Evolving Trends in Pediatric Inflammatory Bowel Disease Management in Japan: A Decade of Nationwide Data
Miki Urushiyama1, Kunio Tarasawa2, Rintaro Moroi1
1Division of Gastroenterology Tohoku University Hospital Sendai Japan.
Insights
Pediatric inflammatory bowel disease (IBD) management in Japan shows a trend toward less invasive treatments. Biologics and capsule endoscopy use increased, while surgery and other invasive methods decreased for pediatric Crohn's disease and ulcerative colitis patients.
Area of Science:
- Gastroenterology
- Pediatric Medicine
- Medical Trends Analysis
Background:
- Pediatric inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), require evolving management strategies.
- Understanding treatment trends is crucial for optimizing care for young patients.
Purpose of the Study:
- To investigate the management trends of pediatric IBD in Japan over a ten-year period (2012-2022).
- To analyze shifts in the utilization of various therapeutic modalities.
Main Methods:
- Retrospective analysis of a Japanese nationwide database (2012-2022).
- Inclusion of patients aged 15 years or younger diagnosed with CD or UC.
- Examination of trends in biologics, capsule endoscopy, total parenteral nutrition (TPN), elemental diets, surgery, and granulocyte and monocyte apheresis (GMA) using statistical trend tests.
Main Results:
- Significant increase in biologic use for pediatric CD (46.0% to 53.6%) and UC (15.0% to 33.0%).
- Marked rise in capsule endoscopy for CD (6.6% to 16.7%) and decreased use of TPN (8.4% to 3.0%).
- Decreased surgery rates for UC (3.7% to 1.7%) and significant reduction in GMA for UC (12.1% to 2.7%).
Conclusions:
- Pediatric IBD management in Japan has shifted towards increased use of biologics and capsule endoscopy.
- There is a discernible trend away from more invasive treatments like surgery and GMA.
- These findings indicate a move towards less invasive and more targeted therapeutic approaches for pediatric IBD.
Aims:
This study aimed to investigate the trends in pediatric inflammatory bowel diseases (IBD) management in Japan over the past decade.
Methods:
We retrospectively analyzed data from Japan's nationwide database from 2012 to 2022. Patients aged ≤ 15 years diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) were included. Trends in the use of biologics, capsule endoscopy, total parenteral nutrition (TPN), elemental diets, surgery, and granulocyte and monocyte apheresis (GMA) were examined using the Cochrane-Armitage and Jonckheere-Terpstra trend tests.
Results:
Among the 8037 and 6153 pediatric UC and CD admissions, respectively, the use of biologics increased significantly (CD: from 46.0% to 53.6%; UC: from 15.0% to 33.0%, p < 0.0001). The use of capsule endoscopy in pediatric patients with CD increased markedly from 6.6% to 16.7% (p < 0.0001), whereas TPN use decreased from 8.4% to 3.0% (p < 0.0001). Surgery rates for patients with CD remained at approximately 5%, whereas those for patients with UC decreased (from 3.7% to 1.7%, p = 0.002). Elemental diets for pediatric patients with CD increased (from 54.4% to 66.2%, p < 0.0001). The use of GMA decreased significantly in patients with UC (from 12.1% to 2.7%, p < 0.0001).
Conclusion:
The use of biologics and capsule endoscopy has increased in pediatric patients with IBD, whereas the use of more invasive treatments has decreased. These trends suggest a shift toward less invasive and more targeted therapeutic strategies in managing pediatric patients with IBD in Japan.
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