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Published on: August 7, 2017
Specific phenotypes may drive an increased incidence of pediatric inflammatory bowel disease in South-Eastern Norway
Svend Andersen1,2, Tomm Bernklev1,3, Ketil Størdal1,4,5
1Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Insights
Pediatric inflammatory bowel disease (PIBD) incidence is rising in South-Eastern Norway, with notable increases in specific disease types like terminal ileitis and proctitis. However, severe complications like stricturing or penetrating disease remain stable.
Area of Science:
- Gastroenterology
- Pediatric Medicine
- Epidemiology
Background:
- Pediatric inflammatory bowel disease (PIBD) incidence has seen a global increase.
- Understanding current trends in PIBD incidence, distribution, and severity is crucial for public health and clinical management.
- The Inflammatory Bowel Disease in South-Eastern Norway (IBSEN) study provides a historical baseline for comparison.
Purpose of the Study:
- To investigate changes in PIBD incidence, disease distribution, and severity in South-Eastern Norway.
- To compare current PIBD data with findings from the original IBSEN study conducted 27 years prior.
- To analyze the phenotypes and complications of Crohn's disease and ulcerative colitis in a pediatric population.
Main Methods:
- A population-based inception cohort study (IBSEN III) was conducted from 2017 to 2019.
- Recruitment included patients under 18 years with PIBD symptoms across nine hospitals.
- Diagnosis and subtyping followed revised Porto criteria, with disease phenotypes classified using the Paris system.
Main Results:
- The crude PIBD incidence rate was 17.8 per 100,000 person-years.
- Crohn's disease (CD) affected 54.6% of patients, with 18% experiencing complications.
- Ulcerative colitis (UC) affected 36.1%, predominantly pancolitis (41%), and 9.3% had IBD unclassified.
- PIBD incidence in those under 16 rose significantly from 4.7 to 13.6 per 100,000 person-years compared to 27 years ago.
- Terminal ileitis and proctitis incidence increased, while stricturing/penetrating disease remained stable.
Conclusions:
- PIBD incidence has significantly increased in South-Eastern Norway since the original IBSEN study.
- Specific trends include a rise in terminal ileitis within CD and proctitis within UC.
- While certain disease manifestations have increased, the rate of stricturing/penetrating disease has remained unchanged.
Objectives:
Pediatric inflammatory bowel disease (PIBD) incidence has increased in recent decades but may be stabilizing, prompting exploration of incidence changes, disease distribution, and severity.
Methods:
From 2017 to 2019, patients under 18 years with PIBD symptoms were recruited from nine hospitals in South-Eastern Norway for Inflammatory Bowel Disease in South-Eastern Norway III (IBSEN III), a population-based inception cohort study. The primary outcome was a diagnosis of any PIBD subtype as defined by revised Porto criteria. Paris classification system defined disease phenotypes, and descriptions of covariates were gathered from patients in IBSEN III.
Results:
We identified 324 PIBD patients, with 216 consenting to the IBSEN III study. The crude incidence rate was 17.8 per 100,000 person-years (PY) (95% confidence interval [CI]: 15.9-19.8). Crohn's disease (CD) was found in 118 patients (54.6%); 48% had ileocolonic distribution, 40% had upper gastrointestinal disease, and 12.8% had perianal disease. Complications (stricturing and/or penetrating) were noted in 18%. Ulcerative colitis (UC) was diagnosed in 78 patients (36.1%), predominantly pancolitis (41%), with 30% having proctitis. One in five suffered severe disease. IBD unclassified was found in 20 patients (9.3%). PIBD incidence in those under 16 was 13.6/100,000 PY, up from 4.7 in the IBSEN study 27 years ago. Terminal ileitis (11%-23%) and proctitis (14%-25%) rose from IBSEN (1990-1993) to IBSEN III, while stricturing/penetrating disease changed insignificantly (17%-16%).
Conclusions:
The incidence of PIBD has risen in South-Eastern Norway, with increased cases of terminal ileitis in CD, unchanged stricturing/penetrating disease, and increased proctitis in UC compared to the original IBSEN study.
Clinical Trial Registration:
ClinicalTrials.gov identifier: NCT02727959.
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