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Hanna LN, Munster LJ, Joshi S, Wendelien van der Bilt JD, Buskens CJ, Hart A, Tozer P. Isolated perianal Crohn's disease: a systematic review and expert consensus proposing novel diagnostic criteria and management advice. Lancet Gastroenterol Hepatol 2025:S2468-1253(25)00007-X. [PMID: 40315877 DOI: 10.1016/s2468-1253(25)00007-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 12/20/2024] [Accepted: 01/08/2025] [Indexed: 05/04/2025]
Abstract
Perianal fistulae can present a diagnostic challenge when distinguishing perianal Crohn's disease from idiopathic perianal fistulae. This distinction is key, as perianal Crohn's disease requires inflammatory bowel disease (IBD) therapy, whereas idiopathic perianal fistulae are primarily managed surgically. When luminal inflammation is absent, but Crohn's disease is suspected, the term isolated perianal Crohn's disease is sometimes applied. However, no formal guidance exists for diagnosing or managing isolated perianal Crohn's disease. Furthermore, whereas fistula granuloma might provide specific evidence of Crohn's disease, they are rarely detected in perianal fistulae, so are unlikely to sensitively delineate aetiology. This project aimed to develop an opinion-based framework for isolated perianal Crohn's disease. A systematic review evaluated clinical features suggestive of isolated perianal Crohn's disease and evidence for IBD therapies in patients with perianal fistulae without luminal IBD. The findings of this systematic review informed a multidisciplinary consensus process with IBD specialists, resulting in the formulation of diagnostic criteria and management recommendations for isolated perianal Crohn's disease. We then tested this diagnostic approach in a prospective cohort of 50 patients treated as having idiopathic perianal fistulae at a proctology referral centre, identifying six (12%) individuals as meeting the diagnostic criteria. Our findings underscore the scarcity of evidence guiding isolated perianal Crohn's disease diagnosis and the need for a composite risk-based assessment. The proposed framework provides a tool for clinical practice and research but requires validation and refinement. Clear communication with patients is essential, given the diagnostic and therapeutic uncertainties. Future studies should refine these criteria, explore biological markers for isolated perianal Crohn's disease, and establish evidence-based methods to differentiate isolated perianal Crohn's disease within the perianal fistulae spectrum.
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Affiliation(s)
- Luke Nathan Hanna
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
| | - Liesbeth Jozefien Munster
- Department of Surgery, Flevoziekenhuis, Almere, Netherlands; Department of Surgery, Amsterdam UMC, VUmc, Amsterdam, Netherlands
| | - Shivani Joshi
- Department of Surgery, St Mark's Hospital and Academic Institute, London, UK
| | | | | | - Ailsa Hart
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
| | - Phil Tozer
- Department of Surgery, St Mark's Hospital and Academic Institute, London, UK
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2
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Wiczynska-Ryl J, Krogulska A. Incidence of Inflammatory Bowel Disease in Children. Gastroenterology Res 2025; 18:71-84. [PMID: 40322194 PMCID: PMC12045794 DOI: 10.14740/gr2007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Accepted: 02/28/2025] [Indexed: 05/08/2025] Open
Abstract
Background Many of the patients with inflammatory bowel disease (IBD) are children and adolescents, and the incidence of pediatric IBD is increasing. However, understanding epidemiological trends is crucial for effective prevention and treatment and reducing the local and global burden of IBD. Little data exist regarding the incidence of IBD in the child population in the Kujawsko-Pomorskie Voivodeship. The aims of this study were to evaluate the incidence of IBD in the period 2011 - 2022 and to compare the data regarding three types of IBD, namely ulcerative colitis (UC), Crohn's disease (CD), and unclassified inflammatory bowel disease (IBD-U), from the first half, i.e. 2011 - 2016, to the second half, i.e. 2017 - 2022. Methods This retrospective study analyzed the medical records of 118 IBD patients hospitalized at the Department of Pediatrics, Allergology and Gastroenterology from the central-northern part of Poland. Results Of the 118 patients diagnosed with IBD, 48 (40.68%) had CD, 57 (48.31%) had UC, and 13 (11.01%) had IBD-U. Between 2011 and 2016, 48 new IBD patients were diagnosed, with a further 70 new cases added between 2017 and 2022, representing a significant increase over the period (P = 0.033). Also, a significant increase was seen for UC, i.e. rising from 19 new cases between 2011 and 2016, to 38 between 2017 and 2022 (P = 0.015). The increase in CD was not significant. Conclusion The incidence of pediatric IBD in the central-northern district of Poland is lower than other countries, it nonetheless appears to be increasing, particularly in children with UC. The number of IBD diagnoses in children has increased by nearly 50% over the last 6 years.
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Affiliation(s)
- Joanna Wiczynska-Ryl
- Department of Pediatrics, Allergology and Gastroenterology, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University, 87-100 Torun, Poland
- The authors contributed equally to this work
| | - Aneta Krogulska
- Department of Pediatrics, Allergology and Gastroenterology, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University, 87-100 Torun, Poland
- The authors contributed equally to this work
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Weidner J, Glauche I, Manuwald U, Kern I, Reinecke I, Bathelt F, Amin M, Dong F, Rothe U, Kugler J. Correlation of Socioeconomic and Environmental Factors With Incidence of Crohn Disease in Children and Adolescents: Systematic Review and Meta-Regression. JMIR Public Health Surveill 2024; 10:e48682. [PMID: 38526534 PMCID: PMC11002755 DOI: 10.2196/48682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 12/28/2023] [Accepted: 01/23/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND The worldwide incidence of Crohn disease (CD) in childhood and adolescence has an increasing trend, with significant differences between different geographic regions and individual countries. This includes an increase in the incidence of CD in countries and geographic regions where CD was not previously prevalent. In response to the increasing incidence, the pediatric care landscape is facing growing challenges. OBJECTIVE This systematic review and meta-analysis were undertaken to comprehensively delineate the incidence rates of CD in pediatric populations across different countries and to explore potential influencing factors. METHODS We performed a systematic review of PubMed and Embase (via Ovid) for studies from January 1, 1970, to December 31, 2019. In addition, a manual search was performed in relevant and previously published reviews. The results were evaluated quantitatively. For this purpose, random effects meta-analyses and meta-regressions were performed to investigate the overall incidence rate and possible factors influencing the incidence. RESULTS A qualitative synthesis of 74 studies was performed, with 72 studies included in the meta-analyses and 52 in the meta-regressions. The results of our meta-analysis showed significant heterogeneity between the individual studies, which cannot be explained by a sample effect alone. Our findings showed geographical differences in incidence rates, which increased with increasing distance from the equator, although no global temporal trend was apparent. The meta-regression analysis also identified geographic location, UV index, and Human Development Index as significant moderators associated with CD incidence. CONCLUSIONS Our results suggest that pediatric CD incidence has increased in many countries since 1970 but varies widely with geographic location, which may pose challenges to the respective health care systems. We identified geographic, environmental, and socioeconomic factors that contribute to the observed heterogeneity in incidence rates. These results can serve as a basis for future research. To this end, implementations of internationally standardized and interoperable registries combined with the dissemination of health data through federated networks based on a common data model, such as the Observational Medical Outcomes Partnership, would be beneficial. This would deepen the understanding of CD and promote evidence-based approaches to preventive and interventional strategies as well as inform public health policies aimed at addressing the increasing burden of CD in children and adolescents. TRIAL REGISTRATION PROSPERO International prospective register of systematic reviews CRD42020168644; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=168644. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2020-037669.
