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Paediatric inflammatory bowel disease in India: a prospective multicentre study
Anshu Srivastava1, Malathi Sathiyasekharan2, Barath Jagadisan3
1Sanjay Gandhi Postgraduate Institute Medical Sciences, Lucknow, Uttar Pradesh.
Insights
Paediatric inflammatory bowel disease (PIBD) in India shows similar patterns to Western countries, but treatments like exclusive enteral nutrition (EEN), biologics, and surgery are underused. Very early onset PIBD (VEOIBD) affects nearly 20% of children.
Area of Science:
- Pediatric gastroenterology
- Inflammatory Bowel Disease (IBD) research
- Clinical epidemiology
Background:
- Paediatric inflammatory bowel disease (PIBD) is a growing global health concern.
- Limited data exists on PIBD demographics and clinical characteristics in India.
- This multicenter study addresses the sparse information on Indian PIBD cases.
Purpose of the Study:
- To evaluate the demographics of PIBD in Indian children.
- To characterize the clinical phenotype and treatment outcomes of PIBD in India.
- To compare very early onset PIBD (VEOIBD) with older PIBD cases.
Main Methods:
- A multicenter study involving children (≤18 years) diagnosed with PIBD.
- Data collection via proforma detailing demographics, clinical profile, and investigations.
- Analysis of disease extent, treatment strategies, and patient outcomes.
Main Results:
- 325 children were enrolled: Crohn's disease (65.2%), ulcerative colitis (28.0%), and IBD unclassified (6.7%).
- Median age at diagnosis was 11 years; 19.2% had VEOIBD.
- While disease phenotype resembles Western cohorts, utilization of EEN, biologics, and surgery was low.
Conclusions:
- PIBD in Indian children shares similarities in disease location and phenotype with Western populations.
- Underutilization of advanced therapeutic options (EEN, biologics, surgery) is noted.
- VEOIBD represents a significant proportion (19.2%) of PIBD cases in India.
Background:
Paediatric inflammatory bowel disease (PIBD) is increasing across the world. However, information from India is sparse. This multicentre study evaluated the demographics, clinical phenotype and outcome of PIBD from India.
Methods:
Data of children (≤18 years) with PIBD were collected using a proforma containing details of demographics, clinical profile, extraintestinal manifestations (EIM), investigations, disease extent and treatment.
Results:
Three hundred twenty-five children [Crohn's disease: 65.2%, ulcerative colitis: 28.0%, IBD unclassified (IBDU): 6.7%, median age at diagnosis: 11 (interquartile range 6.3) years] were enrolled. 6.9% children had family history of IBD. Pancolitis (E4) was predominant in ulcerative colitis (57.8%) and ileocolonic (L3, 55.7%) in Crohn's disease. Perianal disease was present in 10.9% and growth failure in 20.9% of Crohn's disease cases. Steroids were the initial therapy in 84.2%, 5-amino salicylic acid in 67.3% and exclusive enteral nutrition (EEN) in 1.3% cases. Overall, immunomodulators and biologics were given to 84.3 and 17.9% cases, respectively, and 2.9% cases underwent surgery. Very early onset IBD (VEOIBD) was seen in 60 (19.2%) children. IBDU was commoner in the VEOIBD than the older-PIBD (18/60 vs 4/253; P < 0.001). VEOIBD-Crohn's disease patients more often had isolated colonic disease than the older Crohn's disease (45.4% vs 11.8%; P < 0.001). Prevalence of perianal disease, EIM, therapeutic requirements and outcome were not different between VEOIBD and older-PIBD.
Conclusion:
Disease location and phenotype of PIBD in Indian children is similar to the children from the west. However, the therapeutic options of EEN, biologics and surgery are underutilized. VEOIBD accounted for 19.2% of PIBD.
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