Early Onset Inflammatory Bowel Disease
About 20–30 % of individuals with inflammatory bowel disease (IBD) have symptom onset before 30 years of age and have lifelong disease. Ten to fifteen percent of all IBD patients have an established diagnosis under the age of 18 years. Young children (i.e
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Early Onset Inflammatory Bowel Disease Melvin B. Heyman and Neera Gupta
Introduction About 20–30% of individuals with inflammatory bowel disease (IBD) have symptom onset before 30 years of age and have lifelong disease. Ten to fifteen percent of all IBD patients have an established diagnosis under the age of 18 years. Young children (i.e., under 6 years of age) with IBD represent a unique cohort of patients that is recognized as a valuable group of patients to investigate due to its relative lack of environmental exposures compared with older patients. However, information is sparse regarding the presentation and course of disease in this subset of patients. We therefore present information on both early onset (0–5 years) and later onset (6–18 years) pediatric IBD.
Epidemiology of Pediatric Inflammatory Bowel Disease Incidence of Disease and Family History The epidemiology of pediatric IBD has been described in population-based studies from European centers. One of the earlier reports from Denmark, data collected between 1962 and 1987 revealed that the mean incidence of IBD among children below 15 years was 2.2/100,000, 2.0 for UC and 0.2 for CD. At diagnosis children with UC had more extensive disease than adults (P < 0.05) [1]. A similar study on the incidence of Crohn disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC) in children was conducted in western Norway
M.B. Heyman, MD, MPH (*) Department of Pediatrics, Pediatric Gastroenterology, Hepatology, and Nutrition, University of California San Francisco, 500 Parnassus Ave, MU 4-East, Box 0136, San Francisco, CA, 94143-0136, USA e-mail: [email protected] N. Gupta, MD, MAS Department of Pediatric Gastroenterology, Hepatology & Nutrition, Columbia University Medical Center, New York, NY, USA
from 1984–85 [2]. During this 2-year study period, 27 new cases of chronic IBD were diagnosed in children age 15 years or less, ten new cases of CD, and 17 of UC. The mean annual incidence of CD in the child population was 2.5/100,000/year, whereas the incidence of UC in the child population was 4.3/100,000/year [2]. In a similar study Sawczenko et al. reported on a 13-month prospective survey to determine the incidence of childhood IBD in the United Kingdom and the Republic of Ireland, finding an incidence of 5.2/100,000 per year in children younger than 16 years of age from 1998 to 1999. Of the 739 evaluable pediatric subjects reported, 4% were under 5–17% were 5–10 years of age [3]. Data from a 12-year period in Sweden showed an annual incidence of 5.8/100,000 in children 15 years of age or less [4]. However the data suggested an increasing incidence of IBD from 4.6/100,000 in 1984–86 to 7.0/100,000 in 1993–1995 [4]. Most of the increase was among those with UC, with an increase in incidence from 1.4 to 3.2 per 100,000 per year [4]. Lehtinen et al. recently reported on a nationwide study in Finland of data collected between 1987 and 2003 and showed an increasing trend, with pediatric IBD increasing from 5/100,000 in 1987 to 15/100,000 in 2003 [5]. In co
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