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Affiliation(s)
- Jens Weidner
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ingmar Glauche
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ulf Manuwald
- Faculty of Applied Social Sciences, University of Applied Sciences (FHD), Dresden, Germany
| | - Ivana Kern
- Institute and Policlinic for Occupational and Social Medicine, Department of Health Sciences/Public Health, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ines Reinecke
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Franziska Bathelt
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
- Thiem-Research GmbH, Cottbus, Germany
| | - Makan Amin
- Institute and Policlinic for Occupational and Social Medicine, Department of Health Sciences/Public Health, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
- Department for Trauma Surgery and Orthopaedics, Park-Klinik Weissensee, Berlin, Germany
| | - Fan Dong
- Institute and Policlinic for Occupational and Social Medicine, Department of Health Sciences/Public Health, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | | | - Joachim Kugler
- Institute and Policlinic for Occupational and Social Medicine, Department of Health Sciences/Public Health, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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Larrosa-Haro A, Abundis-Castro L, Contreras MB, Gallo MJ, Peña-Quintana L, Targa Ferreira CH, Nacif PA, Vázquez-Frías R, Bravo S, Muñoz-Urribarri AB, Mejía-Castro M, Orsi M, Amil-Díaz J, Busoni V, Cohen-Sabban J, Martin-Capri FJ, Zablah R, Rodríguez-Guerrero MG, Sdepanian VL. Epidemiologic trend of pediatric inflammatory bowel disease in Latin America: The Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) Working Group. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 86:328-334. [PMID: 34518143 DOI: 10.1016/j.rgmxen.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 07/25/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND AIMS The primary aim was to explore the epidemiologic trend of pediatric inflammatory bowel disease in Latin America, and the secondary aims were to obtain an overview of the diagnostic/therapeutic focus of the members of the LASPGHAN and examine the relation of case frequency to year, during the study period. MATERIALS AND METHODS Latin American pediatric gastroenterologists participated in an online survey, conducted through the SurveyMonkey platform, that investigated the yearly frequency of new inflammatory bowel disease patients within the time frame of 2005-2016, their disease variety, the gastrointestinal segments affected, and the diagnostic and treatment methods utilized. The correlation of new case frequency with each study year was evaluated. RESULTS A total of 607 patients were studied. The diagnoses were ulcerative colitis in 475 (78.3%) cases, Crohn's disease in 104 (17.1%), and inflammatory bowel disease D unclassified in 28 (4.6%). The trend in ulcerative colitis was a lineal increase in the frequency of new cases related to each study year, with a significant correlation coefficient. Pancolitis was found in 67.6% of the patients. The diagnostic methods included clinical data, endoscopy, and biopsies in more than 99% of the cases, and imaging studies were indicated selectively. Drug regimens were limited to 5-aminosalicylic acid derivatives, azathioprine, 6-mercaptopurine, infliximab, and adalimumab. CONCLUSIONS Pediatric inflammatory bowel disease in Latin America appears to have increased during the years included in the study period, with a predominance of moderate or severe ulcerative colitis. That lineal trend suggests the predictive likelihood of a gradual increase in the coming years, with possible epidemiologic and clinical implications.
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Affiliation(s)
- A Larrosa-Haro
- Instituto de Nutrición Humana, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico.
| | - L Abundis-Castro
- Banco de Leche Humana, Secretaría de Salud del Estado de Sonora, Sonora, Mexico
| | - M B Contreras
- Servicio de Atención Médica Integral para la Comunidad Juan P. Garrahan, Hospital de Pediatría, Buenos Aires, Argentina
| | - M J Gallo
- Servicio de Gastroenterología, Hepatología y Trasplante Hepatointestinal Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - L Peña-Quintana
- Unidad de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Universitario Materno Infantil, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | - C H Targa Ferreira
- Departamento de Pediatría, Universidad Federal de Ciencias, Porto Alegre, Brazil
| | - P A Nacif
- Servicio de Gastroenterología, Centro Hospitalario Pereira Rossel (CHPR), Montevideo, Uruguay
| | - R Vázquez-Frías
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - S Bravo
- Hospital de Niños Víctor J. Vilela, Rosario (Santa Fe), Argentina
| | | | - M Mejía-Castro
- Centro de Gastroenterología Endoscopia y Nutrición Pediátrica, Managua, Nicaragua
| | - M Orsi
- Servicio de Gastroenterología, Hepatología y Trasplante Hepatointestinal Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Amil-Díaz
- Departamento de Pediatría Médica, Hospital de Sao Joao, Oporto, Portugal
| | - V Busoni
- Servicio de Gastroenterología, Hepatología y Trasplante Hepatointestinal Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Cohen-Sabban
- Servicio de Gastroenterología, Hepatología y Trasplante Hepatointestinal Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - F J Martin-Capri
- Servicio de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Sant Joan de Déu, Esplugues de Llobregat (Barcelona), Spain
| | - R Zablah
- Servicio de Gastroenterología Pediátrica, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador
| | - M G Rodríguez-Guerrero
- Servicio de Gastroenterología Pediátrica, Hospital de Niños José Manuel de los Ríos, Caracas, Venezuela
| | - V L Sdepanian
- Departamento de Pediatría, Universidad Federal de São Paulo, São Paulo, Brazil
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The Incidence of Inflammatory Bowel Disease in the Paediatric Population in the District of Lower Silesia, Poland. J Clin Med 2021; 10:jcm10173994. [PMID: 34501439 PMCID: PMC8432562 DOI: 10.3390/jcm10173994] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 11/22/2022] Open
Abstract
The incidence of IBD has been rising over the last decades. The trend applies not only to well-developed countries but also to the regions with limited number of cases so far, e.g., Asia or Middle East. Aim: The aim of the study was to determine the incidence of paediatric IBD in the district of Lower Silesia, Poland, between 2016 and 2018. Methods: The number of newly diagnosed IBD per 100,000 children, living in the region, was calculated. The characteristics of the group were established. Results: There were 81 cases of paediatric IBD diagnosed between the 1st of January 2016 and 31st of December 2018. The diagnosis of ulcerative colitis (UC) was made for 42 children. In the same period of time 39 cases of Crohn disease (CD) were recognised. The incidences were calculated as 2.57 for UC, and 2.38 for CD. The total incidence of IBD between 2016 and 2018 was 4.96/100,000/year which is rise in the last 20 years. Conclusion: An increase in incidence of IBD in the district of Lower Silesia has been observed.
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6
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Larrosa-Haro A, Abundis-Castro L, Contreras MB, Gallo MJ, Peña-Quintana L, Targa Ferreira CH, Nacif PA, Vázquez-Frías R, Bravo S, Muñoz-Urribarri AB, Mejía-Castro M, Orsi M, Amil-Díaz J, Busoni V, Cohen-Sabban J, Martin-Capri FJ, Zablah R, Rodríguez-Guerrero MG, Sdepanian VL. Epidemiologic trend of pediatric inflammatory bowel disease in Latin America: The Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) Working Group. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2020; 86:S0375-0906(20)30120-8. [PMID: 33223251 DOI: 10.1016/j.rgmx.2020.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/09/2020] [Accepted: 07/25/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES The primary aim was to explore the epidemiologic trend of pediatric inflammatory bowel disease in Latin America, and the secondary aims were to obtain an overview of the diagnostic/therapeutic focus of the members of the LASPGHAN and examine the relation of case frequency to year, during the study period. MATERIALS AND METHODS Latin American pediatric gastroenterologists participated in an online survey, conducted through the SurveyMonkey platform, that investigated the yearly frequency of new inflammatory bowel disease patients within the time frame of 2005 to 2016, their disease variety, the gastrointestinal segments affected, and the diagnostic and treatment methods utilized. The correlation of new case frequency with each study year was evaluated. RESULTS A total of 607 patients were studied. The diagnoses were ulcerative colitis in 475 (78.3%) cases, Crohn's disease in 104 (17.1%), and inflammatory bowel disease D unclassified in 28 (4.6%). The trend in ulcerative colitis was a lineal increase in the frequency of new cases related to each study year, with a significant correlation coefficient. Pancolitis was found in 67.6% of the patients. The diagnostic methods included clinical data, endoscopy, and biopsies in more than 99% of the cases, and imaging studies were indicated selectively. Drug regimens were limited to 5-aminosalicylic acid derivatives, azathioprine, 6-mercaptopurine, infliximab, and adalimumab. CONCLUSIONS Pediatric inflammatory bowel disease in Latin America appears to have increased during the years included in the study period, with a predominance of moderate or severe ulcerative colitis. That lineal trend suggests the predictive likelihood of a gradual increase in the coming years, with possible epidemiologic and clinical implications.
