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Pediatric inflammatory bowel disease: Is it really uncommon in Asian children?
Ujjal Poddar1, Surender Kumar Yachha1, Anshu Srivastava1
1Department of Pediatric Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India.
Insights
Pediatric inflammatory bowel disease (IBD) is increasingly diagnosed in India, with ulcerative colitis more common than Crohn's disease. Most children with IBD require immunomodulators for remission.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Epidemiology
Background:
- Inflammatory bowel disease (IBD) is considered rare in Asian children, with limited data from India.
- This study addresses the scarcity of information on pediatric IBD in the Indian subcontinent.
Purpose of the Study:
- To analyze the experience and characteristics of pediatric IBD cases in India.
- To understand the spectrum, clinical features, and treatment outcomes of IBD in Indian children.
Main Methods:
- Retrospective analysis of prospectively maintained data of 105 children with IBD (July 2001-June 2016).
- Detailed recording of clinical features, endoscopic findings, histopathology, and treatment outcomes.
- Assessment of Crohn's disease phenotype and location using the Paris classification.
Main Results:
- The disease spectrum comprised ulcerative colitis (UC) in 52%, Crohn's disease (CD) in 41%, and IBD-unclassified in 7%.
- A significant increase in pediatric IBD cases was observed in the last 5 years compared to the previous 10 years.
- UC predominantly presented as extensive colitis (75%), while CD cases (74%) had colonic/ileocolonic disease with an inflammatory phenotype (65%).
- Fever, growth failure, abdominal pain, and need for surgery were more frequent in CD than UC (P < 0.0001).
- Remission rates were 94% for UC and 70.6% for CD. Immunomodulators were required in 67% of UC patients for maintenance.
- A significant reduction in empirical antitubercular therapy use was noted over time in CD (76% reduction, P = 0.008).
Conclusions:
- Pediatric inflammatory bowel disease (IBD) is increasingly prevalent in Indian children.
- Ulcerative colitis is more common than Crohn's disease and typically presents as extensive colitis.
- Crohn's disease in this cohort is characterized by an inflammatory phenotype, and most children with IBD require immunomodulators to maintain remission.
Background/Aim:
Inflammatory bowel disease (IBD) is said to be rare in Asian children, and there is scarce information from India. We therefore analyzed our experience of pediatric IBD.
Methods:
Prospectively maintained data of 105 consecutive children [median age 12 (IQR:7-14) years, 71 males] with IBD from July 2001 through June 2016 were retrospectively analyzed. Their detailed clinical features, endoscopic appearance, histopathology, and treatment outcomes were recorded. For Crohn's disease (CD), disease phenotype and disease location were assessed as per Paris classification.
Results:
Disease spectrum includes ulcerative colitis (UC), 55 (52%); CD, 43 (41%); and IBD-unclassified, 7 (7%). There was a significant increase in the number of cases in the last 5 years compared to the previous 10 years (63 vs. 42, r2 = 0.96). Most UC cases (75%) had extensive/pancolitis, 74% of CD had colonic/ileocolonic disease, and 65% had inflammatory phenotype. Fever, growth failure, pain in abdomen, and need for surgery were significantly more frequent in CD than in UC (P < 0.0001). Over a median follow up of 19 (IQR: 7-48) months, remission was achieved in 48 of 51 (94%) UC patients and in 24 of 34 (70.6%) CD patients; an immunomodulator was required to maintain remission in 67% of UC cases. In CD, there was a significant reduction in the use of empirical antitubercular therapy (76%, P = 0.008) with time, and disease progressed in three.
Conclusions:
IBD is not uncommon, and the incidence seems to be increasing among Indian children. UC is more common than CD and is more often an extensive disease. CD is mainly an inflammatory phenotype. The majority of children with IBD required an immunomodulator to maintain remission.
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