Incidence of Pediatric Inflammatory Bowel Disease in Saudi Arabia

Mouzan, Mohammad I. El; Saadah, Omar I.; Alsaleem, Khalid A.; Edreesi, Mohammad Al; Hasosah, Mohammed; Alanazi, Aziz; Mofarreh, Mohammad Al; Asery, Ali; Qourain, Abdulaziz Al; Nouli, K; Hussaini, Abdulrahman Al; Telmesani, Abdulwahab; Alreheili, Khalid M; Alghamdi, Sharifa; Alrobiaa, Nawal; Alzaben, Abdullah; Mobed, Ahmad; Hebbi, Homoud Al; Sarkhy, Ahmad A Al; Mehaidib, Ali Al; Saleem, Badr Al; Assiri, Asaad; Wali, Sami

doi:10.1097/mib.0000000000000048

Cited by 51 publications

(51 citation statements)

References 25 publications

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“…In a systematic review of 140 studies from 38 countries, Sykora et al 20 showed that the highest annual incidence of pediatric IBD is in Europe (23 per 100 000 person-year), followed by North America (15.2 per 100 000 person-year), and it is the lowest in Asia/the Middle East and Oceania (11.4 per 100 000 person-year). In fact, barring a small study of 32 cases from Singapore, 21 all other studies from Asia [22][23][24][25] have shown a low incidence of pediatric IBD (0.5-5.5 per 100 000 person-year). They also showed a steady increase in the incidence of IBD over time globally.…”

Section: Discussionmentioning

confidence: 99%

Pediatric inflammatory bowel disease: Is it really uncommon in Asian children?

et al. 2020

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Background/Aim: Inflammatory bowel disease (IBD) is said to be rare in Asian children, and there is scarce information from India. We therefore analyzed our experience of pediatric IBD. Methods: Prospectively maintained data of 105 consecutive children [median age 12 (IQR:7-14) years, 71 males] with IBD from July 2001 through June 2016 were retrospectively analyzed. Their detailed clinical features, endoscopic appearance, histopathology, and treatment outcomes were recorded. For Crohn's disease (CD), disease phenotype and disease location were assessed as per Paris classification. Results: Disease spectrum includes ulcerative colitis (UC), 55 (52%); CD, 43 (41%); and IBD-unclassified, 7 (7%). There was a significant increase in the number of cases in the last 5 years compared to the previous 10 years (63 vs. 42, r 2 = 0.96). Most UC cases (75%) had extensive/pancolitis, 74% of CD had colonic/ileocolonic disease, and 65% had inflammatory phenotype. Fever, growth failure, pain in abdomen, and need for surgery were significantly more frequent in CD than in UC (P < 0.0001). Over a median follow up of 19 (IQR: 7-48) months, remission was achieved in 48 of 51 (94%) UC patients and in 24 of 34 (70.6%) CD patients; an immunomodulator was required to maintain remission in 67% of UC cases. In CD, there was a significant reduction in the use of empirical antitubercular therapy (76%, P = 0.008) with time, and disease progressed in three. Conclusions: IBD is not uncommon, and the incidence seems to be increasing among Indian children. UC is more common than CD and is more often an extensive disease. CD is mainly an inflammatory phenotype. The majority of children with IBD required an immunomodulator to maintain remission.

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Section: Discussionmentioning

confidence: 99%

Pediatric inflammatory bowel disease: Is it really uncommon in Asian children?

et al. 2020

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“…Firstly, the uses of a clinician estimate of adherence as a sole measure to assess adherence. Secondly, our population comprised primarily of children and adolescents followed at IBD referral centers throughout Saudi Arabia and may not be representative of the general pediatric IBD population [4].…”

Section: Discussionmentioning

confidence: 99%

“…Since 2003, the Pediatric IBD Registry has enrolled and followed newly diagnosed children (<16 years of age) with IBD, recording incidence, demographic information, treatments received and disease complications [4].…”

Section: Data Sourcementioning

confidence: 99%

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Treatment Profile of Pediatric Inflammatory Bowel Disease in Saudi Arabia: Issues in Treatment Adherence