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Affiliation(s)
- A Larrosa-Haro
- Instituto de Nutrición Humana, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México.
| | - L Abundis-Castro
- Banco de Leche Humana, Secretaría de Salud del Estado de Sonora, Sonora, México
| | - M B Contreras
- Servicio de Atención Médica Integral para la Comunidad Juan P. Garrahan, Hospital de Pediatría, Buenos Aires, Argentina
| | - M J Gallo
- Servicio de Gastroenterología, Hepatología y Trasplante Hepatointestinal Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - L Peña-Quintana
- Unidad de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Universitario Materno Infantil, Universidad de Las Palmas de Gran Canaria, Las Palmas, España
| | - C H Targa Ferreira
- Departamento de Pediatría, Universidad Federal de Ciencias, Porto Alegre, Brasil
| | - P A Nacif
- Servicio de Gastroenterología, Centro Hospitalario Pereira Rossel (CHPR), Montevideo, Uruguay
| | - R Vázquez-Frías
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - S Bravo
- Hospital de Niños Víctor J. Vilela, Rosario (Santa Fe), Argentina
| | | | - M Mejía-Castro
- Centro de Gastroenterología Endoscopia y Nutrición Pediátrica, Managua, Nicaragua
| | - M Orsi
- Servicio de Gastroenterología, Hepatología y Trasplante Hepatointestinal Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Amil-Díaz
- Departamento de Pediatría Médica, Hospital de Sao Joao, Oporto, Portugal
| | - V Busoni
- Servicio de Gastroenterología, Hepatología y Trasplante Hepatointestinal Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Cohen-Sabban
- Servicio de Gastroenterología, Hepatología y Trasplante Hepatointestinal Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - F J Martin-Capri
- Servicio de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Sant Joan de Déu, Esplugues de Llobregat (Barcelona), España
| | - R Zablah
- Servicio de Gastroenterología Pediátrica, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador
| | - M G Rodríguez-Guerrero
- Servicio de Gastroenterología Pediátrica, Hospital de Niños José Manuel de los Ríos, Caracas, Venezuela
| | - V L Sdepanian
- Departamento de Pediatría, Universidad Federal de São Paulo, São Paulo, Brasil
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Ivković L, Hojsak I, Trivić I, Sila S, Hrabač P, Konjik V, Senečić-Čala I, Palčevski G, Despot R, Žaja O, Kolaček S. Incidence and Geographical Variability of Pediatric Inflammatory Bowel Disease in Croatia: Data From the Croatian National Registry for Children With Inflammatory Bowel Disease. Clin Pediatr (Phila) 2020; 59:1182-1190. [PMID: 32674589 DOI: 10.1177/0009922820941202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The aim of this study was to determine the annual incidence and geographic distribution of pediatric inflammatory bowel disease (IBD) in Croatia. This is a prospective, cohort, multicenter observational study based on the data obtained from the Croatian national registry for children with IBD. Children and adolescents younger than 18 years diagnosed with IBD, in time period between June 1, 2016, and May 31, 2017, were recruited. In total, 51 new cases were identified; 19 Crohn's disease, 28 ulcerative colitis, and 8 IBD-unclassified. Male preponderance of all 3 types of the disease was noticed. The median age at diagnosis was 14.8 years. The calculated annual incidence of pediatric IBD per 100 000 persons per year was 7.05 (2.63 for Crohn's disease, 3.87 for ulcerative colitis, and 0.55 for IBD-unclassified). A north to south gradient was observed with almost 2 times higher incidence in the northern region of the country.
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Affiliation(s)
| | - Iva Hojsak
- Children's Hospital Zagreb, Zagreb, Croatia.,University of Zagreb, Zagreb, Croatia.,University J. J. Strossmayer, Osijek, Croatia
| | | | - Sara Sila
- Children's Hospital Zagreb, Zagreb, Croatia
| | | | | | | | | | - Ranka Despot
- University Hospital Center Split, Split, Croatia
| | - Orjena Žaja
- University Hospital Sisters of Mercy, Zagreb, Croatia
| | - Sanja Kolaček
- Children's Hospital Zagreb, Zagreb, Croatia.,University of Zagreb, Zagreb, Croatia
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8
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Roberts SE, Thorne K, Thapar N, Broekaert I, Benninga MA, Dolinsek J, Mas E, Miele E, Orel R, Pienar C, Ribes-Koninckx C, Thomson M, Tzivinikos C, Morrison-Rees S, John A, Williams JG. A Systematic Review and Meta-analysis of Paediatric Inflammatory Bowel Disease Incidence and Prevalence Across Europe. J Crohns Colitis 2020; 14:1119-1148. [PMID: 32115645 DOI: 10.1093/ecco-jcc/jjaa037] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease [IBD] is often one of the most devastating and debilitating chronic gastrointestinal disorders in children and adolescents. The main objectives here were to systematically review the incidence and prevalence of paediatric IBD across all 51 European states. METHODS We undertook a systematic review and meta-analysis based on PubMed, CINAHL, the Cochrane Library, searches of reference lists, grey literature and websites, covering the period from 1970 to 2018. RESULTS Incidence rates for both paediatric Crohn's disease [CD] and ulcerative colitis [UC] were higher in northern Europe than in other European regions. There have been large increases in the incidence of both paediatric CD and UC over the last 50 years, which appear widespread across Europe. The largest increases for CD have been reported from Sweden, Wales, England, the Czech Republic, Denmark and Hungary, and for UC from the Czech Republic, Ireland, Sweden and Hungary. Incidence rates for paediatric CD have increased up to 9 or 10 per 100 000 population in parts of Europe, including Scandinavia, while rates for paediatric UC are often slightly lower than for CD. Prevalence reported for CD ranged from 8.2 per 100 000 to approximately 60 and, for UC, from 8.3 to approximately 30. CONCLUSIONS The incidence of paediatric IBD continues to increase throughout Europe. There is stronger evidence of a north-south than an east-west gradient in incidence across Europe. Further prospective studies are needed, preferably multinational and based on IBD registries, using standardized definitions, methodology and timescales.
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Affiliation(s)
- S E Roberts
- Medical School, Swansea University, Swansea, Wales, UK
| | - K Thorne
- Medical School, Swansea University, Swansea, Wales, UK
| | - N Thapar
- Neurogastroenterology and Motility Unit, Department of Gastroenterology, Great Ormond Street Hospital, London, UK
- Stem Cells and Regenerative Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
- Prince Abdullah Ben Khalid Celiac Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
| | - I Broekaert
- Department of Paediatrics, University Children's Hospital, University of Cologne, Cologne, Germany
| | - M A Benninga
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, The Netherlands
| | - J Dolinsek
- Department of Pediatrics, University Medical Center Maribor, Maribor, Slovenia
| | - E Mas
- Unité de Gastroentérologie, Hépatologie, Nutrition, Diabétologie et Maladies Héréditaires, du Métabolisme, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
- IRSD, Université de Toulouse, INSERM, INRA, ENVT, UPS, Toulouse, France
| | - E Miele
- Department of Translational Medical Science, Section of Pediatrics, University of Naples 'Federico II', Naples, Italy
| | - R Orel
- Department of Gastroenterology, Hepatology and Nutrition, Children's Hospital, University Medical Centre, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - C Pienar
- Department of Pediatrics, 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - C Ribes-Koninckx
- Department of Paediatric Gastroenterology, Hepatology & Nutrition, La FE University Hospital, Valencia, Spain
| | - M Thomson
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, UK
| | - C Tzivinikos
- Department of Paediatric Gastroenterology, Al Jalila Children's Specialty Hospital, Dubai, UAE
| | | | - A John
- Medical School, Swansea University, Swansea, Wales, UK
| | - J G Williams
- Medical School, Swansea University, Swansea, Wales, UK
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Regional Incidence of Inflammatory Bowel Disease in a Czech Pediatric Population: 16 Years of Experience (2002-2017). J Pediatr Gastroenterol Nutr 2020; 70:586-592. [PMID: 32058417 PMCID: PMC7170436 DOI: 10.1097/mpg.0000000000002660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Inflammatory bowel disease (IBD) is today a global disease, the incidence of which is growing in the pediatric population. This prospective study aims to decipher IBD incidence and its trend in a pediatric population through 16 years in the South Moravian Region of the Czech Republic. METHODS We evaluated data concerning 358 pediatric patients with newly diagnosed IBD at University Hospital Brno, which is a gastroenterology center for the entire pediatric population (0-18 years) and cares for all pediatric IBD patients in the South Moravian Region (1,187,667 inhabitants). RESULTS The study encompassed 3,488,907 children during 16 years. We diagnosed 192 children (53.6%) with Crohn disease (CD), 123 (34.4%) with ulcerative colitis (UC), and 43 (12.0%) with IBD-unclassified (IBD-U). The incidence of IBD increased from 3.8 (CD 2.9, UC 0.9, and IBD-U 0.0) per 100 000/year in 2002 to 14.7 (CD 9.8, UC 4.0, and IBD-U 0.9) per 100,000/year in 2017 (P < 0.001). The overall IBD incidence per 100,000/year was 9.8 (95% confidence interval [CI]: 8.8--10.9). Constituent incidences per 100,000/year were CD 5.2 (95% CI: 4.5--6.0), UC 3.4 (95% CI: 2.8--4.0), and IBD-U 1.2 (95% CI: 0.9--1.6). IBD incidence was projected to reach 18.9 per 100,000/year in 2022. CONCLUSIONS The overall incidence of pediatric IBD in the Czech Republic is increasing, and especially that of CD, whereas trends in UC and IBD-U appear to be constant. These data highlight the need to identify risk factors involved in the rising incidence of IBD.
