Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
권호 표지
DOI QR코드

DOI QR Code

Pediatric Inflammatory Bowel Disease: A Multicenter Study of Changing Trends in Argentina Over the Past 30 Years

  • Arcucci, Maria Soledad (Pediatric Gastroenterology, Hepatology and Liver Intestinal Transplantation Unit, Hospital Italiano de Buenos Aires) ;
  • Contreras, Monica Beatriz (Pediatric Gastroenterology Service, Hospital de Pediatria S.A.M.I.C. "Prof. Dr. Juan P. Garrahan") ;
  • Gallo, Julieta (Pediatric Gastroenterology, Hepatology and Liver Intestinal Transplantation Unit, Hospital Italiano de Buenos Aires) ;
  • Antoniska, Mariela Andrea (Pediatric Gastroenterology Service, Hospital de Pediatria S.A.M.I.C. "Prof. Dr. Juan P. Garrahan") ;
  • Busoni, Veronica (Pediatric Gastroenterology, Hepatology and Liver Intestinal Transplantation Unit, Hospital Italiano de Buenos Aires) ;
  • Tennina, Cecilia (Pediatric Gastroenterology Service, Hospital de Ninos, Dr. Ricardo Gutierrez) ;
  • D’Agostino, Daniel (Pediatric Gastroenterology, Hepatology and Liver Intestinal Transplantation Unit, Hospital Italiano de Buenos Aires) ;
  • Kakisu, Maria Hisae (Pediatric Service, Hospital Privado de la Comunidad) ;
  • Weyersberg, Christian (Pediatric Gastroenterology Service, Hospital de Pediatria S.A.M.I.C. "Prof. Dr. Juan P. Garrahan") ;
  • Orsi, Marina (Pediatric Gastroenterology, Hepatology and Liver Intestinal Transplantation Unit, Hospital Italiano de Buenos Aires)
  • Received : 2021.09.18
  • Accepted : 2022.03.13
  • Published : 2022.05.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: To analyze the characteristics of pediatric inflammatory bowel disease (IBD) over the past three decades in Argentina and determine if there are differences between the first two decades and the past decade. Methods: We conducted a retrospective multicenter analytical study in children with IBD between 0 and 18 years of age diagnosed between 1987 and 2017 in three tertiary health centers in Argentina. The evaluation included clinical characterization, endoscopy, histology, and imaging data together with therapeutic strategies. The patients were divided into two groups: Group 1, diagnosed between 1987 and 2007, and Group 2, diagnosed between 2008 and 2017. Results: Of the 756 patients included, 409 (54%) had ulcerative colitis (UC), 250 (33%) had Crohn's disease (CD), and 97 (13%) had IBD-unclassified (IBD-U). The positive family history was 3.8%, which was more frequent among children under two years of age (6.7%). There were no significant differences in clinical presentation and extraintestinal manifestations between periods, with hepatic manifestations being the most frequent. In the last decade, we found an upward trend in CD, a downward trend in UC/IBD-U, even after adjustment for socioeconomic status, and a decrease of 50% in surgical treatments coinciding with the advent of biological therapy. Conclusion: This is the first multicenter cohort study in a Latin American country to describe clinical, endoscopic, and therapeutic data across the past 30-year period. Although CD was responsible for the overall increase in incidence, UC was still prevalent in this region.

Keywords

Acknowledgement

We thank Vanina Pagotto for helping with the methods and statistical analysis, Carlos Lifschitz for reviewing and editing the manuscript, and Judith Cohen Sabban, Vilma Cirincione, Jose Antonio Ruiz, Ana Rocca, Liliana Sasson, Adriana Bottero, and Elisabet Mavromatopulos for their assistance with the clinical data, and Maria Teresa D'Avila, Andrea Bosaleh, and Paola Ximena de la Iglesia Niveyro for the interpretation of histopathological samples.

