A questionnaire survey of pediatric inflammatory bowel disease in India

Abstract

Pediatric inflammatory bowel disease (P-IBD) in India shares similarities with adult-onset IBD. Distinctive features were growth failure and more severe forms of the disease necessitating immunomodulators.

Pediatric Inflammatory Bowel Disease in Asia: Epidemiology and natural history

“…Disease behavior and location in pediatric CD showed similar proportions of ileocolonic location; there was more perianal involvement at onset than Western cohorts (Table 3), 5,16,21,25,27,29,52,53 The majority of Asian pediatric CD patients had ileocolonic disease at diagnosis, consistent with EUROKIDS 53 registry data. Published data on L4 (upper gastrointestinal tract) involvement (Table 3) varied widely across the Asian cohorts (11.5e64.0%), a trend similar to published studies on L4 disease in Western cohorts 54 ; this is likely due to the variations in the definition of upper gastrointestinal involvement (presence of macroscopic disease, histological inflammation, or both).…”

“…Published data on L4 (upper gastrointestinal tract) involvement (Table 3) varied widely across the Asian cohorts (11.5e64.0%), a trend similar to published studies on L4 disease in Western cohorts 54 ; this is likely due to the variations in the definition of upper gastrointestinal involvement (presence of macroscopic disease, histological inflammation, or both). For instance, one cohort study in India had defined L4 involvement by focal active gastritis on histology 21 while the other studies have not explicitly stated the definition of L4 disease. Furthermore, not all subjects underwent a pan-gastrointestinal tract evaluation (upper endoscopy, ileocolonoscopy and small bowel imaging); hence the incidence of upper GI disease and small bowel involvement is likely under-reported.…”

“…58,59 Disease location in pediatric UC showed similar proportions of disease extent at onset and higher proportions of proctitis in Korean studies (Table 4). 5,15,21,24,25,60 Pancolonic/extensive UC was the most common phenotype on presentation in both Asian and Western cohorts (Table 4). The incidence of proctitis (E1) at presentation appeared to be relatively higher in Korean studies than other cohorts (Korean w20% vs. 5.0e12.7% in other Asian/ Western cohorts).…”

“…29 Therapeutic data from other pediatric Asian centers report a similarly high rate of steroid use for induction of remission: Sathiyasekaran et al reported 84.0% use of corticosteroids in induction, thiopurine use in 76.2% and 100.0% use of 5-aminosalicylates in an Indian questionnaire study of 122 Indian pediatric CD patients; 12.2% required reintroduction of steroids while on thiopurine due to relapse and an overall 12.2% use of infliximab. 21 Wang et al described corticosteroid use for induction in 50.4%; in 113 pediatric CD patients from a single center in Shanghai, and a fairly high rate of biologics utilization at induction in 45.5%; at maintenance, corticosteroids were used as maintenance in 27.4%, thiopurines in 47.8% and biologics in 42.5%. 52 Interestingly, the data from Shanghai favored the use of thalidomide in 12.4% at induction, increasing to 28.3% at maintenance; existing published data in adults and children with refractory CD does suggest a potential therapeutic efficacy of thalidomide as rescue therapy, although evidence for its use as a first-line agent is currently limited.…”

Editorial: Striving for Excellence in Pediatric Gastroenterology Care — A Continuous Effort

“…Pediatric gastroenterologists and pediatricians in India have witnessed an increase in the number of children being diagnosed with inflammatory bowel disease (IBD) in recent years [4]. The article on BApproach to a child with colitis^provides a road map to the paediatrician for the age-based causes, differentiation of infective from non-infective causes and evaluation of children with colitis [5].…”