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Prevalence of allergic diseases in children with inflammatory bowel disease. Postepy Dermatol Alergol 2019; 36:282-290. [PMID: 31333345 PMCID: PMC6640021 DOI: 10.5114/ada.2018.81189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/17/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction There are many similarities between inflammatory bowel disease (IBD) and allergic diseases, including similar epidemiological data, pathomechanism, clinical course and even treatment methods. So far, many studies of IBD comorbidity with other diseases, including allergy, but mainly in adults, have been conducted. Aim To analyse the prevalence of allergic diseases, i.e. food allergy (FA), cow’s milk allergy (CMA), atopic dermatitis (AD), allergic rhinitis (AR) and asthma in children with IBD. Material and methods The study included 105 IBD patients from the Department of Paediatrics, Allergology and Gastroenterology of Collegium Medicum in Bydgoszcz and 100 children without IBD from the Outpatient Clinics. The authors applied the validated questionnaire as a study method. Results At least one allergic disease was found in 26 (43%) IBD children. The allergological diagnosis was made in IBD children more frequently than in the control group (p = 0.04). The difference was more noticeable with regards to skin prick tests (p = 0.02). FA was the most common disease; it was noted in 19 (32%) IBD children; followed by: AD – in 13 (22%), CMA – in 12 (20%), AR – in 10 (17%) and asthma – in 6 (10%) children. The prevalence of allergic diseases in the control and study groups was comparable (p > 0.05). There was no correlation between age of IBD children and allergy (p > 0.05). Asthma was significantly more common in children undergoing biological treatment (p = 0.01). Conclusions Children with IBD should be constantly monitored by medical professionals, not only due to the underlying disease but also due to a possible concomitant allergic disease.
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Sýkora J, Pomahačová R, Kreslová M, Cvalínová D, Štych P, Schwarz J. Current global trends in the incidence of pediatric-onset inflammatory bowel disease. World J Gastroenterol 2018; 24:2741-2763. [PMID: 29991879 PMCID: PMC6034144 DOI: 10.3748/wjg.v24.i25.2741] [Citation(s) in RCA: 259] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/01/2018] [Accepted: 06/25/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To perform a comprehensive review and provide an up-to-date synopsis of the incidence and trends of inflammatory bowel disease (IBD). METHODS We systematically searched the MEDLINE (source PubMed), EMBASE and Cochrane Library databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (period: 1985-2018) to identify studies reporting population-based data on the incidence of pediatric-onset (< 19 years at diagnosis) IBD in full manuscripts. Two authors carried out screening and data extraction. Choropleth interactive maps and temporal trends were used to illustrate the international differences and incidences of and changes in IBD and subtypes. RESULTS In total, one hundred forty studies reporting data from 38 countries were considered in this review. The highest annual pediatric incidences of IBD were 23/100000 person-years in Europe, 15.2/100000 in North America, and 11.4/100000 in Asia/the Middle East and Oceania. The highest annual incidences of Crohn's disease (CD) were 13.9/100000 in North America and 12.3/100000 in Europe. The highest annual incidences of ulcerative colitis (UC) were 15.0/100000 in Europe and 10.6/100000 in North America. The highest annual incidences of IBD-unclassified (IBD-U) were 3.6/100000 in Europe and 2.1/100000 in North America. In the time-trend analyses, 67% of CD, 46% of UC and 11% of IBD-U studies reported an increasing incidence (P < 0.05). The risk of IBD is increasing among first-generation of migrant populations. CONCLUSION Globally, the incidence of IBD varies greatly by geographical areas. The steadily increasing incidence of pediatric IBD over time indicates its emergence as a global disease, suggesting that studies should investigate the environmental risk factors among pediatric cohorts.
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Affiliation(s)
- Josef Sýkora
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Faculty Hospital, Pilsen 304 60, Czech Republic
| | - Renáta Pomahačová
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Faculty Hospital, Pilsen 304 60, Czech Republic
| | - Marcela Kreslová
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Faculty Hospital, Pilsen 304 60, Czech Republic
| | - Dominika Cvalínová
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Faculty Hospital, Pilsen 304 60, Czech Republic
| | - Přemysl Štych
- Department of Applied Geoinformatics and Cartography, Charles University in Prague, Faculty of Science, Prague 128 43, Czech Republic
| | - Jan Schwarz
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Faculty Hospital, Pilsen 304 60, Czech Republic
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Epidemiology and care structures for children and adolescents and young adults up to the 26th year of life with inflammatory bowel diseases (IBD) in Leipzig/Saxony/Germany. J Public Health (Oxf) 2018. [DOI: 10.1007/s10389-017-0884-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Schwarz J, Sýkora J, Cvalínová D, Pomahačová R, Klečková J, Kryl M, Včelák P. Inflammatory bowel disease incidence in Czech children: A regional prospective study, 2000-2015. World J Gastroenterol 2017; 23:4090-4101. [PMID: 28652662 PMCID: PMC5473128 DOI: 10.3748/wjg.v23.i22.4090] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/31/2017] [Accepted: 03/20/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To examine the incidence and trends in pediatric inflammatory bowel diseases (IBDs) over 2000-2015 and project the incidence to 2018.
METHODS A 16-year prospective study of IBD patients < 19 years of age was conducted in the Czech Republic (the Pilsen region). All incident IBD cases within a well-defined geographical area were retrieved from a prospectively collected computerized clinical database. Historical Czech data were used for comparison (1990-2001). Our catchment population was determined from the census data. We calculated the incidence by relating the number of newly diagnosed cases to the size of the pediatric population-at-risk in each calendar year. Age/sex, disease type, place of residence, and race/ethnicity were identified.
RESULTS In total, 170 new IBD cases [105 Crohn’s disease (CD), 48 ulcerative colitis (UC), and 17 IBD-unclassified (IBD-U)] were identified. The median age at IBD diagnosis was 14.2 years, 59.4% were males, and 97.1% were Caucasians. A male preponderance of IBD (P = 0.026) and CD (P = 0.016) was observed. With 109209 person-years in the catchment area, the average incidence of IBD per 100000 person-years was 10.0 (6.2 for CD, 2.8 for UC, and 1.0 for IBD-U) for children aged 0 to 19 years; for those aged 0 to 15 years, the incidence rate was 7.3 (4.6 for CD, 2.0 for UC, and 0.7 for IBD-U). An increase in incidence with age was observed (P = 0.0003). Over the 16-year period, the incidence increased for IBD patients (P = 0.01) and CD in particular (P < 0.0001), whereas the incidence for UC (P = 0.09) and IBD-U (P = 0.339) remained unchanged. IBD-projected data from 2016 to 2018 were 12.1, 12.3 and 12.6 per 100000 person-years, respectively.
