Inflammatory bowel disease incidence in Czech children: A regional prospective study, 2000-2015

Abstract

AIMTo examine the incidence and trends in pediatric inflammatory bowel diseases (IBDs) over 2000-2015 and project the incidence to 2018.METHODSA 16-year prospective study of IBD patients < 19 years of age was conducted in the Czech Republic (the Pilsen region). All incident IBD cases within a well-defined geographical area were retrieved from a prospectively collected computerized clinical database. Historical Czech data were used for comparison (1990-2001). Our catchment population was determined from the census data. We calculated the incidence by relating the number of newly diagnosed cases to the size of the pediatric population-at-risk in each calendar year. Age/sex, disease type, place of residence, and race/ethnicity were identified.RESULTSIn total, 170 new IBD cases [105 Crohn’s disease (CD), 48 ulcerative colitis (UC), and 17 IBD-unclassified (IBD-U)] were identified. The median age at IBD diagnosis was 14.2 years, 59.4% were males, and 97.1% were Caucasians. A male preponderance of IBD (P = 0.026) and CD (P = 0.016) was observed. With 109209 person-years in the catchment area, the average incidence of IBD per 100000 person-years was 10.0 (6.2 for CD, 2.8 for UC, and 1.0 for IBD-U) for children aged 0 to 19 years; for those aged 0 to 15 years, the incidence rate was 7.3 (4.6 for CD, 2.0 for UC, and 0.7 for IBD-U). An increase in incidence with age was observed (P = 0.0003). Over the 16-year period, the incidence increased for IBD patients (P = 0.01) and CD in particular (P < 0.0001), whereas the incidence for UC (P = 0.09) and IBD-U (P = 0.339) remained unchanged. IBD-projected data from 2016 to 2018 were 12.1, 12.3 and 12.6 per 100000 person-years, respectively.CONCLUSIONPediatric-onset IBD incidence is around its highest point. The increase, which is particularly pronounced for CD, may be challenging to relate to causes of pediatric disease.

Current global trends in the incidence of pediatric-onset inflammatory bowel disease

“…Kolek et al[ 140 ] published results from Moravia (the eastern part of the Czech Republic) showing increasing incidence of CD and UC between 1999 and 2001. The Czech Republic has among the highest rates of IBD worldwide as recently observed by our group (2000-2015)[ 45 ] (10.0, 6.2, 2.8 and 1.0/100000 for IBD, CD, UC and IBD-U, respectively) and have been shown to be increasing in future projections[ 45 ]. In neighboring Poland, UC incidence was higher than that of CD with significant regional differences, but the incidence was markedly lower than that observed in the West.…”

“…Few studies using north-south/west-east gradients have demonstrated particularly high rates in the north[ 39 - 42 ], except for northern France[ 43 ] and Spain[ 44 ]. Although our review did not specifically investigate disease incidence gradients, this phenomenon has been less prominent over the last three decades[ 45 - 51 ].…”

Incidence and Geographical Variability of Pediatric Inflammatory Bowel Disease in Croatia: Data From the Croatian National Registry for Children With Inflammatory Bowel Disease

“…Polish incidence is 2.7/100 000 children/year, and in the Czech Republic it is as many as 10/100 000 children/year. 33,34 Polish authors, as a possible reason for the unexpectedly low incidence cite the possibility of underreporting of patients due to differences in diagnostic treatment options in different parts of the country. 34 Also, when comparing data from those 2 countries, it should be borne in mind that the Polish study was done more than 10 years before the Czech and the incidence is rising all over the world.…”

“…33,34 Polish authors, as a possible reason for the unexpectedly low incidence cite the possibility of underreporting of patients due to differences in diagnostic treatment options in different parts of the country. 34 Also, when comparing data from those 2 countries, it should be borne in mind that the Polish study was done more than 10 years before the Czech and the incidence is rising all over the world. PIBD incidence in Germany is estimated to be between 5 and 11/100 000 children/year 35 and in Netherlands it is 5.2/100 000 children/year, 29 and both are lower than ours.…”

Presence of Mycobacterium avium Subspecies paratuberculosis Monitored Over Varying Temporal and Spatial Scales in River Catchments: Persistent Routes for Human Exposure

“…Like that of Johne’s disease, the incidence of Crohn’s disease continues to increase with consequential economic health costs [25,26,27,28,29], particularly in children. Both Northern and Central Europe and Australia showed an average 5-fold per decade increase in the disease in children under 16 [30,31,32].…”