at the lower end relative to North America and United Kingdom. There is more Crohn's disease than ulcerative colitis and only a minority of Crohn's disease patients presented with the classic triad of abdominal pain, weight loss, and diarrhoea. 5-aminosalicylic acid preparations and steroids as first line treatment of Crohn's disease were much more common than nutritional therapy. It is rare for New Zealand Polynesian children to develop paediatric inflammatory bowel disease.
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