CONCLUSION Pediatric-onset IBD incidence is around its highest point. The increase, which is particularly pronounced for CD, may be challenging to relate to causes of pediatric disease.
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Virta LJ, Saarinen MM, Kolho KL. Inflammatory Bowel Disease Incidence is on the Continuous Rise Among All Paediatric Patients Except for the Very Young: A Nationwide Registry-based Study on 28-Year Follow-up. J Crohns Colitis 2017; 11:150-156. [PMID: 27555642 DOI: 10.1093/ecco-jcc/jjw148] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/02/2016] [Accepted: 07/17/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS The burden of inflammatory bowel disease [IBD] in health care is high. We conducted research on the temporal changes in the incidence of paediatric IBD [PIBD] using nationwide registry-based data in Finland. METHODS All PIBD cases diagnosed at less than 20 years of age during 1987-2014 [in total, 5415 patients] were retrieved from a database documenting reimbursements for drug costs. Incidence rates were calculated by dividing the number of annual new PIBD cases by the size of the paediatric population at risk during each calendar year. Temporal trends in the incidences of PIBD and its subtypes, ulcerative colitis [UC] and Crohn's disease [CD], were estimated using Poisson regression analyses. RESULTS The mean annual incidence of PIBD increased from 7/100000 for the years 1987-1990 to 23/100000 for the years 2011-2014. The average rate of increase was 4.1% (95% confidence interval [CI]: 3.6-4.5) per annum. In the period 2000-2014, the increase rate in the annual incidence of UC [3.8%; 95% CI: 2.7-5.0], was steeper than for CD [2.5%; 95% CI: 1.0-3.8]. The most pronounced increase occurred in UC among adolescents aged 16-19 years [4.8%; 95% CI: 2.9-6.7]. For children less than 10 years of age, the rate of change remained low. Approximately 0.17% of the birth cohort for the years 1999-2000 was diagnosed with PIBD by the age of 14 years. CONCLUSION The incidence of PIBD is primarily increasing among adolescents, challenging the identification of the possible environmental triggers for the disease.
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Affiliation(s)
- Lauri J Virta
- Research Department, Social Insurance Institution of Finland, Turku, Finland
| | - Maiju M Saarinen
- Departments of Public Health and Child Neurology, University of Turku and Turku University Hospital, Turku, Finland
| | - Kaija-Leena Kolho
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Finland
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Ahmed I, Roy BC, Khan SA, Septer S, Umar S. Microbiome, Metabolome and Inflammatory Bowel Disease. Microorganisms 2016; 4:microorganisms4020020. [PMID: 27681914 PMCID: PMC5029486 DOI: 10.3390/microorganisms4020020] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/25/2016] [Accepted: 06/06/2016] [Indexed: 12/17/2022] Open
Abstract
Inflammatory Bowel Disease (IBD) is a multifactorial disorder that conceptually occurs as a result of altered immune responses to commensal and/or pathogenic gut microbes in individuals most susceptible to the disease. During Crohn’s Disease (CD) or Ulcerative Colitis (UC), two components of the human IBD, distinct stages define the disease onset, severity, progression and remission. Epigenetic, environmental (microbiome, metabolome) and nutritional factors are important in IBD pathogenesis. While the dysbiotic microbiota has been proposed to play a role in disease pathogenesis, the data on IBD and diet are still less convincing. Nonetheless, studies are ongoing to examine the effect of pre/probiotics and/or FODMAP reduced diets on both the gut microbiome and its metabolome in an effort to define the healthy diet in patients with IBD. Knowledge of a unique metabolomic fingerprint in IBD could be useful for diagnosis, treatment and detection of disease pathogenesis.
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Affiliation(s)
- Ishfaq Ahmed
- Department of Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, 4028 Wahl Hall East, Kansas City, KS 66160, USA.
| | - Badal C Roy
- Department of Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, 4028 Wahl Hall East, Kansas City, KS 66160, USA.
| | - Salman A Khan
- Department of Internal Medicine and Department of Pediatrics, University of Missouri, Kansas City, MO 64110, USA.
| | - Seth Septer
- Department of Internal Medicine and Department of Pediatrics, University of Missouri, Kansas City, MO 64110, USA.
| | - Shahid Umar
- Department of Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, 4028 Wahl Hall East, Kansas City, KS 66160, USA.
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Incidence Trends and Geographical Variability of Pediatric Inflammatory Bowel Disease in Slovenia: A Nationwide Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:921730. [PMID: 26688822 PMCID: PMC4672110 DOI: 10.1155/2015/921730] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 11/04/2015] [Accepted: 11/04/2015] [Indexed: 12/21/2022]
Abstract
Background. The aims of the study were to determine the incidence rate of pediatric inflammatory bowel disease (PIBD) and its trends for the period of 2002–2010 and to assess the geographical distribution of PIBD in Slovenia. Materials and Methods. Medical records of patients (0–18 years) with newly diagnosed IBD during the study period were retrospectively reviewed. Results. The mean incidence rate for IBD in 2002–2010 was 7.6 per 100,000 children and adolescents per year, 4.5 for Crohn's disease (CD), 2.9 for ulcerative colitis (UC), and 0.2 for IBD-unclassified, respectively. The incidence rate increased from 5.8 per 100,000 per year in 2002–2004 to 8.6 in 2005–2007 and remained stable afterwards. Statistically significant difference in the incidence rate between the Northeastern and Southwestern parts of the country was observed (p = 0.025). Conclusion. This nationwide study demonstrates that Slovenia is among the European countries with the highest PIBD incidence. During the study period a substantial rise of PIBD incidence was observed during the first half of the study and it seems to have stabilized in the second half. The significant difference in PIBD incidence between Northeastern and Southwestern parts of the country merits further exploration of the possible environmental factors.
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Holmes EA, Xiang F, Lucas RM. Variation in incidence of pediatric Crohn's disease in relation to latitude and ambient ultraviolet radiation: a systematic review and analysis. Inflamm Bowel Dis 2015; 21:809-17. [PMID: 25789921 DOI: 10.1097/mib.0000000000000320] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pediatric Crohn's disease (CD) is a lifelong, debilitating, and costly disease. In previous studies, CD incidence increased with higher geographic latitude in the Northern Hemisphere. This may indicate a role for lower vitamin D status as a risk factor for CD. Analysis of worldwide incidence of pediatric CD has not been previously reported. METHODS We undertook a systematic review of population-based studies reporting incidence of pediatric CD and published between 2003 and 2013. Included studies had well-defined diagnostic criteria for CD, evidence of high case ascertainment, reported incidence according to age group, and provided a specific location. Average daily ambient ultraviolet radiation (UVR) for each location was derived from satellite data. Negative binomial regression was used to assess the association between pediatric CD incidence and latitude and ambient UVR, adjusting for the study year. RESULTS Twenty-eight articles provided 39 incidence data points. Incidence of pediatric CD increased with higher latitude, and in association with a greater number of months where the average daily UVR was lower than a previously published threshold of 1.488 kJ/m. Incidence of pediatric CD increased over calendar time. CONCLUSIONS After applying rigorous quality assessment criteria, and including only population-based studies, there was a modest increase in incidence of pediatric CD with higher latitude and greater number of months with low ambient UVR. Reporting using nonconsistent diagnostic criteria and age groups, with poorly defined geographic locations, makes it difficult to compare data across different studies.
