ORLANDO — The incidence of inflammatory bowel disease is rising in children and adolescents, a retrospective study of 272 newly diagnosed pediatric patients indicates, and children of all races, ethnicities, genders, and ages can be affected.
Researchers overseas have shown an increasing incidence of inflammatory bowel disease (IBD) in children, for example, in Sweden (Eur. J. Gen. Pract. 2006;12:88–90) and Taiwan (J. Formos. Med. Assoc. 2004;103:685–91).
“I wanted to see if this is also happening in the U.S.,” Dr. Hoda Malaty said in an interview at her poster during the annual meeting of the American College of Gastroenterology. “I have a great interest in IBD in children because there are a lot of gaps in the literature.”
Dr. Malaty and her associates assessed 272 children with a first diagnosis of IBD who were enrolled in a disease registry at Texas Children's Hospital during 1991–2002. The investigators compared patients based on two time periods: 1991–1996 versus 1997–2002. The ratio was 1.2 boys to each girl.
The overall incidence of IBD increased from 1% to 2.5% from the first time period to the second. “It's on the rise. It increased about three times,” said Dr. Malaty, a pediatrician within the department of medicine, section of gastroenterology and hepatology, Texas Children's Hospital and Baylor College of Medicine, Houston. She had no relevant disclosures, and UCB Inc. supported the study.
A total of 56% of patients in the cohort had Crohn's disease, 22% had ulcerative colitis, and 22% had indeterminate colitis. There was no significant difference in mean age at diagnosis between children with Crohn's disease (11.7 years) and those with ulcerative colitis (10.4 years).
Another U.S. pediatric IBD study was done in Wisconsin (J. Pediatr. 2003;143: 525–31), “but they didn't look at race or ethnicity,” Dr. Malaty said. Using census data for the denominator, she and her associates found a significantly higher incidence of IBD in white children (4.15 per 100,000 per year), compared with African American children (1.83), or Hispanic children (0.61). Although Crohn's disease was more common than ulcerative colitis in all groups, the difference was particularly pronounced in African American children.
“IBD was not diagnosed in children for a long time,” Dr. Malaty said. “It was thought to be an adult, Caucasian, Jewish disease.” Now the disease can be diagnosed histologically, pathologically, and/or with endoscopy in children as young as 1 year, she said. “It is no longer difficult to diagnose.”
Symptoms, such as abdominal pain and rectal bleeding, are not specific enough for diagnosis, Dr. Malaty said. “You have to think twice if symptoms persist.” The general physician should refer a patient with continued symptoms to a pediatric gastroenterologist to obtain biopsies during endoscopy and/or colonoscopy, she said. A limitation in the number of pediatric gastroenterologists, however, is an additional challenge.