Paediatric inflammatory bowel disease in a multiracial Asian country

Abstract

Information on demographics, disease presentation, laboratory findings, radiological investigations, and endoscopic and histological findings were obtained from the patients' medical records.RESUlTS 32 patients were diagnosed with IBD, 30 of whom had Crohn's disease and 2 had ulcerative colitis. The incidence of IBD rose from an initial rate of 2.2 per 100,000 patients in the year 2000 to a peak of 11.4 patients per 100,000 patients by 2008. Median age of onset of symptoms was 10.5 years. There were more boys (63%) than girls in the group and a higher representation of Indians (34.4%). The most common presenting symptoms were abdominal pain (87.5%), diarrhoea (75.0%) and weight loss (71.9%). Extraintestinal manifestations such as fever and arthralgia were found in over 50% of patients. The most common physical findings were perianal abnormalities (56.3%), mouth ulcers (37.5%) and growth failure (15.6%). Abnormal laboratory findings such as low albumin, raised erythrocyte sedimentation rate, anaemia, thrombocytosis and high C-reactive protein were found in nearly half of the patients. Endoscopic and histological findings showed that a majority of patients (90.6%) also had evidence of inflammation in the upper gastrointestinal tract.CONClUSION Paediatric IBD is on the rise. The higher occurrence in Indians, earlier onset and more florid presentation may suggest different genetic and environmental influences specific to Asian children.

Crohn's disease should be considered in children with inflammatory oral lesions

“…1). The 28 original papers included in the review comprised nine observational studies, five retrospective studies and 14 case reportsfive case series and nine single cases (11)(12)(13)(14).…”

“…Crohn's disease is a chronic transmural granulomatous inflammatory disorder, a type of inflammatory bowel disease (IBD) that may occur in any part of the gastrointestinal tract, including the mouth. The incidence of the childhood-onset disease is estimated to be 0.1-11.2 cases per 100 000 individuals per year, and an aetiopathogenesis role of immunological, genetic, infectious, environmental, psychosocial, dietary factors has been suggested (1,(3)(4)(5)(6)(7)(8)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). The prevalence of oral manifestations in adults is 0.5-20% (20,21).…”

Enteral Nutrition in Crohn’s Disease: An Underused Therapy

“…The Australian Crohn's and Colitis Association predicts that by 2020 the number of people affected with CD and UC will increase by 20–25%. IBD is more prevalent in westernised regions including Europe, Australia, and North America although a rising trend has been noticed in Asia, Africa, and South America [2]. …”

What might be the cause for the emerging inflammatory bowel disease in Saudi outpatients?

“…This eventually led me to publish a paper in 2012 with a unified hypothesis on the etiology of IBD,[2] in which I included some evidences collected at that time, such as the remarkable increase of IBD in Alberta of Canada since the early 1990s, in Brisbane of Australia since the middle 1990s, in North California of the United States since the late 1990s, and in southeastern Norway since the middle 2000s, shortly after the approval of sucralose in Canada in 1991, in Australia in 1993, in the United States in 1998, and by the European Union in 2004. After the publication of that paper, more evidences are accumulating, such as the recent study showing a remarkable increase of pediatric IBD, also mainly CD, in Singapore since the beginning of this new millennium,[3] which happened again shortly after the approval of sucralose in Singapore in 1998. As Saudi Arabia approved sucralose around 2000, I recommend checking out the possible link between sucralose and the recent emergence of IBD in this country.…”