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Investigating Intestinal Inflammation in DSS-induced Model of IBD
Published on: February 1, 2012
A questionnaire survey of pediatric inflammatory bowel disease in India
Malathi Sathiyasekaran1, Sumathi Bavanandam, Srinivas Sankaranarayanan
1Kanchi Kamakoti Childs Trust Hospital, 12 A, Nageshwara Road, Nungambakkam, Chennai, 600 034, India, mal.bwcs@gmail.com.
Insights
Pediatric inflammatory bowel disease (IBD) in Indian children presents similarly to adults but with notable differences. Key features include growth failure and severe disease courses requiring immunomodulators.
Area of Science:
- Gastroenterology
- Pediatrics
- Immunology
Background:
- Inflammatory bowel disease (IBD) is a significant pediatric health concern.
- Data on pediatric IBD (P-IBD) in India is limited, necessitating further research.
- This study focuses on the specific characteristics of IBD in Indian children.
Purpose of the Study:
- To elucidate the epidemiological and clinical features of pediatric IBD in India.
- To identify unique aspects of ulcerative colitis (UC) and Crohn's disease (CD) in Indian children.
- To inform clinical management and research directions for P-IBD in this population.
Main Methods:
- A multicenter questionnaire survey was conducted among 221 children and adolescents (≤18 years) diagnosed with IBD.
- Participants included cases of ulcerative colitis (UC), Crohn's disease (CD), and unclassified IBD (IBD-U).
- Data collection spanned seven centers across India.
Main Results:
- The mean age of presentation for UC and CD was approximately 10-11 years, with no gender predilection.
- Common symptoms included diarrhea and bloody stools in UC, and abdominal pain, fever, anemia, and growth failure in CD.
- Extraintestinal manifestations (EIM) were observed in 23.6% of UC and 36.1% of CD cases. Pancolitis was predominant in UC (70.9%), while ileocolonic disease was common in CD (72.9%). Severe disease courses and complications like toxic megacolon (UC) and fistulae/abscesses (CD) were noted. Immunomodulators and biologicals were utilized, with 4.3% of UC patients requiring surgery.
Conclusions:
- Pediatric IBD in India shares similarities with adult IBD but exhibits distinct features.
- Growth failure and more severe disease presentations requiring immunomodulatory therapy are characteristic of P-IBD in Indian children.
- Findings highlight the need for tailored management strategies for pediatric IBD in the Indian subcontinent.
Background:
Inflammatory bowel disease (IBD) is not uncommon in children and is an important cause of morbidity. Since information on IBD in Indian children is sparse, the study aimed at highlighting the salient features in them.
Materials And Methods:
A questionnaire survey was done among 221 children and adolescents with IBD [ulcerative colitis (UC) 93 (42.1 %); Crohn's disease (CD) 122 (55.2 %); unclassified (IBD-U) 6 (2.7 %)] across seven centers in India. The cut-off age was 18 years and below.
Results:
The mean age of presentation for UC and CD was 10.2 ± 4.4 and 11.0 ± 4.5 years, respectively, with no gender difference. Diarrhea (69.9 %, p = 0.001) and blood in the stools (90.3 %, p = 0.0001) were common in UC, whereas abdominal pain (73.8 %, p = 0.01), fever (39.3 %, p = 0.0001), anemia (64.7 %, p = 0.001), and growth failure (76.2 %, p = 0.0001) were common in CD. Extraintestinal manifestations (EIM) were a feature in 23.6 % and 36.1 % of UC and CD, respectively. Pancolitis (E3) was predominant in UC (70.9 %) and 88 % required steroids. Ileocolonic CD (L3) was common in 72.9 %; 76.2 % required azathioprine for maintenance. Of the children with UC, 11.8 % had complications like massive hemorrhage and toxic megacolon, while 27 % of CD had fistulae, perianal abscess, stricture, and perforation. Biologicals were used in 0.8 % of severe UC and in 12.2 % of CD. In UC, 4.3 % required surgical intervention.
Conclusion:
Pediatric inflammatory bowel disease (P-IBD) in India shares similarities with adult-onset IBD. Distinctive features were growth failure and more severe forms of the disease necessitating immunomodulators.
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