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Spectrum and trend of pediatric inflammatory bowel disease: A two-decade experience from northern India
Neelam Mohan1, Shivani Deswal2, Anubhuti Bhardwaj2
1Department of Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta - The Medicity Hospital, Sector - 38, Gurugram, 122 001, India. drneelam@yahoo.com.
Insights
Pediatric inflammatory bowel disease (IBD) is increasing in northern India, with ulcerative colitis more common than Crohn's disease. Diagnosis is often delayed, especially for Crohn's disease, with a rise in cases observed over two decades.
Area of Science:
- Gastroenterology
- Pediatrics
- Epidemiology
Background:
- Pediatric inflammatory bowel disease (P-IBD) data from northern India is scarce, despite its prevalence in Western countries.
- This study addresses the need for regional data on the clinical spectrum of P-IBD in northern India.
Purpose of the Study:
- To analyze the clinical spectrum of pediatric inflammatory bowel disease (P-IBD) in northern India.
- To identify trends and diagnostic challenges in P-IBD within the region.
Main Methods:
- Retrospective analysis of 126 children (<18 years) diagnosed with IBD between 1999 and 2019.
- Data collected via pre-designed proforma, entered into MS Excel, and analyzed using SPSS v21.0.
- Phenotypes of Ulcerative Colitis (UC) and Crohn's Disease (CD) classified using the Paris classification.
Main Results:
- Ulcerative Colitis (UC) diagnosed in 60.3%, Crohn's Disease (CD) in 34.9%, and IBD-unclassified (IBD-U) in 4.76%.
- Mean age at diagnosis 11.3 years; 12.7% had very early onset IBD (VEOBD). Median time to diagnosis was 12 months, significantly longer (52.5 months) in CD.
- Pancolitis with rectal bleeding (UC) and ileocolonic involvement with abdominal pain (CD) were common presentations. Stricturing disease seen in 27% of CD cases. A 2.75-fold rise in IBD cases noted in the last decade (2010-20).
Conclusions:
- P-IBD is increasing in northern India, with UC more prevalent than CD.
- Significant delays in diagnosis, particularly for CD, were observed.
- Pancolitis and ileocolonic disease are common sites for UC and CD, respectively, with stricturing disease a notable feature in CD.
Background:
Pediatric inflammatory bowel disease (IBD) has been known to be a disease predominant in the west. There is scarcity of data on pediatric IBD (P-IBD) from northern India. The objective of our study was to analyze the clinical spectrum of P-IBD in northern India.
Methods:
A retrospective analysis of 126 children (<18-year old) diagnosed with IBD from January 1999 to December 2019 was done on a pre-designed proforma. It was systematically entered in a MS Excel spreadsheet and analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0. The descriptive phenotypes of Ulcerative colitis (UC) and Crohn's disease (CD) were revised according to the Paris classification.
Results:
Of 126 children, UC was diagnosed in 76 (60.3%), CD in 44 (34.9%) and IBD-unclassified (IBD-U) in six (4.76%) patients. The mean age at diagnosis was 11.3 years; 38.8% were < 10 years with the male: female ratio of 1.6:1. Sixteen children (12.7%) had very early onset IBD (VEOBD). Overall, the median time to diagnosis in IBD was 12 months (interquartile range [IQR]: 3.25-24), which was as high as 52.5 months (IQR: 11-98) in CD. Pancolitis with bleeding per rectum and ileocolonic involvement with pain in abdomen were the commonest presentations in UC and CD, respectively. Stricturing disease was seen in 27% of CD cases. Relapses were seen in 46% (35/76) of U.C and 23% (10/44) of CD kids. Step-up treatment protocol was employed in them with the use of biologicals in 12% of cases. There was a 2.75-fold rise in the IBD cases in the last 10 years (2010-20). There was reduction in time to diagnosis (21 months vs. 90 months; p - 0.012) and empirical anti-tubercular therapy use (90% vs. 5.8%) in CD over two decades.
Conclusion:
From our experience in a tertiary care centre in northern India, P-IBD is on the rise. UC is more common than CD. Pancolitis and ileocolonic disease are the commonest disease sites in UC and CD, respectively There is a significant delay in the time to diagnosis in CD. Stricturing disease was seen in a quarter of children with CD.
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