Epidemiology and Clinical Features of Paediatric IBD in Southeast Asian Children
Marion M Aw
The rising trend of Paediatric Inflammatory Bowel Disease (PIBD) in the last decade in Asia provided the impetus to set up the Asian PIBD Regional Network. Paediatric Gastroenterologist from seven countries came together in 2017 to form this collaborative network, with the main aims to describe the epidemiology, disease characteristics and clinical course for children with IBD. Indirectly it also presented the opportunity for us to improve and standardize the care of children with IBD in this region.
A total of 256 children (58.2% male), diagnosed to have IBD below the age of 21 years, have been entered into our retrospective registry. Male sex predominance was seen both in Crohns disease (CD) as well as Ulcerative Colitis (UC). There was a relative high prevalence of Indian patients. Of this cohort, 57.8% had CD, 38.7 % had UC and 5.5% were diagnosed to have IBD-U (unclassified). The mean (SD) age at diagnosis was 9.96 (4.5) and 7.5 (4.7) years for children with CD and UC respectively (p< 0.0001). Over half (56.6%) had early onset IBD, being diagnosed at younger than 10 years of age, with a significant proportion (30.9%) diagnosed before the age of 6 years. Children with CD were more likely to present with abdominal pain, weight loss and constitutional symptoms (fever, anorexia, fatigue) compared to children with UC, who had a higher chance of presenting with bloody diarrhoea. With regards to disease location and behavior, CD was mainly colonic and ileocolonic (68.9%) and neither structuring or penetrating (75%). Peri-anal disease was seen in 21.6% of children. Extra-intestinal manifestations (EIMs) were detected in about 24.5% of children, with 11% (9/80) having 2 EIMs and 1.3% (1/80) having 3 EIMs. Stomatitis with/without oral ulcers, liver involvement, and arthritis were the most common EIMs.
IBD has become a clinically relevant disease for children in Asia, and can no longer be considered a Western disease. There are some distinct epidemiological differences here compared to the West; namely a younger age of onset with more early onset and very early onset IBD. There is an over-representation of the Indian ethnicity, and patients with CD tend to have more peri-anal involvement at diagnosis. Better recognition and a greater understanding of the epidemiology as well as disease characteristics of PIBD in Asia would be important to help us tailor management and determine if strategies recommended in the West would be equally applicable to our patients in Asia.