Published online Jun 14, 2017. doi: 10.3748/wjg.v23.i22.4090
Peer-review started: December 25, 2016
First decision: January 10, 2017
Revised: January 31, 2017
Accepted: March 20, 2017
Article in press: March 20, 2017
Published online: June 14, 2017
To examine the incidence and trends in pediatric inflammatory bowel diseases (IBDs) over 2000-2015 and project the incidence to 2018.
A 16-year prospective study of IBD patients < 19 years of age was conducted in the Czech Republic (the Pilsen region). All incident IBD cases within a well-defined geographical area were retrieved from a prospectively collected computerized clinical database. Historical Czech data were used for comparison (1990-2001). Our catchment population was determined from the census data. We calculated the incidence by relating the number of newly diagnosed cases to the size of the pediatric population-at-risk in each calendar year. Age/sex, disease type, place of residence, and race/ethnicity were identified.
In total, 170 new IBD cases [105 Crohn’s disease (CD), 48 ulcerative colitis (UC), and 17 IBD-unclassified (IBD-U)] were identified. The median age at IBD diagnosis was 14.2 years, 59.4% were males, and 97.1% were Caucasians. A male preponderance of IBD (P = 0.026) and CD (P = 0.016) was observed. With 109209 person-years in the catchment area, the average incidence of IBD per 100000 person-years was 10.0 (6.2 for CD, 2.8 for UC, and 1.0 for IBD-U) for children aged 0 to 19 years; for those aged 0 to 15 years, the incidence rate was 7.3 (4.6 for CD, 2.0 for UC, and 0.7 for IBD-U). An increase in incidence with age was observed (P = 0.0003). Over the 16-year period, the incidence increased for IBD patients (P = 0.01) and CD in particular (P < 0.0001), whereas the incidence for UC (P = 0.09) and IBD-U (P = 0.339) remained unchanged. IBD-projected data from 2016 to 2018 were 12.1, 12.3 and 12.6 per 100000 person-years, respectively.
Pediatric-onset IBD incidence is around its highest point. The increase, which is particularly pronounced for CD, may be challenging to relate to causes of pediatric disease.
Core tip: The incidence of inflammatory bowel diseases (IBDs) is around its highest point to date. It has been markedly rising over a 16-year period and is especially pronounced for Crohn’s disease (CD), such that CD is now more common than ulcerative colitis and IBD-unclassified. The changes in IBD incidence in developed countries cannot be explained by changes in genetic background, but the influence of environmental hazards on incidence may be involved in the pathogenesis of IBD. Analyses of time trends and the implications of environmental determinants are required to unravel concurrent factors and causal relationships with the ultimate goal of improving the current care of these patients.