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Outcome of pediatric inflammatory bowel disease in Asian children: a multinational 1-year follow-up study
Pornthep Tanpowpong1, Suporn Treepongkaruna1, James Guoxian Huang2,3
1Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Pediatric inflammatory bowel disease (PIBD) in Asia shows persistent abdominal pain at one year. Treatment improvements are needed, focusing on predictors for remission and flares in pediatric IBD care.
Area of Science:
- Gastroenterology
- Pediatric Medicine
- Inflammatory Bowel Disease Research
Background:
- Limited short-term follow-up data exists for pediatric inflammatory bowel disease (PIBD) in Southeast Asia.
- Epidemiological data on PIBD in Asian countries necessitates further investigation.
Purpose of the Study:
- To analyze and compare baseline and 1-year follow-up (1FU) data for PIBD in Asian children.
- To assess disease outcomes and treatment patterns in a multinational Asian cohort.
Main Methods:
- A multinational network collected data from 368 pediatric patients (<19 years) across 5 Asian countries.
- Gastrointestinal endoscopy was required for PIBD diagnosis, with data collected on demographics, clinical information, outcomes, and treatments at 1FU.
- Statistical analysis identified independent factors for clinical remission and IBD flares at 1 year.
Main Results:
- At 1FU, abdominal pain persisted in 10.5% of Crohn's disease and 7.1% of ulcerative colitis patients.
- Mucosal healing was observed in 21% of CD and 23% of UC cases undergoing assessment endoscopy.
- Independent predictors for 1-year clinical remission in CD included oral prednisolone, antibiotic use, and immunomodulator use; weight loss at diagnosis predicted IBD flares.
Conclusions:
- A significant proportion of children with PIBD experience persistent abdominal pain at 1 year.
- Suboptimal rates of repeat endoscopy and infliximab use, alongside high systemic corticosteroid use, highlight areas for quality improvement.
- Quality improvement initiatives targeting identified predictors can enhance PIBD care in Asia and similar regions.
Background:
Epidemiological data on pediatric inflammatory bowel disease (PIBD) have been reported in Asian countries. However, short-term follow-up data, especially in Southeast Asian countries, are limited.
Purpose:
Analyze and compare the baseline and 1-year follow-up (1FU) data for PIBD in Asian children.
Methods:
The multinational network included patients with PIBD (aged <19 years) in 5 Asian countries (Malaysia, Philippines, Singapore, Sri Lanka, and Thailand). The diagnosis of PIBD requires gastrointestinal endoscopy. The patients' demographics, clinical information, disease- related outcomes, and treatment data at 1FU were collected.
Results:
In 1995-2021, 368 patients were enrolled (Crohn disease [CD], 56.8%; ulcerative colitis [UC], 38%; and inflammatory bowel disease [IBD]-unclassified, 5.2%). At 1FU, symptoms including diarrhea, bloody stools, and nausea/vomiting subsided in <3%, while abdominal pain persisted in 10.5% of patients with CD and 7.1% of patients with UC. Assessment endoscopy was performed at 1FU in 38% of CD and 31% of UC cases, of which 21% and 23% showed mucosal healing, respectively. Oral prednisolone was administered to 55.3% of patients at diagnosis and 26.8% at 1FU, while infliximab was administered to 2.5% and 7.2% of patients at diagnosis and 1FU, respectively. Independent factors of 1-year clinical remission for CD were oral prednisolone (odds ratio [OR], 0.20; 95% confidence interval [CI], 0.06-0.68), antibiotic use (OR, 0.09; 95% CI, 0.01-0.54), and immunomodulator use (OR, 5.26; 95% CI, 1.52-18.22). A history of weight loss at diagnosis was the only independent risk factor of an IBD flare by 1FU (OR, 2.01; 95% CI, 1.12-3.63).
Conclusion:
The proportion of children with PIBD and abdominal pain at 1FU remained high. The rates of repeat endoscopy and infliximab use were suboptimal with high rates of systemic corticosteroid use. Quality improvement based on the aforementioned predictors may enhance PIBD care in this geographic region or similar settings.
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