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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Epidemiological characteristics of Asian children with inflammatory bowel disease at diagnosis: Insights from an Asian-Pacific multi-centre registry network
James Guoxian Huang, Yoko Kin Yoke Wong, Kee Seang Chew, Pornthep Tanpowpong, Karen Sophia Calixto Mercado, Almida Reodica, Shaman Rajindrajith, Kai-Chi Chang, Yen-Hsuan Ni, Suporn Treepongkaruna, Way-Seah Lee, Marion Margaret Aw
James Guoxian Huang, Marion Margaret Aw, Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore 119228, Singapore
James Guoxian Huang, Marion Margaret Aw, Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
Yoko Kin Yoke Wong, Epidemiology, Singapore Clinical Research Institute, Singapore 138669, Singapore
Kee Seang Chew, Way-Seah Lee, Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur 50603, Malaysia
Pornthep Tanpowpong, Suporn Treepongkaruna, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Karen Sophia Calixto Mercado, Department of Pediatrics, Makati Medical Centre, Manila 1229, Philippines
Almida Reodica, Department of Pediatrics, The Medical City, Manila 0900, Philippines
Shaman Rajindrajith, Department of Pediatrics, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
Kai-Chi Chang, Yen-Hsuan Ni, Department of Pediatrics, National Taiwan University Hospital, Taipei 100229, Taiwan
Author contributions: Huang JG, Wong YKY, Chew KS, Tanpowpong P, Calixto Mercado KS, Reodica A, Rajindrajith S, Chang KC, Ni YH, Treepongkaruna S, Lee WS, and Aw MM were involved in the conception of the work and data collection; Wong YKY was involved in the data interpretation; Huang JG, Wong YKY, Treepongkaruna S, Lee WS, and Aw MM contributed to the article drafting; Huang JG, Treepongkaruna S, Lee WS, and Aw MM were involved in the critical revision of the article; and all authors were involved in final approval of the published version.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer. Ethics approval for the storage of anonymised clinical data on a multi-centre central data registry hosted by the Singapore Clinical Research Institute was granted by the National Healthcare Group (NHG) Domain Specific Review Board (Approval letter for study code NUH/2019-00060 dated 23rd January 2020), followed by a separate ethics approval for data extraction and analysis (Approval letter for study code 2019/00751 dated 20th October 2021 to 19th October 2022).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at james_huang@nuhs.edu.sg on reasonable request.
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 that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: James Guoxian Huang, MBBS, Assistant Professor, Doctor, Staff Physician, Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore 119228, Singapore. james_huang@nuhs.edu.sg
Received: November 3, 2021
Peer-review started: November 3, 2021
First decision: December 26, 2021
Revised: January 3, 2022
Accepted: March 25, 2022
Article in press: March 25, 2022
Published online: May 7, 2022
ARTICLE HIGHLIGHTS
Research background
There remains a dearth of epidemiological literature on paediatric inflammatory bowel disease (IBD) in most parts of Asia. While there have been several published cohort studies out of East Asia, little is known on the actual disease burden beyond isolated case series and single-centre studies in the rest of the Asia-Pacific region. This would represent the first cohort study from a multi-centre Asian-Pacific PIBD registry first initiated in 2017.
Research motivation
The main issue was a lack of a standardised data platform in Asian-Pacific paediatric gastroenterology centres. A standardised data platform is vital to allow an accurate and validated way of reporting the disease behaviour and phenotype of PIBD across different healthcare systems in the heterogeneous Asia-Pacific region. This facilitates meaningful epidemiological comparisons with other established PIBD cohorts from North America and Western Europe.
Research objectives
This cohort study describes the epidemiological characteristics of all PIBD patients at the point of initial presentation, whom are managed at one of seven paediatric gastroenterology centres in the Asian-Pacific region (Singapore, Sri Lanka, Malaysia, Thailand, Philippines, Taiwan R.O.C). The objectives were to establish if there were unique disease characteristics of PIBD in the Asia-Pacific region in contrast to East Asian and Caucasian cohorts, as well as inter-ethnic disease phenotypic differences in the multi-ethnic populations of Asia-Pacific.
Research methods
Standardised disease data collection forms using existing validated disease activity indices and disease classification systems for PIBD were stored electronically on a centrally-hosted secure REDCAP platform. Participating Asian-Pacific sites were invited to enrol patients with an established diagnosis of IBD from the point of initial presentation.
Research results
Epidemiological data from our registry demonstrates a rapid rise in PIBD incidence, particularly in the last 5 years. The unique disease characteristics of our Asian-Pacific cohort include a large proportion of very-early onset (VEO)-IBD (29.3%) similar to the high proportions of VEO disease reported from mainland China, Saudi Arabia and India. There is also a relative over-representation of the Indian/ South Asian ethnicity in the multi-ethnic countries of Singapore and Malaysia. Patients of Indian ethnicity with Crohn’s disease (CD) were also most likely to present with symptomatic perianal disease.
Research conclusions
The rise in PIBD incidence across the Asian-Pacific region is consistent with the observed rise in incidence in many other global cohorts. The high proportion of very early onset IBD in the Asia-Pacific region may represent a shift in epidemiological trends in PIBD, as other established IBD cohorts similarly report the fastest growth in IBD incidence amongst very young children. The higher incidence of symptomatic perianal CD amongst Indian patients in Singapore/Malaysia suggests inter-ethnic genetic differences may cause variability in disease behaviour.
Research perspectives
Future research should be targeted at establishing national disease data registries to fully encapsulate the true burden of IBD in the Asia-Pacific region, and prospective follow-up data from this multi-centre registry is essential to determine if any of the observed epidemiological trends at diagnosis have implications on longer term outcomes.
