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Incidence and Phenotype at Diagnosis of Very-early-onset Compared with Later-onset Paediatric Inflammatory Bowel
E Bequet1, H Sarter2,3, M Fumery4
1Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Lille University Jeanne de Flandre Children's Hospital, University of Lille, Lille, France.
Insights
Very-early-onset inflammatory bowel disease (VEO-IBD) incidence remained stable, unlike early-onset IBD (EO-IBD) which increased. VEO-IBD presents differently, suggesting a genetic cause, while EO-IBD may be linked to environmental factors.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Epidemiology
Background:
- Very-early-onset inflammatory bowel disease (VEO-IBD) is distinct from early-onset IBD (EO-IBD).
- Comparing VEO-IBD (onset <6 years) and EO-IBD (onset 6-16 years) is crucial for understanding disease trajectories.
- Longitudinal data analysis is needed to track incidence and phenotype changes over time.
Purpose of the Study:
- To compare incidence trends and diagnostic phenotypes of VEO-IBD and EO-IBD.
- To analyze changes in IBD presentation based on age at diagnosis.
- To investigate potential etiological differences between VEO-IBD and EO-IBD.
Main Methods:
- Utilized data from a prospective, population-based French registry (1988-2011).
- Analyzed 1412 pediatric IBD cases, categorizing them into VEO-IBD (<6 years) and EO-IBD (6-16 years).
- Compared incidence rates, clinical characteristics, and disease subtypes between the two groups.
Main Results:
- VEO-IBD incidence was low and stable (3% of cases), while EO-IBD incidence significantly increased by 116% (p < 10-4).
- VEO-IBD cases more frequently presented with ulcerative colitis or unclassified IBD (40% vs 26%, p=0.04) and symptoms like rectal bleeding.
- Crohn's disease in VEO-IBD was more likely to involve isolated colonic disease (39% vs 14%, p=0.003).
Conclusions:
- VEO-IBD incidence is stable with a distinct phenotype, suggesting a potential genetic etiology.
- The rising incidence of EO-IBD may be associated with environmental factors.
- Understanding these differences is key for targeted VEO-IBD and EO-IBD management.
Background And Aims:
Very-early-onset inflammatory bowel disease [VEO-IBD] is a form of IBD that is distinct from that of children with an older onset. We compared changes over time in the incidence and phenotype at diagnosis between two groups according to age at IBD diagnosis: VEO-IBD diagnosed before the age of 6 years, and early-onset IBD [EO-IBD] diagnosed between 6 and 16 years of age.
Methods:
Data were obtained from a cohort enrolled in a prospective French population-based registry from 1988 to 2011.
Results:
Among the 1412 paediatric cases [< 17 years], 42 [3%] were VEO-IBD. In the VEO-IBD group, the incidence remained stable over the study period. In contrast, the incidence of EO-IBD increased from 4.4/105 in 1988-1990 to 9.5/105 in 2009-2011 [+116%; p < 10-4]. Crohn's disease [CD] was the most common IBD, regardless of age, but ulcerative colitis [UC] and unclassified IBD were more common in VEO-IBD cases [40% vs 26%; p = 0.04]. VEO-IBD diagnosis was most often performed in hospital [69% vs 43%; p < 10-3]. Rectal bleeding and mucous stools were more common in patients with VEO-IBD, whereas weight loss and abdominal pain were more frequent in those with EO-IBD. Regarding CD, isolated colonic disease was more common in the VEO-IBD group [39% vs 14%; p = 0.003].
Conclusions:
In this large population-based cohort, the incidence of VEO-IBD was low and stable from 1988 to 2011, with a specific clinical presentation. These results suggest a probable genetic origin for VEO-IBD, whereas the increase in EO-IBD might be linked to environmental factors.
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