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Features and Outcomes of Inflammatory Bowel Disease among Filipino Children in a Tertiary Hospital: An Eleven-year
Pilarica I Caguiat-Jo1, Germana Emerita V Gregorio1
1Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila.
Insights
Pediatric inflammatory bowel disease (IBD) is increasingly diagnosed in the Philippines, with very early-onset IBD linked to poorer remission rates. Diagnostic delay, wasting, and pancolitis in ulcerative colitis patients correlate with higher relapse rates.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Epidemiology
Background:
- Inflammatory bowel disease (IBD), encompassing Crohn's disease, ulcerative colitis, and IBD-unclassified, is a chronic gastrointestinal inflammatory condition.
- Pediatric IBD, while historically less common in Asia, shows a rising incidence, with distinct phenotypes compared to Western populations.
- Limited data exists on pediatric IBD in the Philippines, necessitating local studies on clinical features and outcomes.
Purpose of the Study:
- To characterize the clinico-demographic factors associated with remission and relapse in Filipino pediatric IBD patients.
- To identify predictors of treatment response and disease course in this population.
Main Methods:
- A retrospective review of medical records for patients under 19 diagnosed with IBD between January 2013 and December 2023 at a tertiary government hospital.
- Data collected included clinical, biochemical, imaging, endoscopic, and histologic features, alongside treatment and outcomes.
- Statistical analyses, including Chi-square and T-tests, were used to compare variables, with odds ratios assessing associations (p <0.05).
Main Results:
- The study included 47 pediatric IBD patients (mean age 11 ± 5.46 years; 64% males), with 25% diagnosed with very early-onset IBD (VEO-IBD).
- Crohn's disease (CD) was the most common subtype. Active perianal disease occurred in 30% of CD patients.
- Fifty-seven percent achieved remission within one year. One-year relapse rates were higher in ulcerative colitis (UC) than CD. VEO-IBD was associated with failure to achieve steroid-free remission (OR 20.8).
- Diagnostic delay (OR 13.6), wasting (OR 12.6), and pancolitis in UC (OR 75) were significantly associated with higher one-year relapse rates.
Conclusions:
- Pediatric IBD in the Philippines is predominantly Crohn's disease, with a notable proportion of VEO-IBD cases.
- Treatment response to steroids was similar across IBD subtypes.
- Factors such as diagnostic delay, wasting, and pancolitis in UC are critical predictors of higher relapse rates in pediatric IBD.
Background:
Inflammatory bowel disease (IBD), comprising Crohn's disease, ulcerative colitis, and IBD-unclassified, is a chronic relapsing inflammatory disorder of the gastrointestinal tract, with up to 25% of cases presenting in childhood or adolescence. Although historically uncommon in Asia, the incidence of pediatric IBD in the region has been increasing, and disease phenotype appears to differ from Western populations. In the Philippines, data on pediatric IBD remain limited, with no comprehensive local studies describing its clinical features, subtypes, and outcomes.
Objectives:
To describe the clinico-demographic factors that are associated with remission and relapse rates in Filipino pediatric patients with IBD.
Methods:
Retrospective review of records of patients <19 years old with IBD from January 2013 to December 2023 in a tertiary government hospital. The clinical, biochemical, imaging, endoscopic, and histologic features, treatment, and outcomes were obtained. Chi-square and T-tests were done to compare the variables and odds ratios to check for associations; significance level set at p <0.05.
Results:
Forty-seven (47) children (mean age 11 ± 5.46 years; 64% males) had IBD. Median age at diagnosis was 13 (IQR 8years). Twelve (25%) were very early onset IBD (VEO-IBD). Median duration of symptoms was 9 (IQR 4-20) months. Bloody stools were more common in UC and IBDU than in CD. Active perianal disease was seen in 30% of CD patients. For induction, UC and IBDU patients used mostly steroids and 5-ASA, while CD patients used mostly exclusive enteral nutrition and steroids. Only 30 patients had at least a 1-year follow-up. Twenty-seven (57%) went into remission within one year. Five CD patients underwent surgery. There was no difference in the 1-year steroid-free remission among the subtypes. One-year relapse rate was significantly higher in UC than in CD. VEO-IBD was associated with not achieving 1-year steroid-free remission (OR 20.8; p value 0.045). One-year relapse rate was associated with diagnostic delay (OR 13.6; p value 0.034), presence of wasting (OR 12.6; p value 0.029), and pancolitis in UC (OR 75; p value 0.043).
Conclusion:
The majority of pediatric IBD has CD, with 25% VEO-IBD. 30% of CD had active perianal disease. All subtypes responded similarly to steroids. A higher relapse rate was associated with diagnostic delay, wasting, and pancolitis in UC patients.
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