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Multicenter registry of pediatric inflammatory bowel disease from a developing country
Pornthep Tanpowpong1, Settapong Jitwongwai2, Teera Kijmassuwan2
1Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Pediatric inflammatory bowel disease (PIBD) in Thailand shows a high rate of very early onset (VEO-IBD). Initial symptoms like diarrhea and weight loss predict poor remission, while female sex and Crohn's disease predict steroid use.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Epidemiology
Background:
- Rising global incidence of pediatric inflammatory bowel disease (PIBD).
- Scarcity of multicenter collaborative studies on PIBD in developing countries.
- Focus on Thai children with PIBD.
Purpose of the Study:
- Define initial presentation of PIBD in Thai children.
- Determine short-term outcomes of PIBD in Thai children.
- Establish a multicenter registry for PIBD in Thailand.
Main Methods:
- Multicenter study involving four teaching hospitals in Thailand.
- Diagnosis of PIBD confirmed by gastrointestinal endoscopy and histopathology in children under 19.
- Data collection included demographics, clinical information, and 1-year follow-up treatment.
Main Results:
- 72 children diagnosed with PIBD (35 Crohn's disease (CD), 36 ulcerative colitis (UC)).
- 38% of cases were very early onset IBD (VEO-IBD), with a mean age of 7.9 years.
- CD presented with more inflammatory signs (fever, weight loss) and less bloody stools than UC.
- At 1 year, 30.7% failed remission, and 43.7% used systemic corticosteroids.
- Diarrhea and weight issues predicted failure to achieve remission; female sex and CD predicted corticosteroid use.
Conclusions:
- High proportion of VEO-IBD identified in Thai children.
- Crohn's disease (CD) cases showed a greater inflammatory burden at presentation.
- Initial diarrhea and weight issues are independent predictors of poor clinical remission.
- Female sex and CD are independent predictors of corticosteroid use at one-year follow-up.
Background:
Despite the rising incidence of pediatric inflammatory bowel disease (PIBD) globally, multicenter collaborative studies of PIBD children among developing countries remain sparse. We therefore aimed to define the initial presentation and short-term outcomes of Thai children with PIBD from a multicenter registry.
Methods:
Four teaching hospitals participated in this study. A diagnosis of PIBD requires gastrointestinal endoscopy and histopathology in children aged < 19 years. Besides demographics, we collected clinical information and treatment with the data at 1-year follow up.
Results:
We included 35 Crohn's disease (CD), one IBD-unclassified, and 36 ulcerative colitis (UC) children (total n = 72 with 60.6% males). The mean age at diagnosis was 7.9 years (SD 4.1) with 38% being very early onset IBD (VEO-IBD). When compared with UC, the CD children were more likely to exhibit fever (42.3 vs. 13.9%), weight loss/failure to thrive (68.6 vs. 33.3%), and hypoalbuminemia (62.9 vs. 36.1%) but less likely to have bloody stools (51.4 vs. 91.7%) (all P < 0.05). No significant differences in demographics, clinical data and medications used with regards to VEO-IBD status. At 1 year after diagnosis (n = 62), 30.7% failed to enter clinical remission and 43.7% remained on systemic corticosteroids. Diarrhea (OR 9.32) and weight issues (OR 4.92) at presentation were independent predictors of failure to enter clinical remission; and females (OR 3.08) and CD (vs. UC) (OR 3.03) were predictors of corticosteroids use at 1-year follow-up.
Conclusions:
A high proportion of VEOIBD is noted, and CD was more likely to present with significant inflammatory burden. Diarrhea and weight issues at presentation were independent predictors of failure to enter clinical remission; and females and CD (vs. UC) were predictors of corticosteroids use at 1-year follow-up.
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