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
ARTICLE HIGHLIGHTS
Research background

Inflammatory bowel disease (IBD) has been reported most commonly in Western populations and rarely in others. Increasing reports from developing countries including the Kingdom of Saudi Arabia (KSA) attracted global interest in the search of factors implicated in the pathogenesis of IBD. The present report, exploring IBD profile in different regions may reveal important regional variations undetectable in global national studies.

Research motivation

Although increasing incidence trend of Pediatric IBD is well known in the KSA, regional variation in culture and lifestyle may be involved in variation of IBD profile. The result may direct further research to clarify the causes of regional variation.

Research objectives

The main objective of this report was to explore regional variations in the profile of pediatric IBD in the KSA. The finding of significantly more severe Crohn’s disease (CD) presentation in children from the Eastern region indicates the need for prospective studies to uncover the causes of this variation from the other regions. The results of such studies may increase our understanding of the pathogenesis of IBD.

Research methods

Data from a national multicenter study of pediatric IBD were used. The incidence, time trend, and clinical presentation of CD and ulcerative colitis (UC) in the Central, Western, and Eastern regions of the KSA were analyzed, and regional comparison was performed. Poisson regression analysis was used to assess regional incidence and Chi-square test for demographic and clinical parameters. A P < 0.05 was considered significant.

Research results

We found increasing incidence trend of pediatric UC and CD in all regions of the KSA. However, comparison with other regions, children with CD from the ER presented with significantly higher prevalence of complications such as fistula or stenosis, higher anemia, erythrocyte sedimentation rate, and C-reactive protein; as well as less blood in stools and lower albumin levels. The causes of this finding of more disease presentation of CD remains to be studied.

Research conclusions

In this study, the more severe clinical profile of CD in children from the ER of the KSA is a new finding. We hypothesize that lifestyle and microbiota variation are potential causes. Regional analysis is recommended as it may reveal significant variations undetectable by overall national studies. Prospective studies focusing on environmental factors are needed to search the cause. Identification of factors implicated in the severe clinical presentation in CD may lead to preventive and therapeutic recommendations.

Research perspectives

This study revealed significantly more severe clinical presentation of CD in one of the regions (ER) of the KSA. This finding indicates the need for prospective studies to search the causes of this clinical picture.