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Affiliation(s)
- Elizabeth A Holmes
- *National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia; and †Telethon Kids Institute, University of Western Australia, Perth, Australia
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Wędrychowicz A, Tomasik P, Pieczarkowski S, Kowalska-Duplaga K, Grzenda-Adamek Z, Fyderek K. Clinical value of serum eosinophilic cationic protein assessment in children with inflammatory bowel disease. Arch Med Sci 2014; 10:1142-6. [PMID: 25624851 PMCID: PMC4296054 DOI: 10.5114/aoms.2013.34415] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 07/14/2012] [Accepted: 09/04/2012] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Eosinophils contribute to the pathogenesis of inflammatory bowel disease (IBD) in the intestine. Eosinophilic cationic protein (ECP) is one of the most important eosinophilic specific mediators released during activation. The aim of the study was to evaluate the clinical value of serum ECP determination in children with active and inactive IBD and its correlation with disease activity. MATERIAL AND METHODS There were 125 children with IBD (63 with Crohn's disease - CD, 44 with ulcerative colitis - UC, 18 indeterminate colitis - IC) enrolled in the study. Among them 83 children were in the active phase of the disease, while the remaining 42 were in remission. The control group consisted of 56 healthy children. The ECP was assessed three times in children with active IBD, at baseline and after 2 and 6 weeks of treatment and once in children with inactive IBD and controls using fluoroenzymeimmunoassays. RESULTS We found elevated ECP at baseline in the total active IBD group when compared to the inactive IBD and control groups, decreasing during treatment. Serum ECP was also elevated in the active UC and CD groups when compared to the inactive UC and CD groups, and correlated with clinical UC and CD activity (R = 0.57 and R = 0.52, p < 0.05, respectively) and duration of the clinical manifestation in UC (R = 0.62, p < 0.05) but not with the disease location in the gastrointestinal tract, or endoscopic and histopathological activity. CONCLUSIONS Evaluation of serum ECP in children with IBD may be useful in disease activity assessment at onset and during the treatment.
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Affiliation(s)
- Andrzej Wędrychowicz
- Department of Pediatrics, Gastroenterology and Nutrition, Polish-American Children's Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Przemysław Tomasik
- Department of Clinical Biochemistry, Polish-American Children's Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Pieczarkowski
- Department of Pediatrics, Gastroenterology and Nutrition, Polish-American Children's Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Kinga Kowalska-Duplaga
- Department of Pediatrics, Gastroenterology and Nutrition, Polish-American Children's Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Zofia Grzenda-Adamek
- Department of Pediatrics, Gastroenterology and Nutrition, Polish-American Children's Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Fyderek
- Department of Pediatrics, Gastroenterology and Nutrition, Polish-American Children's Hospital, Jagiellonian University Medical College, Krakow, Poland
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Lovasz BD, Lakatos L, Horvath A, Pandur T, Erdelyi Z, Balogh M, Szipocs I, Vegh Z, Veres G, Müller KE, Golovics PA, Kiss LS, Mandel MD, Lakatos PL. Incidence rates and disease course of paediatric inflammatory bowel diseases in Western Hungary between 1977 and 2011. Dig Liver Dis 2014; 46:405-411. [PMID: 24495511 DOI: 10.1016/j.dld.2013.12.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 12/03/2013] [Accepted: 12/14/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Limited data are available on paediatric inflammatory bowel diseases in Eastern Europe. Our aim was to analyse disease characteristics in the population-based Veszprem province database between 1977 and 2011. METHODS 187 (10.5%, ulcerative colitis/Crohn's disease/undetermined colitis: 88/95/4) out of 1565 incident patients were diagnosed with a paediatric onset in this population-based prospective inception cohort. RESULTS The incidence of Crohn's disease and ulcerative colitis increased from 0 and 0.7 in 1977-1981 to 7.2 and 5.2 in 2007-2011 per 100,000 person years. Ileocolonic location (45%) and inflammatory disease behaviour (61%) were most frequent in Crohn's disease, while azathioprine use was frequent (66%) and surgical resection rates were high (33% at 5 years) in cases with paediatric onset. In ulcerative colitis, 34% of patients were diagnosed with extensive disease, with high rates of disease extension (26% and 41% at 5 and 10 years), fulminant episodes (19.3%) and systemic steroid use (52.3%). The cumulative rate of colectomy was low (6.9%). CONCLUSIONS The incidence of paediatric inflammatory bowel diseases has rapidly increased in the last three decades in Western Hungary. Ileocolonic disease and a need for azathioprine were characteristic in paediatric Crohn's disease, while paediatric onset ulcerative colitis was characterised by extensive disease and disease extension, while the need for colectomy was low.
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Affiliation(s)
- Barbara D Lovasz
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Laszlo Lakatos
- Department of Medicine, Csolnoky F. Province Hospital, Veszprem, Hungary
| | - Agnes Horvath
- Department of Pediatrics, Csolnoky F. Province Hospital, Veszprem, Hungary
| | - Tunde Pandur
- Department of Medicine, Csolnoky F. Province Hospital, Veszprem, Hungary
| | - Zsuzsanna Erdelyi
- Department of Medicine, Csolnoky F. Province Hospital, Veszprem, Hungary
| | - Mihaly Balogh
- Department of Medicine, Grof Eszterhazy Hospital, Papa, Hungary
| | - Istvan Szipocs
- Department of Medicine, Municipal Hospital, Tapolca, Hungary
| | - Zsuzsanna Vegh
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary; Department of Medicine, Csolnoky F. Province Hospital, Veszprem, Hungary
| | - Gabor Veres
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Katalin E Müller
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Petra A Golovics
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Lajos S Kiss
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Michael D Mandel
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
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Rogler D, Fournier N, Pittet V, Bühr P, Heyland K, Friedt M, Koller R, Rueger V, Herzog D, Nydegger A, Schäppi M, Schibli S, Spalinger J, Rogler G, Braegger CP. Coping is excellent in Swiss Children with inflammatory bowel disease: results from the Swiss IBD cohort study. J Crohns Colitis 2014; 8:409-20. [PMID: 24230970 DOI: 10.1016/j.crohns.2013.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 09/24/2013] [Accepted: 10/15/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) starting during childhood has been assumed to impair quality of life (QoL) of affected children. As this aspect is crucial for further personality development, the health-related quality of life (HRQOL) was assessed in a Swiss nationwide cohort to obtain detailed information on the fields of impairment. METHODS Data were prospectively acquired from pediatric patients included in the Swiss IBD Cohort Study. IBD activity was evaluated by PCDAI and PUCAI. The age adapted KIDSCREEN questionnaire was evaluated for 110 children with IBD (64 with Crohn's disease 46 with ulcerative colitis). Data were analyzed with respect to established reference values of healthy controls. RESULTS In the KIDSCREEN index a moderate impairment was only found for physical wellbeing due to disease activity. In contrast, mental well-being and social support were even better as compared to control values. A subgroup analysis revealed that this observation was restricted to the children in the German speaking part of Switzerland, whereas there was no difference compared to controls in the French part of Switzerland. Furthermore, autonomy and school variables were significantly higher in the IBD patients as compared to controls. CONCLUSIONS The social support for children with IBD is excellent in this cohort. Only physical well-being was impaired due to disease activity, whereas all other KIDSCREEN parameters were better as compared to controls. This indicates that effective coping and support strategies may be able to compensate the burden of disease in pediatric IBD patients.
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Affiliation(s)
- Daniela Rogler
- Division of Gastroenterology and Nutrition, University Children's Hospital, Zurich, Switzerland; Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Nicolas Fournier
- Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Valérie Pittet
- Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Patrick Bühr
- Division of Gastroenterology and Nutrition, University Children's Hospital, Zurich, Switzerland
| | - Klaas Heyland
- Division of Gastroenterology and Nutrition, University Children's Hospital, Zurich, Switzerland
| | - Michael Friedt
- Division of Gastroenterology and Nutrition, University Children's Hospital, Zurich, Switzerland
| | - Rebekka Koller
- Division of Gastroenterology and Nutrition, University Children's Hospital, Zurich, Switzerland
| | - Vanessa Rueger
- Division of Gastroenterology and Nutrition, University Children's Hospital, Zurich, Switzerland
| | - Denise Herzog
- Division of Paediatric Gastroenterology, Cantons Hospital Fribourg, Fribourg, Switzerland
| | - Andreas Nydegger
- Division of Gastroenterology, University Children's Hospital of Lausanne, Lausanne, Switzerland
| | - Michela Schäppi
- Division of Gastroenterology, University Children's Hospital Geneva, Geneva, Switzerland
| | - Susanne Schibli
- Division of Gastroenterology, University Children's Hospital Bern, Bern, Switzerland
| | - Johannes Spalinger
- Division of Gastroenterology, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Gerhard Rogler
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Christian P Braegger
- Division of Gastroenterology and Nutrition, University Children's Hospital, Zurich, Switzerland; Children's Research Centre, University of Zurich, Zurich, Switzerland.
