Systematic Reviews
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2018; 24(25): 2741-2763
Published online Jul 7, 2018. doi: 10.3748/wjg.v24.i25.2741
Current global trends in the incidence of pediatric-onset inflammatory bowel disease
Josef Sýkora, Renáta Pomahačová, Marcela Kreslová, Dominika Cvalínová, Přemysl Štych, Jan Schwarz
Josef Sýkora, Renáta Pomahačová, Marcela Kreslová, Dominika Cvalínová, 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
Přemysl Štych, Department of Applied Geoinformatics and Cartography, Charles University in Prague, Faculty of Science, Prague 128 43, Czech Republic
Author contributions: Sýkora J and Schwarz J contributed equally to this work, and were responsible for the conception, the study design, the integrity of the data and the accuracy of the data analysis and performed the data acquisition; Pomahačová R, Kreslová M, Cvalínová D and Štych P analyzed the data, drafted the manuscript and revised it critically for important intelectuall content; Štych P performed and edited choropleth maps; Sýkora J and Schwarz J wrote the manuscript; all authors have seen and approved the version of manuscript to be submitted.
Supported by the “On Our Own Feet Movement - Přátelé stonožky” - Endowment Program; and Research Project Progress Q-39.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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:
Correspondence to: Jan Schwarz, MD, Assistant Professor, Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Faculty Hospital, Alej Svobody 80, Pilsen 304 60, Czech Republic.
Telephone: +420-377-104330 Fax: +420-377-104693
Received: March 29, 2018
Peer-review started: March 29, 2018
First decision: May 9, 2018
Revised: June 1, 2018
Accepted: June 25, 2018
Article in press: June 25, 2018
Published online: July 7, 2018
Research background

The incidence of inflammatory bowel disease (IBD) is increasing globally. Multiple studies have reported the pediatric IBD incidence in individuals over the past few years. However, the global and regional IBD incidences in childhood and their trends over time are not well reported. The highest pediatric incidence is traditionally observed in industrialized countries in North America and Western Europe. The incidence of IBD is increasing in both developed and developing countries. The variations in the disease incidence may reflect differences in the distribution of various environmental triggers for the disease within specific areas. The changing incidence of pediatric IBD worldwide provides an opportunity to study disease etiology.

Research motivation

The incidence of IBD is increasing worldwide in both adults and children. Thus, epidemiological knowledge is essential for defining new etiological hypotheses and predictors of the development of IBD to better define how environmental factors might influence disease onset and to guide future studies. Furthermore, additional evidence has recently become available due to the publication of previous reviews, but many incidence rates have since changed. Consequently, currently, a window of opportunity exists for the completion of a new, rigorous pediatric systematic review.

Research objectives

The authors aimed to summarize up-to-date studies investigating the incidence of pediatric-onset IBD and track the changes over time based on a comprehensive search of credible published pediatric studies and current knowledge regarding pediatric IBD incidence.

Research methods

A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched electronic databases (MEDLINE, EMBASE, and Cochrane Library). Studies investigating the incidence and trends of pediatric IBD over time were eligible for inclusion. Interactive maps and temporal trends were used to illustrate the incidences of and changes in IBD.

Research results

One hundred forty studies met the inclusion criteria, demonstrating a substantial increase in the incidence of pediatric IBD and great geographic variations. The incidence of IBD remains the highest in the northern populations of Europe and America and has remained stable or even decreased. Rising rates of pediatric IBD were observed in previously low-incidence areas and much of the developing world, and among children of immigrants. The incidence rates of Crohn’s disease (CD) and ulcerative colitis (UC) vary worldwide between 0.2/100000 and 13.9/100000 and between 0.1/100000 and 15/100000, respectively. In the time-trend analyses, 67% of CD and 46% of UC studies reported a significant increase.

Research conclusions

This study is among the most comprehensive studies to summarize the global IBD incidence. The IBD incidence is increasing or stable over time in both developed and developing regions of the world, indicating an emerging epidemic of the disease outside the Western world, whereas those in Northern Europe may have reached a plateau. The reasons contributing to these continued increases remain unclear. Whether genetic or environmental factors are the cause of these differences remains to be determined. Investigations of IBD performed in locations where it is emerging rapidly provide an opportunity to further identify the causative factors within specific populations. Whether the incidence of IBD in children will continue to increase or remain static is unclear.

Research perspectives

Our data may serve as an essential resource for future studies and can be used to prioritize public health efforts in areas with the highest incidence. Knowing the increasing incidence of IBD and different geographic distribution may provide new insight into the etiology of pediatric IBD and direct future investigative studies. We must find ways to match genetic and environmental factors to pediatric IBD. An understanding of the early evolution of IBD is important and must be further investigated to unravel its etiology. This understanding is particularly important for preventing or curing the disease during the early stages. Attempts to perform studies with global coordination and additional prospective, population-based studies should be encouraged.