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Disease Activity Patterns of Paediatric Inflammatory Bowel Disease: A Danish Nationwide Cohort Study (1996-2018)
Mads Damsgaard Wewer1,2, Sabine Jansson2,3, Mikkel Malham2,3
1Gastro Unit, Medical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
Insights
Pediatric inflammatory bowel diseases (IBD) often present with severe activity at diagnosis. While disease activity improves over time, biological treatments did not change remission rates, and colectomies remained frequent in ulcerative colitis patients.
Area of Science:
- Gastroenterology
- Pediatric Gastroenterology
- Epidemiology
Background:
- Inflammatory bowel diseases (IBD) exhibit varied disease activity patterns.
- Understanding these patterns in pediatric populations is crucial for effective management.
Purpose of the Study:
- To characterize disease activity patterns in a Danish nationwide pediatric IBD cohort.
- To assess disease progression and treatment outcomes over time.
Main Methods:
- Retrospective analysis of a nationwide Danish cohort of pediatric Crohn's disease (pCD) and pediatric ulcerative colitis (pUC) patients diagnosed between 1996 and 2018.
- Disease activity assessed at diagnosis based on medication, hospitalizations, and surgeries.
- Longitudinal follow-up to evaluate disease activity at 5 and 10 years post-diagnosis.
Main Results:
- At diagnosis, severe disease activity was prevalent: 87% in pCD and 80% in pUC.
- Five years post-diagnosis, 70% of pCD and 61% of pUC patients achieved no disease activity; at 10 years, this rose to 72% and 64%, respectively.
- Despite the introduction of biological treatments, the proportion of patients with no disease activity remained unchanged, and colectomy rates in pUC were consistently high (16% by 10 years).
Conclusions:
- Pediatric IBD is frequently diagnosed with severe disease activity.
- Disease activity generally improves over 5-10 years, but biological therapies have not improved remission rates.
- Colectomy remains a significant outcome for pediatric ulcerative colitis patients.
Background And Aims:
Inflammatory bowel diseases [IBD] are heterogeneous in the frequency and severity of their flare-ups. We aimed to describe disease activity patterns in a Danish nationwide paediatric IBD cohort.
Methods:
Paediatric patients [<18 years at diagnosis] with Crohn's disease [pCD] or ulcerative colitis [pUC] in the study period from 1996 to 2018 were identified in national registers. Disease activity [severe, moderate-to-mild, remission] was assessed at diagnosis according to medications prescribed, hospitalizations, and surgeries.
Results:
In total, 1965 pCD and 1838 pUC incident patients were included in the cohort. At diagnosis, severe disease activity was found in 87%/80% of pCD/pUC and in addition 6.1% of pUC patients had undergone a colectomy during the first year after diagnosis. Five years after diagnosis, the annual proportions of pCD/pUC with no disease activity were 70%/61%, and 10 years after diagnosis the proportions were 72%/64%. Colectomy was required in 6.1, 12, and 16% of pUC patients after 1, 5 and 10 years. No improvement of disease activity was seen in the proportion of prevalent pCD [N = 2515] and pUC [N = 2428] in the study period 2000-2018 concomitant with the introduction of biological treatment. However, decreasing disease activity was the most common pattern in both pCD and pUC [43 and 47%], respectively.
Conclusions:
pIBD was characterized by a high proportion of patients with severe activity at diagnosis, followed by an improvement after 5 and 10 years of follow-up. Notably, the proportion of patients with no disease activity was unchanged when biological treatment was introduced and the number of colectomies in pUC remained high.
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