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Urlep D, Trop TK, Blagus R, Orel R. Incidence and phenotypic characteristics of pediatric IBD in northeastern Slovenia, 2002-2010. J Pediatr Gastroenterol Nutr 2014; 58:325-332. [PMID: 24135984 DOI: 10.1097/mpg.0000000000000207] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The purpose of the present study was to determine the incidence of inflammatory bowel disease (IBD) and its subgroups in children in northeastern Slovenia (NE Slovenia) during the period 2002-2010, and to assess the phenotypic characteristics at the diagnosis and during the follow-up. METHODS A retrospective investigation was conducted on a cohort of newly diagnosed children and adolescents with IBD ages 0 to 18 years between 2002 and 2010 and residing in NE Slovenia. The phenotypic characteristics were determined at presentation and during follow-up. The location of Crohn disease (CD) and ulcerative colitis (UC) was assessed according to the Paris classification at diagnosis, and later in patients who had a follow-up period >2 years. The type of therapy at diagnosis and during follow-up, and the need for surgery were determined. The study covered approximately one-third of the total pediatric population (0-18 years). RESULTS In total, 107 cases of IBD were diagnosed during the study period. The mean annual incidence (per 100,000) was 7.6 (95% confidence interval [CI] 6.3-9.2) for all IBD, 4.6 (95% CI 3.6-5.9) for CD, and 2.8 (95% CI 1.9-3.8) for UC. The incidences of total IBD, CD, and UC increased from 5.7 (3.8-8.2), 3.9 (2.3-6.1), and 1.8 (0.8-3.5) in the period 2002-2004, respectively, to 8.9 (6.3-12.2), 5.0 (3.1-7.6), and 3.4 (1.9-5.6) in the period 2008-2010, respectively. During the follow-up, the proportion of complicated CD disease behavior (stricturing/penetrating) had doubled. A total of 18.5% of patients with CD underwent bowel surgery. CONCLUSIONS The incidence of childhood IBD in the northeastern part of the country is high and comparable with that reported from the developed western countries of Europe, and is probably still increasing. This increase may be the result of changes in the lifestyle, especially in dietary habits during the last 20 years.
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Affiliation(s)
- Darja Urlep
- *Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Ljubljana, University Medical Center Ljubljana †Faculty of Medicine, Institute for Biostatistics and Medical Informatics, University of Ljubljana, Ljubljana, Slovenia
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Lovasz BD, Golovics PA, Vegh Z, Lakatos PL. New trends in inflammatory bowel disease epidemiology and disease course in Eastern Europe. Dig Liver Dis 2013; 45:269-276. [PMID: 23010518 DOI: 10.1016/j.dld.2012.08.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 08/15/2012] [Accepted: 08/15/2012] [Indexed: 12/11/2022]
Abstract
Trends in current epidemiological data suggest that the incidence of inflammatory bowel diseases is changing. Eastern Europe previously was seen as a low incidence area; however, new data confirm that incidence and prevalence are quickly increasing in some countries, reaching moderate-to-high incidence as reported in Western European countries. The quality of the studies also improved. Recently, data became available on the natural history of the disease from Eastern European countries. Current trends are similar to those reported from Western Europe and North America, including less complicated disease at diagnosis, accelerated use of immunomodulators and decreased need for surgery in Crohn's disease, more cases of proctitis and relatively low colorectal cancer risk in ulcerative colitis. In addition, in-depth analysis of disease course enabled the identification of possible predictive factors leading to some novel findings, such as the association between the decline in surgery risk and early treatment strategy. In contrast, some unexplained differences exist, such as the low overall colectomy risk in ulcerative colitis.
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Affiliation(s)
- Barbara D Lovasz
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
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23
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Petritsch W, Fuchs S, Berghold A, Bachmaier G, Högenauer C, Hauer AC, Weiglhofer U, Wenzl HH. Incidence of inflammatory bowel disease in the province of Styria, Austria, from 1997 to 2007: a population-based study. J Crohns Colitis 2013; 7:58-69. [PMID: 22542057 DOI: 10.1016/j.crohns.2012.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 03/14/2012] [Accepted: 03/15/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND The incidence of inflammatory bowel disease (IBD) varies widely between different countries. This large variation is also observed for the incidence of its main two forms, ulcerative colitis (UC) and Crohn's disease (CD). Controversy exists whether IBD incidence is increasing, especially in western countries. Currently no data are available for Austria. This study therefore aimed to evaluate for the first time the incidence of IBD over an eleven-year period in Styria, a province of Austria with a population of 1.2 million. METHODS All patients with an initial diagnosis of IBD between 1997 and 2007, who were Styrian residents, were eligible for this retrospective study. Data were acquired from electronically stored hospital discharge reports and individual reports by patients and physicians. According to population density Styria was divided into two rural and one urban area. RESULTS Throughout the study period 1527 patients with an initial diagnosis of IBD were identified. The average annual incidence was 6.7 (95% CI 6.2-7.1) per 100,000 persons per year for CD and 4.8 (95% CI 4.5-5.2) for UC. The average annual incidence increased significantly (p<0.01) for both diseases during the 11 year study period. Median age at initial diagnosis was 29 years (range 3-87) for CD and 39 years (range 3-94) for UC. At diagnosis, 8.5% of all IBD patients were <18 years of age. The incidence of both CD and UC was significantly higher in the urban area than in rural areas (CD: 8.8, 95% CI 7.8-9.8 versus 5.5, 95% CI 4.7-6.4 and 5.9, 95% CI 5.3-6.7; [p<0.001]; UC: 5.8, 95% CI 5.1-6.6 versus 4.0, 95% CI 3.4-4.7 and 4.7, 95% CI 4.1-5.4; [p=0.04]). CONCLUSION We observed an overall increase in the incidence of ulcerative colitis and Crohn's disease in a part of Austria during an eleven year period. IBD was more predominant in the largest urban area than in rural areas.
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Affiliation(s)
- W Petritsch
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Austria.
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Neuman MG, Nanau RM. Inflammatory bowel disease: role of diet, microbiota, life style. Transl Res 2012; 160:29-44. [PMID: 22687961 DOI: 10.1016/j.trsl.2011.09.001] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 08/27/2011] [Accepted: 09/01/2011] [Indexed: 02/08/2023]
Abstract
Inflammatory bowel disease (IBD) encompassed several chronic inflammatory disorders leading to damage of the gastrointestinal tract (GI). The 2 principal forms of these disorders are ulcerative colitis (UC) and Crohn disease (CD). Bacteria are involved in the etiology of IBD, and the genetic susceptibility, environmental factors, and lifestyle factors can affect the individual's predisposition to IBD. The review discusses the potential role of environmental factors such as diet and microbiota as well as genetics in the etiology of IBD. It is suggested that microbial ecosystem in the human bowel colonizing the gut in many different microhabitats can be influence by diet, leading to formation of metabolic processes that are essential form the bowel metabolism.
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Affiliation(s)
- Manuela G Neuman
- Department of In Vitro Drug Safety and Biotechnology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Nanau RM, Neuman MG. Metabolome and inflammasome in inflammatory bowel disease. Transl Res 2012; 160:1-28. [PMID: 22687960 DOI: 10.1016/j.trsl.2011.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 08/22/2011] [Accepted: 08/22/2011] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel disease (IBD) encompasses several chronic inflammatory disorders leading to the damage of the gastrointestinal tract. The 2 principal forms of these disorders are ulcerative colitis (UC) and Crohn's disease (CD). Bacteria are involved in the etiology of IBD. Many microorganisms have been put forward as causative factors in IBD, but the primary etiologic agents are still not known. The underlying genetic, environmental, and lifestyle issues can affect the individual's predisposition to these diseases. Immune factors identified in IBD are: dysregulation of the innate and adaptive immune system directed against luminal bacteria or their products found in the intestinal lumen and inappropriate immune responses to organisms in the intestine that normally do not elicit a response, possibly because of intrinsic alterations in mucosal barrier function. However, recent advances in basic science research revealed new insights into the role of specific immune cells and their mediators in intestinal inflammation. The inflammatory mediators known as "inflammasome" are a consequence of the metabolic products (metabolom) of cells and commensal or pathogenic bacteria. Elucidation of inflammasome and metabolom has led to the development of biomarkers specific for each disease that are involved into management strategies targeted at altering specific pathogenic mechanisms that have the potential to modify or change the natural course of these disease entities. The review discusses the potential role of biomarkers in monitoring the inflammasome and therefore the severity of intestinal damage. The microbial ecosystem in the human gut in different microhabitats and metabolic niches contribute to the bowel metabolome.In addition, this review will focus on our expanding understanding of microbial factors associated with both the initiation and maintenance of IBD. New insights acquired from murine genetic models of inflammatory bowel disease will also be discussed.
