Aim An accurate understanding of trends in incidence and prevalence as well as disease burden of paediatric-onset inflammatory bowel disease (PIBD) within a large region are essential to plan services and unravel possible aetiological factors. We aimed to delineate these trends together with numbers of PIBD cases requiring surgery and immunomodultory/biological therapies. Methods Incident and prevalent cases of PIBD in South-East Scotland were prospectively collected from service establishment in August 1997 to April 2011. All cases of Crohn's disease (CD), ulcerative colitis (UC) and IBD-unclassified (IBDU) were diagnosed by standard criteria and detailed demographic information and both medical and surgical therapies were recorded on a departmental database. Date of first attendance and of discharge from paediatric services was also recorded, allowing calculation of incidence and yearly point prevalence (1st April). To allow for accrual of cases during the establishment phase of the PIBD service, only data from 2000-2010 was used for incident and prevalent rates. Rates were sex-adjusted and statistical analysis carried out using GraphPad Prism and R. Results A total of 318 children with IBD were cared for during the 14 year period. The cohort comprised of 206 CD (65%), 73 UC (23%) and 39 IBDU (12%) cases. The median age at diagnosis was 11.6 years (IQR 9.1-13.4 years) with an overall preponderance of males. Overall incidence of IBD in the period 2000-2010 was 6.4/100,000/year with a significant rise from 5.6/100,000/year to 7.2/100,000/year between the periods of 2000-2004 and 2005-2010 (p=0.002). This was mainly driven by an increase in the incidence of CD in males from the earlier (4.0/100,000/year) to the later (5.5/100,000/year) epoch (p=0.002). The overall rates of UC (1.5/100,000/year) and IBDU (0.9/100,000/year) remained relatively stable. The point prevalence of IBD rose from 23.1/100,000 (2000-2004) to 48.7/100,000 (2005-2010). During the total follow up time of 1432 patient years, 68% of patients required azathioprine, 27% methotrexate, 18% biologicals and 21% needed IBD-related surgery. Conclusion Evaluating a well defined paediatric population over a 14 year period gives a clear indication of the rising trend in the incidence and prevalence of PIBD. In addition, knowledge of the requirement for medical and surgical therapies allows for the tailoring of local service provision.
Introduction:The intestinal microbiota may play a role in the disease process of IBD. In this study we examined the small and large intestinal microbiota in children at the time of diagnosis of IBD, before medical treatment had been instituted.Patients and methods: Faecal samples were obtained from children with suspected IBD before bowel cleaning and duodenal fluids at duodenalscopy. The samples were transported anaerobically and cultivated quantitatively for aerobic and anaerobic bacteria within 24h. After diagnosis was established, microbiota composition was compared between the diagnostic groups; ulcerative colitis (UC n¼20), Crohn's disease (CD, n¼10) and diseased controls i.e. children in whom the IBD diagnosis was excluded and with no histological signs of mucosal inflammation (n¼24). Faecal samples from healthy control children (n¼11) were also included for comparison. Children with indeterminate colitis (n¼1), other type of colitis (allergic, infectious, unspecific n¼8) and celiac disease (n¼2) were excluded from the analyses due to small group numbers.Results: The duodenal microbiota did not differ significantly between the diagnostic groups. In contrast children with UC had a distinctly different faecal microbiota compared with diseased and healthy controls. Thus, children with UC had a significantly lower ratio of anaerobic to facultative bacteria in faeces (respectively 30 compared with 500 in diseased and healthy controls, p¼0.0001 and p¼0.001). Further, children in the UC group had lower counts of anaerobic bacteria (average: 10 8.8 Colony Forming Unit, CFU/g faeces) compared with diseased (10 10.1 CFU/g faeces) and healthy (10 10.2 CFU/g faeces) controls (p ¼ 0.0001 for both). The low proportion of anaerobic bacteria in the UC group was unrelated to frequency of diarrhoea or to precence of blood in stools. Among the anaerobes, bifidobacteria and clostridia were both significantly reduced in children with UC compared with diseased controls (p ¼ 0.002 and p ¼ 0.03, respectively) and healthy controls (p ¼ 0.006 and p ¼ 0.02, respectively), whereas the counts of Bacteroides did not differ between the diagnostic groups. Furthermore, the children presenting with UC had significantly increased ratio of Gram-negative to Gram-positive bacteria in faeces compared with diseased (p ¼ 0.02) and healthy (p ¼ 0.03) controls.Conclusions: The results suggest that the microbiota in UC is dysbalanced with a relative lack of certain Gram-positive anaerobes and a relative increase in facultative and Gram-negative bacteria. This dysbalanced microbiota in the colon might provoke and perpetuate inflammation.
Introduction to the symposium. Inflammatory Bowel Disease (IBD) in paediatric patients was reported as early as in 1932. In Burrill Crohn's first report from 1932 of 14 patients with the disease, a 17 year old adolescent was among them. In 1941 he described two boys with Crohn's disease (CD) and growth retardation and pubertal delay (1). At the Joint meeting of ESPGHAN and NASPGHAN in Paris 1980, there were just two abstracts on IBD, one from Boston, USA, and one from Sweden. Now, 26 years later, the interest in and knowledge of paediatric IBD has almost exploded, so a symposium for two and half days on the subject appears entirely appropriate.Porto Criteria. The ESPGHAN IBD-working group was initiated in the 1990s by Hans Buller, who at the time was working in Amsterdam in the Netherlands. The working group focused initially on epidemiology and risk factors.
Introduction to the symposium. Inflammatory Bowel Disease (IBD) in paediatric patients was reported as early as in 1932. In Burrill Crohn's first report from 1932 of 14 patients with the disease, a 17 year old adolescent was among them. In 1941 he described two boys with Crohn's disease (CD) and growth retardation and pubertal delay (1). At the Joint meeting of ESPGHAN and NASPGHAN in Paris 1980, there were just two abstracts on IBD, one from Boston, USA, and one from Sweden. Now, 26 years later, the interest in and knowledge of paediatric IBD has almost exploded, so a symposium for two and half days on the subject appears entirely appropriate.Porto Criteria. The ESPGHAN IBD-working group was initiated in the 1990s by Hans Buller, who at the time was working in Amsterdam in the Netherlands. The working group focused initially on epidemiology and risk factors.
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