Epidemiology of inflammatory bowel diseases in childhood

Abstract

Inflammatory Bowel Disease (IBD) is common in most industrialised countries and childhood IBD accounts for nearly 30% of total cases. Various studies, mostly from Europe and USA have reported epidemiological characteristics of childhood IBD. The incidence figures vary greatly from region to region and within a region over time. Almost all reported studies have documented an increase in the incidence, mainly of Crohn's disease over the last few decades. The reasons for the increase are not clear but epidemiological observations have led to many postulates. Incidence in developing countries is perceived to be low, but limited data suggest that it may not be as uncommon as previously thought. IBD can occur at any age but is rare in infancy. Among childhood IBD, early onset IBD appears to be different epidemiologically and is characterised by predominance of colonic involvement and high positive family history. It has become apparent that only about 25% of childhood Crohn's disease presents with classical triad of abdominal pain, diarrhoea and weight loss. Pediatricians should be aware of atypical manifestations and should maintain high index of suspicion. Though epidemiological studies of childhood IBD done so far have contributed towards understanding of IBD, they have differed in study design, population, time period, age group and case definitions. Unfortunately there are no uniform, clear diagnostic criteria which are evidence based. To address this problem, recently the IBD working group of European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) has published "The Porto Criteria" which details a consensus based diagnostic criteria for the diagnosis of childhood IBD. This should bring uniformity in ascertainment of newly diagnosed IBD cases. An European multicentre prospective database has also been established to facilitate future epidemiological studies.

Incidence of stricturing and penetrating complications of Crohnʼs disease diagnosed in pediatric patients

“…17 Studies in pediatric patients have suggested early onset disease (age 0–5 years) may represent a different disease phenotype. 5,18,19 In a previous study, we found that children who are older at diagnosis (6–17 years) are at higher risk for the development of complicated disease compared with children who are younger at diagnosis (0–5 years). 2 Therefore, adjusting the classification system further to create an age category for patients diagnosed at 0–5 years may be beneficial.…”

Highlights in IBD Epidemiology and Its Natural History in the Paediatric Age

“…The current mean prevalence of IBD in the general population of Western countries is estimated at 1/1,000 inhabitants [25, 26]. Although there are only few epidemiologic data available regarding developing countries, the disease's incidence and prevalence seem to be increasing over the past 50 years in practically all regions of the world, indicating its emergence as a global disease [27, 28]. The trend appears to have stabilised for the adult population but not for the paediatric one, especially in Central and Southern Europe where it appears to be rising [29, 30].…”

Presentation and Disease Course in Early- Compared to Later-Onset Pediatric Crohn's Disease

“…Prior reports suggest that early-onset IBD differs epidemiologically and is characterized by predominant colonic involvement and a high positive family history compared to older age of onset (10, 11). Another study reported a high proportion of colonic and perianal disease in early-onset CD (12).…”