References

  1. Ray K. IBD: the changing epidemiology of IBD. Nat Rev Gastroenterol Hepatol 2017;14:690.
  2. Benchimol EI, Fortinsky KJ, Gozdyra P, Van den Heuvel M, Van Limbergen J, Griffiths AM. Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends. Inflamm Bowel Dis 2011;17:423-39. https://doi.org/10.1002/ibd.21349
  3. Hildebrand H, Finkel Y, Grahnquist L, Lindholm J, Ekbom A, Askling J. Changing pattern of paediatric inflammatory bowel disease in northern Stockholm 1990-2001. Gut 2003;52:1432-4. https://doi.org/10.1136/gut.52.10.1432
  4. Turunen P, Kolho KL, Auvinen A, Iltanen S, Huhtala H, Ashorn M. Incidence of inflammatory bowel disease in Finnish children, 1987-2003. Inflamm Bowel Dis 2006;12:677-83. https://doi.org/10.1097/00054725-200608000-00002
  5. Vind I, Riis L, Jess T, Knudsen E, Pedersen N, Elkjaer M, et al. Increasing incidences of inflammatory bowel disease and decreasing surgery rates in Copenhagen City and County, 2003-2005: a population-based study from the Danish Crohn colitis database. Am J Gastroenterol 2006;101:1274-82. https://doi.org/10.1111/j.1572-0241.2006.00552.x
  6. Bernstein CN, Blanchard JF, Rawsthorne P, Wajda A. Epidemiology of Crohn's disease and ulcerative colitis in a central Canadian province: a population-based study. Am J Epidemiol 1999;149:916-24. https://doi.org/10.1093/oxfordjournals.aje.a009735
  7. Benchimol EI, Guttmann A, Griffiths AM, Rabeneck L, Mack DR, Brill H, et al. Increasing incidence of paediatric inflammatory bowel disease in Ontario, Canada: evidence from health administrative data. Gut 2009;58:1490-7. https://doi.org/10.1136/gut.2009.188383
  8. Benchimol EI, Bernstein CN, Bitton A, Carroll MW, Singh H, Otley AR, et al. Trends in epidemiology of pediatric inflammatory bowel disease in Canada: distributed network analysis of multiple population-based provincial health administrative databases. Am J Gastroenterol 2017;112:1120-34. https://doi.org/10.1038/ajg.2017.97
  9. Vicentin R, Wagener M, Pais AB, Contreras M, Orsi M. One-year prospective registry of inflammatory bowel disease in the Argentine pediatric population. Arch Argent Pediatr 2017;115:533-40.
  10. Larrosa-Haro A, Abundis-Castro L, Contreras MB, Gallo MJ, Pena-Quintana L, Targa Ferreira CH, et al. Epidemiologic trend of pediatric inflammatory bowel disease in Latin America: The Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) Working Group. Rev Gastroenterol Mex (Engl Ed) 2021;86:328-34.
  11. Gonzalez M, Ossa JC, Alliende GF, Canales RP, Cofre DC, Faundez R, et al. [Inflammatory bowel disease in pediatrics (IBD): review. Working group of the Latin American Society of Pediatric Gastroenterology Gastroenterology, Hepatology and Pediatric Nutrition]. Acta Gastroenterol Latinoam 2018;48:226-41.Spanish
  12. IBD Working Group of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition. Inflammatory bowel disease in children and adolescents: recommendations for diagnosis--the Porto criteria. J Pediatr Gastroenterol Nutr 2005;41:1-7. https://doi.org/10.1097/01.MPG.0000163736.30261.82
  13. Levine A, Koletzko S, Turner D, Escher JC, Cucchiara S, de Ridder L, et al. ESPGHAN revised porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr 2014;58:795-806. https://doi.org/10.1097/mpg.0000000000000239
  14. Levine A, Griffiths A, Markowitz J, Wilson DC, Turner D, Russell RK, et al. Pediatric modification of the Montreal classification for inflammatory bowel disease: the Paris classification. Inflamm Bowel Dis 2011;17:1314-21. https://doi.org/10.1002/ibd.21493
  15. Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol 2005;19(Suppl A):5A-36A. https://doi.org/10.1155/2005/269076
  16. Roberts SE, Thorne K, Thapar N, Broekaert I, Benninga MA, Dolinsek J, et al. A systematic review and meta-analysis of paediatric inflammatory bowel disease incidence and prevalence across Europe. J Crohn's Colitis 2020;14:1119-48. https://doi.org/10.1093/ecco-jcc/jjaa037
