Epidemiological characteristics of Asian children with inflammatory bowel disease at diagnosis: Insights from an Asian-Pacific multi-centre registry network

Table 1 Demographic features of 311 children with inflammatory bowel disease in 6 Asia-Pacific regions

	IBD subtypes				P value (CD vs UC)
	ALL IBD, n = 311	CD, n = 174 (55.9%)	UC, n = 119 (38.3%)	IBD-U, n = 18 (5.8%)
Country (n, row %)
Malaysia	95	39 (41.1)	47 (49.5)	9 (9.5)
Philippines	29	24 (82.8)	1 (3.4)	4 (13.8)
Singapore	108	59 (54.6)	49 (45.4)	0 (0.0)	-
Sri Lanka	19	10 (52.6)	7 (36.8)	2 (10.5)
Taiwan R.O.C.	19	19 (100.0)	0 (0.0)	-
Thailand	41	23 (56.1)	15 (36.6)	3 (7.3)
Mean age at diagnosis, yr (SD)	9.07 (4.56)	10.18 (4.34)	7.73 (4.39)	7.34 (5.1)	< 0.001
Age groups (n, column %)
Very early onset < 6 yr	91 (29.3)	30 (17.2)	51 (42.9)	10 (55.6)	< 0.001
Early onset < 10 yr	164 (52.7)	75 (43.1)	78 (65.5)	11 (61.1)	0.001
Sex (n, column %)
Male	181 (58.2)	101 (58.0)	68 (57.1)	12 (66.7)	NS
Female	130 (41.8)	73 (42.0)	51 (42.9)	6 (33.3)

CD: Crohn’s disease; IBD-U: Inflammatory bowel disease- Unclassified; UC: Ulcerative colitis.

Table 2 Ethnic distribution of inflammatory bowel disease vs population census in countries with multiracial populations (Singapore and Malaysia)

	Total, n = 203	Singapore population census 2020[1]	Malaysian population census 2020[2]	CD, n = 92	UC, n = 91	IBD-U, n = 9	CD:UC ratio	P value
Ethnic group (n, column %)
Chinese	70/203 (36.5)	74.3	22.6	38 (41.3)	31 (34.1)	1 (11.1)	1.2	NS
Indian/South Asian	71/203 (37.0)	9.0	6.8	35 (38.0)	33 (36.3)	3 (33.3)	1.0	NS
Malay	51/203 (26.6)	13.5	69.6	19 (20.7)	27 (29.7)	5 (55.6)	0.7	0.037

CD: Crohn’s disease; IBD-U: Inflammatory bowel disease-Unclassified; UC: Ulcerative colitis.

Table 3 Clinical features in different subtypes of PIBD in the Asia-Pacific region

	IBD subtypes			P value (CD vs UC)
	CD, n = 174 (55.9%)	UC, n = 119 (38.3%)	IBD-U, n = 18 (5.8%)
Symptoms at diagnosis (n, column %)
Abdominal pain	107 (61.5)	53 (44.5)	7 (38.9)	0.004
Chronic diarrhoea	104 (59.8)	69 (58.0)	10 (55.6)	0.760
Bloody diarrhoea	60 (34.5)	89 (74.8)	11 (61.1)	< 0.001
Weight loss	81 (46.6)	44 (37.0)	9 (50.0)	0.104
Fever	66 (37.9)	21 (17.6)	2 (11.1)	< 0.001
Loss of appetite	57 (32.8)	19 (16.0)	6 (33.3)	0.001
Malaise/fatigue	28 (16.1)	8 (6.7)	1 (5.6)	0.016
Oral ulcers	36 (20.7)	1 (0.8)	0 (0.0)	< 0.001
Perianal symptoms (pain/discharge)	23 (13.2)	3 (2.5)	1 (5.6)	0.002
Joint pains	13 (7.5)	6 (5.0)	0 (0.0)	0.407
Physical signs at diagnosis (n, column %)
Pallor	68 (39.1)	32 (26.9)	5 (27.8)	0.031
Hepatomegaly	8 (4.6)	12 (10.1)	2 (11.1)	0.067
Abdominal tenderness	47 (27.0)	15 (12.6)	2 (11.1)	0.003
Asymptomatic perianal tags	25 (14.4)	3 (2.5)	1 (5.6)	0.001
Perianal fissure	20 (11.5)	2 (1.7)	1 (5.6)	0.002
Muscle wasting	25 (14.4)	7 (5.9)	1 (5.6)	0.022
Arthritis	12 (6.9)	3 (2.5)	0 (0.0)	0.095
Erythema nodosum	8 (4.6)	0 (0.0)	0 (0.0)	0.018
Anthropometric parameters (SD)
Mean weight Z-score	-1.4 (1.7)	-1.0 (1.7)	-0.7 (2.2)	0.110
Mean height Z-score	-0.8 (1.5)	-0.6 (1.6)	-0.6 (2.4)	0.583
Growth failure (Height Z-score less than -2) (%)	18.4	16.1	17.6	0.907
Mean BMI Z-score	-1.5 (1.8)	-0.9 (1.7)	-0.6 (1.8)	0.013
Laboratory investigations at diagnosis (SD)
Mean haemoglobin, g/dL	10.6 (1.9)	11.0 (2.5)	10.9 (1.5)	0.221
Mean ESR, mm/hr	50.8 (30.5)	42.6 (34.4)	34.9 (32.2)	0.063
Mean C-reactive protein, mg/L	54.6 (55.0)	20.1 (24.3)	7.1 (9.1)	< 0.001
Mean albumin, g/dL	33.0 (8.7)	35.4 (8.4)	37.2 (7.1)	0.040
Mean ALT, U/L	18.5 (20.5)	72.7 (162.0)	20.4 (13.4)	< 0.001
Mean AST, U/L	27.0 (32.9)	84.2 (170.7)	30.5 (10.5)	0.001
Mean GGT, U/L	38.3 (79.8)	126.7 (160.8)	30.8 (40.0)	< 0.001
Mean faecal calprotectin, μg/g	783 (1009.0)	583.4 (353.1)	593.5 (300.5)	0.447

