Pediatric inflammatory bowel disease grew by more than 40% in a 15-year period in Ontario, Canada, according to a retrospective cohort study published in the October issue of Gastroenterology.
Although rates of inflammatory bowel disease (IBD) rose in children and adolescents of all ages, the steepest increase occurred in children with very-early-onset IBD (VEO-IBD), defined as disease diagnosed before they were 10 years old, said Dr. Eric Benchimol at the University of Ottawa and his associates. But these patients also tended to use fewer health services and have fewer surgeries for IBD, compared with older children with the disease, the investigators said (Gastroenterology 2014 October [doi.org/10.1053/j.gastro.2014.06.023]).
Source: American Gastroenterological Association
The findings add to research indicating that VEO-IBD is a distinct form of IBD and indicate the need to assess subgroups of these patients to look at phenotype, genotype, intestinal microbiome, and treatment response, the investigators said.
For the study, researchers created a cohort based on an algorithm of health care visits that identified all children and adolescents in Ontario diagnosed with IBD before age 18 years. The analysis included 7,143 patients with IBD, among whom about 14% had VEO-IBD, the investigators reported.
The overall rate of IBD in children up to 18 years old increased from 9.4 to 13.2 cases per 100,000 population from 1994 through 2009 (P less than .0001), the researchers said. And the yearly increase in VEO-IBD averaged 7.4% – more than three times greater than the 2.2% average annual rise among children diagnosed at 10 years and older, the investigators reported.
But health care utilization trends did not mirror changes in incidence, Dr. Benchimol and associates reported. For example, children diagnosed before they were 6 years old had significantly fewer outpatient visits for IBD, compared with children diagnosed at 10 years and older (odds ratio for girls, 0.67; 95% confidence interval, 0.58-0.78; OR for boys, 0.86; 95% CI, 0.75-0.98). Furthermore, patients diagnosed before age 6 years were less likely to be hospitalized for IBD than were older children with the disease (hazard ratio for girls, 0.70; 95% CI, 0.56-0.87; HR for boys, 1.12; 95% CI, 0.94-1.33), the investigators said.
The likelihood of undergoing intestinal resection also was lower for children diagnosed before age 6 years with Crohn’s disease, compared with older girls (HR, 0.35; 95% CI, 0.16-0.78) and boys (HR, 0.59; 95% CI, 0.34-0.99), said the researchers. And patients diagnosed before age 6 years with ulcerative colitis were less likely to undergo colectomy than were older girls (HR, 0.88; 95% CI, 0.47-1.63) and boys (HR, 0.42; 95% CI, 0.21-0.85). In contrast, rates of IBD-related surgery and hospitalization were similar between children diagnosed at 6-9.9 years of age and those diagnosed at age 10 up to 18 years, the investigators said.
A cohort study from the United States also found a lower likelihood of surgery in children with VEO-IBD, the researchers noted. Large-bowel involvement without ileal disease is prominent in young children with IBD, and these patients might be unlikely to undergo resection because colectomy requires a permanent ostotomy, they added.
The work was supported by the American College of Gastroenterology, the Ontario Ministry of Health and Long-Term Care, the Canadian Institutes of Health Research, the Crohn’s and Colitis Foundation of Canada, the National Institutes of Health, the Wolpow Family Chair in IBD Treatment and Research, the Ontario Ministry of Research and Innovation, and the Leona M. and Harry B. Helmsley Charitable Trust. The authors reported no conflicts of interest.