  17. Castro M, Papadatou B, Baldassare M, Balli F, Barabino A, Barbera C, et al. Inflammatory bowel disease in children and adolescents in Italy: data from the pediatric national IBD register (1996-2003). Inflamm Bowel Dis 2008;14:1246-52. https://doi.org/10.1002/ibd.20470
  18. Lattimer LD, Chandler MB, Borum ML. Hispanics and inflammatory bowel disease. Inflamm Bowel Dis 2015;21:1214-8. https://doi.org/10.1097/MIB.0000000000000300
  19. Kugathasan S, Loizides A, Babusukumar U, McGuire E, Wang T, Hooper P, et al. Comparative phenotypic and CARD15 mutational analysis among African American, Hispanic, and White children with Crohn's disease. Inflamm Bowel Dis 2005;11:631-8. https://doi.org/10.1097/01.MIB.0000171279.05471.21
  20. Figueroa CC, Quera PR, Valenzuela EJ, Jensen BC. [Inflammatory bowel disease: experience of two Chilean centers]. Rev Med Chil 2005;133:1295-304. Spanish.
  21. Martin-de-Carpi J, Rodriguez A, Ramos E, Jimenez S, Martinez-Gomez MJ, Medina E. Increasing incidence of pediatric inflammatory bowel disease in Spain (1996-2009): the SPIRIT Registry. Inflamm Bowel Dis 2013;19:73-80. https://doi.org/10.1002/ibd.22980
  22. Khalili H, Hakansson N, Chan SS, Chen Y, Lochhead P, Ludvigsson JF, et al. Adherence to a Mediterranean diet is associated with a lower risk of later-onset Crohn's disease: results from two large prospective cohort studies. Gut 2020;69:1637-44. https://doi.org/10.1136/gutjnl-2019-319505
  23. Kelsen JR, Sullivan KE, Rabizadeh S, Singh N, Snapper S, Elkadri A, et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition position paper on the evaluation and management for patients with very early-onset inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2020;70:389-403. https://doi.org/10.1097/mpg.0000000000002567
  24. Mamula P, Markowitz JE, Baldassano RN. Inflammatory bowel disease in early childhood and adolescence: special considerations. Gastroenterol Clin North Am 2003;32:967-95, viii. https://doi.org/10.1016/S0889-8553(03)00046-3
  25. Oliveira SB, Monteiro IM. Diagnosis and management of inflammatory bowel disease in children. BMJ 2017;357:j2083. https://doi.org/10.1136/bmj.j2083
  26. Greuter T, Bertoldo F, Rechner R, Straumann A, Biedermann L, Zeitz J, et al. Extraintestinal manifestations of pediatric inflammatory bowel disease: prevalence, presentation, and anti-TNF treatment. J Pediatr Gastroenterol Nutr 2017;65:200-6. https://doi.org/10.1097/MPG.0000000000001455
  27. Kugathasan S, Judd RH, Hoffmann RG, Heikenen J, Telega G, Khan F, et al. Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in Wisconsin: a statewide population-based study. J Pediatr 2003;143:525-31. https://doi.org/10.1067/S0022-3476(03)00444-X
  28. De Filippo C, Cavalieri D, Di Paola M, Ramazzotti M, Poullet JB, Massart S, et al. Impact of diet in shaping gut microbiota revealed by a comparative study in children from Europe and rural Africa. Proc Natl Acad Sci U S A 2010;107:14691-6. https://doi.org/10.1073/pnas.1005963107
  29. Ali S, Tamboli CP. Advances in epidemiology and diagnosis of inflammatory bowel diseases. Curr Gastroenterol Rep 2008;10:576-84. https://doi.org/10.1007/s11894-008-0105-9
  30. Martin-de-Carpi J, Rodriguez A, Ramos E, Jimenez S, Martinez-Gomez MJ, Medina E, et al. The complete picture of changing pediatric inflammatory bowel disease incidence in Spain in 25 years (1985-2009): the EXPERIENCE registry. J Crohn's Colitis 2014;8:763-9. https://doi.org/10.1016/j.crohns.2014.01.005
  31. Sykora J, Pomahacova R, Kreslova M, Cvalinova D, Stych P, Schwarz J. Current global trends in the incidence of pediatric-onset inflammatory bowel disease. World J Gastroenterol 2018;24:2741-63. https://doi.org/10.3748/wjg.v24.i25.2741