Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2020; 26(4): 416-423
Published online Jan 28, 2020. doi: 10.3748/wjg.v26.i4.416
Regional variation of pediatric inflammatory bowel disease in Saudi Arabia: Results from a multicenter study
Mohammad I El Mouzan, Mohammed H AlEdreesi, Mohammed Y Hasosah, Abdulrahman A Al-Hussaini, Ahmad A Al Sarkhy, Asaad A Assiri
Mohammad I El Mouzan, Ahmad A Al Sarkhy, Asaad A Assiri, Department of Pediatrics, Gastroenterology Unit, King Saud University, Riyadh11461, Saudi Arabia
Mohammed H AlEdreesi, Specialty Pediatrics Division, Pediatric Gastroenterology, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia
Mohammed Y Hasosah, Department of Pediatrics, Gastroenterology Unit, King Saud bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia
Abdulrahman A Al-Hussaini, Children Hospital, Gastroenterology Division, King Fahad Medical City, Riyadh 11525, Saudi Arabia
Asaad A Assiri, Supervisor of Prince Abdullah Bin Khalid Celiac Disease Research Chair, Gastroenterology Unit, King Saud University, Riyadh 11461, Saudi Arabia
Author contributions: El Mouzan MI designed the study and drafted the manuscript, AlEdreesi MH, Hasosah MY, Al-Hussaini AA, Al Sarkhy AA, and Assiri AA contributed equally to data collection and critical review of the manuscript. All authors reviewed the final manuscript.
Supported by the Deanship for Scientific Research, King Saud University, Riyadh, Kingdom of Saudi Arabia, No. RGP-1436-007.
Institutional review board statement: This manuscript is a portion of the project entitled “the characteristics of inflammatory bowel disease in Saudi children” approved by the IRB of the College of Medicine, King Saud University (No: 10/2647/IRB in 29/6/2010).
Informed consent statement: Parents and/or children gave consent and/or assent to participate in the study before enrollment.
Conflict-of-interest statement: All authors declare no conflict of interest related to this study
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
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/
Corresponding author: Mohammad I El Mouzan, MD, Professor and Consultant Pediatrician, Department of Pediatrics, Gastroenterology Unit, College of Medicine, King Saud University, King Abdullah Road, PO BOX 2925, Riyadh 11461, Saudi Arabia. drmouzan@gmail.com
Received: September 9, 2019
Peer-review started: September 5, 2019
First decision: September 19, 2019
Revised: December 31, 2019
Accepted: January 8, 2020
Article in press: January 8, 2020
Published online: January 28, 2020
Processing time: 134 Days and 16.4 Hours
Abstract
BACKGROUND

Incidence and severity variations of inflammatory bowel disease (IBD) have been reported from Western populations between continents and regions of the same countries. However, no data were available from other countries.

AIM

To investigate the regional differences in the IBD profiles of pediatric patients from the Kingdom of Saudi Arabia.

METHODS

Data from a national multicenter IBD study were used. The incidence, time trend, and clinical presentation of Crohn’s disease (CD) and ulcerative colitis (UC) in the Central region (CR), Western region (WR), and Eastern region (ER) were analyzed and compared. Statistical analysis included Poisson regression analysis for incidence variation and Chi-square test for demographic and clinical parameters. A P < 0.05 was considered significant.

RESULTS

The prevalence of positive family history was lower in children with CD from the ER than the CR or the WR. Consanguinity rate was higher in children with CD and UC from the CR and the ER, respectively. The incidences and time trends of CD and UC were not significantly different between regions. In the ER, a significantly higher percentage of children with CD presented with abdominal pain (P < 0.001), blood in stools (P = 0.048), stricturing or penetrating disease (P = 0.029), higher erythrocyte sedimentation rate (P < 0.001), higher C-reactive protein (P < 0.001), higher anemia (P = 0.017), and lower albumin level (P = 0.014). For children with UC from the ER, a significantly higher percentage presented with anemia (P = 0.006) and a lower percentage with pancolitis (P < 0.001).

CONCLUSION

The most important finding is the identification of significantly more severe presentation of CD in the ER of the Kingdom of Saudi Arabia. Prospective studies are needed to explain such variations.

Keywords: Crohn’s disease; Ulcerative colitis; Epidemiology; Children; Regional variation

Core tip: This article reports regional variations of Crohn’s disease and ulcerative colitis in the Central region, Western region, and the Eastern region of the Kingdom of Saudi Arabia. Although incidence trend was increasing in all regions, children from the Eastern region presented with a significantly more severe Crohn’s disease than those from the Central region and Western region. Regional analysis in other countries may reveal significant variations indicating the need for prospective studies to identify the causes of such variations.