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Pediatric inflammatory bowel disease in Greece: 30-years experience of a single center
Konstantina Dimakou1, Ioanna Pachoula1, Ioanna Panayotou1
1First Department of Pediatrics University of Athens (Konstantina Dimakou, Ioanna Pachoula, Ioanna Panayotou, Irini Orfanou, Evagelia Lagona, Eleftheria Roma-Giannikou, George Chouliaras), Athens, Greece.
Insights
Pediatric inflammatory bowel disease (IBD) care has advanced. Over three decades, Crohn's disease (CD) increased significantly while ulcerative colitis (UC) decreased, with younger diagnoses in UC and IBD unclassified (IBDU).
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease (IBD) Research
- Clinical Trends Analysis
Background:
- Significant advancements in pediatric inflammatory bowel disease (IBD) care.
- Need to understand long-term trends in pediatric IBD presentation, management, and outcomes.
- Study focuses on a single pediatric gastroenterology center over three decades.
Purpose of the Study:
- To describe trends in clinical presentation of pediatric IBD over 30 years.
- To analyze changes in management strategies for pediatric IBD.
- To evaluate outcomes of pediatric IBD patients over time.
Main Methods:
- Retrospective review of medical records for children diagnosed with IBD.
- Study period: January 1981 to December 2011.
- Inclusion criteria: Children referred to a pediatric gastroenterology unit.
Main Results:
- 483 children diagnosed with IBD; mean age at diagnosis 9.6 years.
- Prevalence: Ulcerative Colitis (UC) 55.2%, Crohn's Disease (CD) 34.5%, IBD Unclassified (IBDU) 10.1%.
- Significant increase in CD (18.5% to 48.8%) and decrease in UC (79.6% to 33.2%) from 1981-2011.
- Younger age at diagnosis for UC and IBDU compared to CD.
- Treatments included 5-ASA (96.6%), steroids (77.0%), thiopurines (50.2%), biologics (14%); 10% surgery.
Conclusions:
- Most pediatric IBD patients received 5-ASA, steroids, and immunomodulators.
- UC and IBDU patients were diagnosed at a younger age than CD patients.
- A notable shift towards increased CD diagnoses and decreased UC diagnoses occurred over the study period.
Background:
Significant advances have been made in the care of children with inflammatory bowel disease (IBD). We aimed to describe the trends during the last 3 decades in the clinical presentation, management, and outcome of pediatric IBD at a single center.
Methods:
Medical records of children with IBD referred to a pediatric gastroenterology unit from January 1981 to December 2011 were reviewed retrospectively.
Results:
A total of 483 children were diagnosed with IBD, with mean age at diagnosis of 9.6 years (range 6 months - 18 years). Ulcerative colitis (UC) was diagnosed in 267 (55.2%), Crohn's disease (CD) in 167 (34.5%), and IBD unclassified (IBDU) in 49 (10.1%). Children with UC and IBDU were younger than those with CD [mean age at diagnosis 9.2, 8.9, and 10.5 years respectively; P (UC vs. CD)<0.01 and P (IBDU vs. CD)=0.028]. Patients received 5-ASA (96.6%), steroids (77.0%), thiopurines (50.2%), biological agents (14%), and 10% underwent surgical intervention. The cohort was divided into three subgroups according to the date of diagnosis; Group A: 1981-1989, Group B: 1990-1999, and Group C: 2000-2011. During the last two decades a significant increase in CD (Group A 18.5%, Group B 23.8%, Group C 48.8%; P<0.01) compared with the first decade with parallel decrease in UC (Group A 79.6%, Group B 71.9%, Group C 33.2%; P<0.001) was observed.
Conclusions:
Most children received 5-ASA, steroids, and immunomodulators. Patients with UC and IBDU were younger than those with CD. A significant increase in CD with parallel decrease in UC during the last decade was found.
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