Hasosah¹,

Mouzan²,

Saadah³

et al. 2015

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Background: Inflammatory bowel disease (IBD), with its 3 subgroups: Crohn's disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC), is a chronic relapsing inflammatory disorder of the gastrointestinal (GI) tract. Medication adherence is particularly problematic in pediatric IBD. To date this has not been studied in the Middle East. Objectives: The aim of this study was to describe the treatment modalities of IBD and to evaluate adherence to treatment in a population-based cohort of Saudi children. Methods: A cross-sectional study was conducted in all regions of Saudi Arabia. All participating centers were asked to provide information on IBD medications and adherence to prescribed therapies. Results: 354 children with IBD were identified from our database. The age at diagnosis ranged from 1to 14 years, with 145 (41%) diagnosed with UC, 195 (55%) with CD and 14 (4%) with IC. The most common drugs therapy used in IBD was corticosteroids in CD and 5-ASA in UC. Patients with UC were treated with 5-ASA significantly more than patients with CD (76% vs. 62%; P= 0.004). In contrast, patients with CD were treated with infliximab significantly more than patients with UC (22% vs. 6%; P= 0.000). Overall, 15.8% of patients were non-adherent with patients with CD demonstrating a higher level of nonadherence, although this was not significantly different from UC patients (11% vs. 3.8%; P>0.05). Poor adherence to specific drugs was reported significantly more in CD than UC patients; mesalamine (p= 0.022), steroids (p= 0.021) and thiopurines (p= 0.006). Conclusion: Poor adherence occurs most frequently in CD patients and with 5-ASA, corticosteroids and thiopurines. These data can be used to help care providers and policy makers such as the Ministry Of Health define and quantify the burden of IBD among children in Saudi Arabia. Further research in IBD is required to determine the reasons for nonadherence/ poor adherence in the pediatric IBD population so that strategies can be devised to reduce it. Key Points: Medication adherence is particularly problematic in pediatric inflammatory bowel disease (IBD). We found that steroids and 5-Amino salicylic acids are the most widely used medications in pediatric IBD patients. Nonadherence occurs most frequently with 5-ASA, steroids and thiopurines in Crohns. These data should help health care providers quantify the burden of IBD among children.

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“…However, despite this clear genetic contribution, the modest concordance rate in monozygotic twins suggests an important role for the environment in modulating risk. Furthermore, the incidence of IBD has recently increased in regions such as the Middle East and Asia, which have historically been low-prevalence areas, as well as among immigrants to Western Europe and North America [2]. …”

Section: Introduction To Ibdmentioning

confidence: 99%

Microbiota as Therapeutic Targets

Xavier¹

2016

Dig Dis

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Background: Inflammatory bowel disease (IBD) represents a family of diseases including Crohn's disease and ulcerative colitis. IBD has garnered significant attention in recent years due to successes in 2 areas of basic science: complex human genetics and host-microbe interactions. Advances in understanding the genetics of IBD, mainly driven by genome-wide association studies, have identified more than 160 genetic loci that modulate the risk of disease. Notably, several of these genes have pointed to alterations in host-microbe interactions as being critical factors in pathogenesis. Investigations into the microbial communities of the gastrointestinal tract (or the ‘gut microbiome') in IBD have yielded important insights into several aspects of interactions between microbiota and the host immune system, including how alterations to microbial community composition and function have important consequences for immune homeostasis. Key Messages: The anatomy of the gastrointestinal tract plays a role in defining not only intestinal function, but also the microbial ecosystem that lives within the gut. Careful investigations into the composition and function of these microbial communities have suggested that patients with IBD have an imbalance in their gut microbiota, termed dysbiosis. These studies, as well as studies using samples from healthy individuals, have begun to uncover mechanisms of crosstalk between particular microbes (and microbial products) and immunomodulatory pathways, alterations which may drive immune diseases such as IBD. Conclusions: Investigations into the role of the microbiome in IBD have provided important clues to potential pathogenic mechanisms. Harnessing this knowledge to develop therapeutics and identify biomarkers is currently a major translational goal, holding great promise for clinically meaningful progress.

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Incidence of Pediatric Inflammatory Bowel Disease in Saudi Arabia

Cited by 51 publications

References 25 publications

Pediatric inflammatory bowel disease: Is it really uncommon in Asian children?

Pediatric inflammatory bowel disease: Is it really uncommon in Asian children?

Treatment Profile of Pediatric Inflammatory Bowel Disease in Saudi Arabia: Issues in Treatment Adherence

Microbiota as Therapeutic Targets

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