Inflammatory bowel disease in paediatrics: Navigating the old challenges and emerging frontiers

Table 1 Global vs Arabian Gulf pediatric inflammatory bowel disease epidemiology

Feature	Global	Arabian Gulf region
Overall trend	Rising incidence worldwide, particularly in newly industrialized and urbanizing regions	Significant and consistent increase in incidence and recognition, especially over the past two decades
Incidence change (1990-2019)	Increase 22.8% globally in children/adolescents (Global Burden of Disease data)	Increasing across Gulf countries (e.g., Saudi Arabia, Qatar, Bahrain) with documented annual case growth
Proportion diagnosed before age 20	Approximately 25%-30% of total IBD cases	Similar or higher in some regional cohorts, with peak onset between ages 10-16
VEO-IBD (age < 6)	Rising; accounts for approximately 15% of pediatric IBD in some registries; often severe or monogenic	Presumed to be rising; more common in consanguineous populations; monogenic IBD increasingly reported
High-incidence regions	Canada, Northern Europe (Sweden, United Kingdom), Oceania (NZ, Australia): ≥ 10-20/100000/year	Transitioning from low to moderate incidence; still lower than North America/Europe but rapidly increasing
Recent pediatric incidence (per 100000/year)	Canada: 15-20 +; Sweden: 10-12; Japan: 3-4.5; South Korea: 2.5-4.0; Brazil: Approximately 5.5	Bahrain: CD 1.0, UC 2.5; Saudi Arabia: Regional estimates 3-4; Jordan (all ages): 6.9
Prevalence (per 100000 pediatric population)	Canada: CD 50-60, UC 30; United States (2016): Approximately 77 total; Europe: CD 8.2-60, UC 8.3-30	Bahrain: CD 9.3, UC 16.3; Saudi Arabia: CD 4.1, UC 2.76; Kuwait: CD 1.53, UC 0.6; Egypt: CD 2.0, UC 1.5
Highest incidence	Canada: Up to 23 per 100000/year (Nova Scotia, Alberta); among the highest globally	Jordan: 6.9 per 100000/year (all ages); Bahrain: Pediatric incidence of approximately 3.5 per 100000/year
Genetic role	About 20% have a family history; monogenic IBD is common in VEO-IBD	Consanguinity increases familial clustering and monogenic IBD risk in early-onset cases
Environmental risk factors	Westernization, hygiene hypothesis, antibiotic exposure, sedentary lifestyle	Similar environmental changes linked to rising IBD (urbanization, western diets, reduced microbial exposure)
Common pediatric phenotype	CD more common than UC; aggressive disease in younger children (CD)	CD predominates; ileocolonic involvement, more extensive disease, frequent growth failure, severe onset in many cohorts
IBD-U	Approximately 10%-15% at initial diagnosis; requires further subclassification	Common at presentation due to overlapping features and limited access to advanced diagnostics
Data gaps	Better registry coverage in North America/Europe; underreported in parts of Asia, South America	Hospital-based data dominate; lack of national registries in many MENA states

CD: Crohn’s disease; UC: Ulcerative colitis; VEO-IBD: Very early-onset inflammatory bowel disease; IBD-U: Inflammatory bowel disease-unclassified; IBD: Inflammatory bowel disease; MENA: Middle East and North Africa.