Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2017; 23(22): 4090-4101
Published online Jun 14, 2017. doi: 10.3748/wjg.v23.i22.4090
Inflammatory bowel disease incidence in Czech children: A regional prospective study, 2000-2015
Jan Schwarz, Josef Sýkora, Dominika Cvalínová, Renáta Pomahačová, Jana Klečková, Martin Kryl, Petr Včelák
Jan Schwarz, Josef Sýkora, Dominika Cvalínová, Renáta Pomahačová, Department of Paediatrics, Charles University, Faculty of Medicine in Pilsen, Faculty Hospital, 30460 Pilsen, Czech Republic
Jana Klečková, Martin Kryl, Petr Včelák, Department of Computer Science and NTIS - Research Centre, Faculty of Applied Sciences, University of West Bohemia, 30614 Pilsen, Czech Republic
Author contributions: Schwarz J and Sýkora J and contributed equally to this work; Schwarz J, Sýkora J, Cvalínová D and Pomahačová R designed the research, recruited the subjects, and performed the data acquisition; Schwarz J, Sýkora J, Klečková J, Kryl M and Včelák P analyzed the data and drafted the manuscript; Schwarz J, Sýkora J and Klečková J wrote the manuscript; Cvalínová D, Pomahačová R, Klečková J, Kryl M and Včelák P critically revised the manuscript for important intellectual content; Sýkora J approved the final manuscript.
Supported by the “On Our Own Feet Movement - Přáteléstonožky” - Endowment Program.
Institutional review board statement: This study was conducted according to good clinical practice and the Declaration of Helsinki. The research protocol was reviewed and duly approved by the relevant ethics committee.
Informed consent statement: Written informed consent was provided by the parents or caregivers of all participants prior to study inclusion in accordance with the institutional research review board requirements, and all children provided verbal consent before being included in the study.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: There are no additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jan Schwarz, MD, Researcher in Pediatric Gastroenterology, Department of Paediatrics, Charles University, Faculty of Medicine in Pilsen, Faculty Hospital, Alej Svobody 80, 30460 Pilsen, Czech Republic. schwarzj@fnplzen.cz
Telephone: +420-377-104330 Fax: +420-377-104693
Received: December 22, 2016
Peer-review started: December 25, 2016
First decision: January 10, 2017
Revised: January 31, 2017
Accepted: March 20, 2017
Article in press: March 20, 2017
Published online: June 14, 2017
Processing time: 174 Days and 11.8 Hours
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.

Keywords: Inflammatory bowel disease; Incidence; Children; Czech Republic; Pilsen region; Projections; Crohn’s disease; Ulcerative colitis

Core tip: The incidence of inflammatory bowel diseases (IBDs) is around its highest point to date. It has been markedly rising over a 16-year period and is especially pronounced for Crohn’s disease (CD), such that CD is now more common than ulcerative colitis and IBD-unclassified. The changes in IBD incidence in developed countries cannot be explained by changes in genetic background, but the influence of environmental hazards on incidence may be involved in the pathogenesis of IBD. Analyses of time trends and the implications of environmental determinants are required to unravel concurrent factors and causal relationships with the ultimate goal of improving the current care of these patients.