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Affiliation(s)
- Radu M Nanau
- In Vitro Drug Safety and Biotechnology, University of Toronto, Toronto, Canada
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Henderson P, Hansen R, Cameron FL, Gerasimidis K, Rogers P, Bisset WM, Reynish EL, Drummond HE, Anderson NH, Van Limbergen J, Russell RK, Satsangi J, Wilson DC. Rising incidence of pediatric inflammatory bowel disease in Scotland. Inflamm Bowel Dis 2012; 18:999-1005. [PMID: 21688352 DOI: 10.1002/ibd.21797] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 05/16/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND An accurate indication of the changing incidence of pediatric inflammatory bowel disease (PIBD) within a population is useful in understanding concurrent etiological factors. We aimed to compare the current incidence and other demographic attributes of PIBD in the Scottish population to previous data. METHODS A national cohort of prospectively and retrospectively acquired incident cases of PIBD diagnosed less than 16 years old in pediatric services in Scotland was captured for the period 2003-2008; historical Scottish data were used for comparison (1990-1995). Age/sex-adjusted incidences were calculated and statistical comparisons made using Poisson regression. RESULTS During the 2003-2008 study period 436 patients were diagnosed with PIBD in Scotland, giving an adjusted incidence of 7.82/100,000/year. The incidence of Crohn's disease (CD) was 4.75/100,000/year, ulcerative colitis (UC) 2.06/100,000/year, and inflammatory bowel disease-unclassified (IBDU) 1.01/100,000/year. Compared with data from 1990-1995 when 260 IBD patients were diagnosed, significant rises in the incidence of IBD (from 4.45/100,000/year, P < 0.0001), CD (from 2.86/100,000/year, P < 0.0001), and UC (from 1.59/100,000/year, P = 0.023) were seen. There was also a significant reduction in the median age at IBD diagnosis from 12.7 years to 11.9 years between the periods (P = 0.003), with a continued male preponderance. CONCLUSIONS The number of Scottish children diagnosed with IBD continues to rise, with a statistically significant 76% increase since the mid-1990 s. Furthermore, PIBD is now being diagnosed at a younger age. The reason for this continued rise is not yet clear; however, new hypotheses regarding disease pathogenesis and other population trends may provide further insights in future years.
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Affiliation(s)
- Paul Henderson
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
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Bak-Romaniszyn L, Szala A, Sokolowska A, Mierzwa G, Czerwionka-Szaflarska M, Swierzko AS, Zeman K, Cedzynski M. Mannan-binding lectin deficiency in pediatric patients with inflammatory bowel disease. Scand J Gastroenterol 2011; 46:1275-8. [PMID: 21702710 DOI: 10.3109/00365521.2011.594087] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The incidence of inflammatory bowel disease (IBD) in Europe has increased significantly. At least a fourth of patients are children. Mannan-binding lectin (MBL) is believed to be an important component of innate immunity, acting as an opsonin and activator of the lectin pathway (LP) of complement. The data relating any of the LP factors to IBD are sparse and contradictory and were obtained mainly from adult patients. The aim of this study was to investigate the possible role of MBL in Crohn's disease (CD) and ulcerative colitis (UC) in children. METHODS MBL2 gene single nucleotide polymorphisms (PCR-RFLP) and MBL concentrations (ELISA) were determined. RESULTS The frequency of MBL2 gene variants responsible for MBL deficiency (LXPA/O and O/O) is significantly higher in CD patients compared with controls or children with UC. A relatively high frequency of the codon 52 mutation (D allele) was noted in these patients. Practically no difference was found between UC and control (C) groups. Similarly, the average MBL levels as well as the number of MBL-deficient (MBL concentrations < 150 ng/ml) individuals differed between CD patients and controls or children suffering from UC. Again, there was no difference between UC and C groups. CONCLUSIONS These data suggest that MBL deficiency may be associated with CD but not with UC in pediatric patients. The possible role of MBL in IBD requires confirmation in larger series and further investigation of the mechanisms involved.
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Józefczuk J, Woźniewicz BM. Diagnosis and therapy of microscopic colitis with presence of foamy macrophages in children. ISRN GASTROENTEROLOGY 2011; 2011:756292. [PMID: 21991528 PMCID: PMC3168515 DOI: 10.5402/2011/756292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 05/04/2011] [Indexed: 01/01/2023]
Abstract
We discuss the diagnosis of and efficacy 5-amino-2-hydroxybenzoic acid (5-ASA), Saccharomyces boulardii, or magnesium in therapy of microscopic colitis with presence of foamy macrophages. A basis for diagnosis and inclusion to the analysed group was presence of characteristic foamy macrophages in histopathological examination of hematoxylin and eosin-stained specimens collected from the large intestine, reviewed under ×200 or ×320 magnification. No statistically significant improvement was found following the use of 5-amino-2-dihydroxybenzoic acid in therapy of the disease. The use of Saccharomyces boulardii was associated with statistically significant improvement in clinical, endoscopic, and histopathological condition. Use of magnesium caused a histological, statistically significant improvement but failed to have any effect on the clinical and endoscopic presentation. In the group of children in whom no therapeutic intervention was provided, a statistically significant spontaneous clinical improvement was observed, but no statistically significant changes in endoscopic and microscopic condition were found.
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Affiliation(s)
- Jan Józefczuk
- Pediatric Ward, Hospital in Sandomierz, Schinzla 13, 27-600 Sandomierz, Poland
| | - Bogdan Marian Woźniewicz
- Department of Pathology, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730 Warsaw, Poland
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Benchimol EI, Fortinsky KJ, Gozdyra P, Van den Heuvel M, Van Limbergen J, Griffiths AM. Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends. Inflamm Bowel Dis 2011; 17:423-39. [PMID: 20564651 DOI: 10.1002/ibd.21349] [Citation(s) in RCA: 704] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Temporal trends in the incidence of pediatric-onset inflammatory bowel disease (IBD) are controversial and a wide range of estimates have been reported worldwide. We conducted a systematic review of research describing the epidemiology of childhood-onset IBD to assess changes in incidence rates over time and to evaluate international differences. METHODS The following electronic databases were searched for articles published 1950-2009: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane IBD/Functional Bowel Disorders Group Specialised Trial Register. All included studies reported incidence or prevalence of IBD, Crohn's disease (CD) or ulcerative colitis (UC). Two authors independently completed the data extraction form for each eligible study. Choropleth maps demonstrated the international incidence of IBD, CD, and UC. Incidence of CD and UC was graphed using data from studies reporting rates in multiple time periods. RESULTS The search yielded 2209 references and review resulted in 139 included studies from 32 countries. A wide range of incidence was reported internationally; however, rates of IBD were not described in most countries. Twenty-eight studies (20.1%) used statistical analysis to assess trends over time, and 77.8% reported statistically significantly increased incidence of pediatric IBD. Of studies calculating statistical trends in CD incidence, 60% reported significantly increased incidence. Of similar UC studies, 20% reported significantly increased incidence. CONCLUSIONS Globally rising rates of pediatric IBD (due primarily to the rising incidence of CD) was demonstrated in both developed and developing nations; however, most countries lack accurate estimates. Analyzing incidence trends may help identify specific environmental and genetic risk factors for pediatric IBD.
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