ALT: Alanine transaminase; AST: Aspartate transaminase; BMI: Body mass index; CD: Crohn’s disease; ESR: Erythrocyte sedimentation rate; GGT: Gamma-glutamyl transferase; IBD-U: Inflammatory bowel disease-Unclassified; UC: Ulcerative colitis.

Table 4 Disease characteristics of Crohn’s disease and ulcerative colitis

Disease characteristics	N	SA	P value (SA vs non-SA)
CD	n = 174	n = 35 (20.1)
Disease severity based on PCDAI score (n, column %)1
Inactive (≤ 10)	17 (12.3)	4 (14.3)	NS
Mild (11-30)	46 (33.3)	9 (32.1)
Moderate-severe (> 30)	75 (54.3)	15 (53.6)
Disease location (n, column %)
L1 (distal 1/3 ileum +/- limited caecal disease)	28 (18.7)	4 (12.5)	0.505 (SA)
L2 (colonic)	54 (36.0)	10 (31.3)
L3 (ileocolonic)	62 (41.3)	16 (50.0)
Isolated L4 disease	6 (4.0)	2 (6.3)
L4a	59 (40.7)	13 (39.4)	0.973 (SA)
L4b	12 (8.3)	3 (9.1)
No L4 disease	74 (51.0)	17 (51.3)
Disease behaviour (n, %)
B1 (inflammatory)	136 (90.7)	31 (93.9)	0.858 (SA)
B2 (stricturing)	5 (3.3)	1 (3.0)
B3 (penetrating)	8 (5.3)	1 (3.0)
B2/B3	1 (0.7)	0 (0.0)
Perianal involvement (n, %)
Perianal symptoms at presentation	23 (13.2)	10 (28.6)	0.003 (SA)
Any form of perianal manifestation (clinical exam or imaging)	53 (30.5)	18 (51.4)	0.003 (SA)
UC	n = 119	n = 33 (27.7)
Disease severity based on PUCAI score (n, column %)2
Inactive (< 10)	7 (8.3)	0 (0.0)	0.353 (SA)
Mild (10-34)	36 (42.9)	11 (47.8)
Moderate (35-64)	28 (33.3)	9 (39.1)
Severe (≥ 65)	13 (15.5)	3 (13.0)
Disease location (n, column %)
E1 (proctitis)	8 (7.5)	2 (6.9)	0.353 (SA)
E2 (left sided)	16 (15.1)	5 (17.2)
E3 (extensive)	5 (4.7)	5 (17.2)
E4 (pancolitis)	77 (72.6)	17 (58.6)
Disease severity (n, column %)
S0 (never severe)	79 (78.2)	20 (74.1)	0.542 (SA)
S1 (ever severe)	22 (21.8)	7 (25.9)

¹Disease activity scores available only for 138/174 Crohn’s disease patients.

²Disease severity scores available for 84/119 Ulcerative colitis patients.

CD: Crohn’s disease; PCDAI: Pediatric Crohn’s Disease Activity Index; PUCAI: Pediatric Ulcerative Colitis Activity Index; SA: South Asian; UC: Ulcerative colitis.