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Indian Pediatr 2009;46: 639-640 |
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Pediatric Inflammatory Bowel Disease in South
India |
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B Avinash, AK Dutta and A Chacko
Department of Gastrointestinal Sciences, Christian
Medical College, Vellore, Tamil Nadu, India.
Email:
[email protected] |
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Abstract
Among 34 children diagnosed to have inflammatory
bowel disease (IBD) over past 8 years, 23 had Crohn’s disease and 11 had
ulcerative colitis. Pediatric patients accounted for 7% of new cases of
IBD seen annually. Median delay in diagnosis was 15 months. Nutritional
impairment was significantly more common in Crohn’s disease.
Key words: Children, Crohn’s disease, Inflammatory bowel
disease, Mal nutrition, Ulcerative Colitis.
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All children upto 15 years of age with inflammatory
bowel disease (IBD) seen at CMC Vellore between January 2000 to March 2008
(8 years) were retrospectively evaluated. All underwent ileocolonoscopy
and upper GI endoscopy with multiple segmental biopsies. Diagnosis of
ulcerative (UC) colitis was based on the presence of diarrhea or rectal
bleeding for more than 6 weeks and colonoscopic biopsy showing features
suggestive of ulcerative colitis(1). Diagnosis of Crohn’s disease(CD) was
established by clinical evaluation,
a combination of endoscopic, histological, radio-logical, and/or
biochemical investigations and response to therapy(2). The study was
approved by institute ethics committee.
A total of 34 patients with IBD (23 CD and 11 UC) were
identified. The proportion of IBD was 0.03% per year (33 per 100,000) of
all new pediatric patients attending the hospital. Pediatric patients
accounted for approximately 7% of all new cases of IBD seen annually.
Table I describes and compares the clinical and demographic
profile of these patients. Eight (34.8%) patients with crohn’s disease had
ileocolonic granulomas and four of these also had gastric granulomas.
Imaging showed small bowel involvement in 14 patients with crohn’s
disease. Extraintestinal manifestations included joint pain (n=4),
and oral ulcers (n=1) in crohn’s disease; and arthralgia (n=1)
in ulcerative colitis. Nutritional impairment was present in 52.2% of CD
patients (weight <3rd percentile = 39.1%, height and weight below 3rd
percentile = 13.1%) and 9.1% UC patient (height <3rd percentile). All IBD
patients were treated with 5ASA. In addition to ASA, 7 (34.7%) CD patients
were treated with steroids (budesonide 4, prednisolone 3) and another 7
(30.4%) steroid dependent/resistant patients with azathioprine/methotrexate.
Three patients with UC required steroids along with ASA. Four CD patients
(17.3%) had surgery at diagnosis or during follow up (3 for perianal
fistula and 1 for ileal perforation). One UC patient aged 13 years
underwent total proctocolectomy.
TABLE I
Clinical and Laboratory Profile of Children with Inflammatory Bowel Disease
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Crohn’s disease (n = 23) |
Ulcerative colitis (n = 11) |
P |
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Sex (males) |
15 (65.2%) |
6 (54.5%) |
0.7 |
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Age (mean ± SD) |
11.9 ± 2.8 yrs. |
9.5 ± 3.4 yrs. |
0.04 |
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Duration of symptoms (median, range) |
15(1- 60) mo |
15 (6-48) mo |
0.5 |
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Abdominal pain |
15 (65.2%) |
5 (44.5%) |
0.5 |
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Diarrhea |
21 (91.3%) |
11 (100%) |
1 |
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Blood in stool |
13 (56.5%) |
9 (81.8 %) |
0.3 |
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Anorexia |
9 (39.1%) |
2 (18.2%) |
0.3 |
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Nutritional impairment# |
12 (52.2%) |
1 (9.1%) |
0.02 |
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Extraintestinal manifestations |
5 (21.7%) |
1 (9.1%) |
0.6 |
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Location (%) |
13/8/2 (56.5/34.8/8.7)
(IC†/C‡/I§) |
2/9 (18.2/81.8)
(proctitis / pancolitis) |
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Hemoglobin (g%) |
10.3 ± 1.8 |
10.5 ± 1.6 |
0.7 |
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Albumin (g%) |
3.2 ± 0.7 |
3.6 ± 1.0 |
0.2 |
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ESR (mm/h) |
59 ± 34 |
46 ± 33 |
0.3 |
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Severity (mild/moderate/severe)¶ |
8.7/69.6/21.72/16/5 |
18.2/54.5/27.32/6/3 |
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Follow up (median, range) |
24 mo (0-10 y) |
2 mo (0 to 6 y) |
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†IC – Ileocolonic, ‡C – Colonic, §I – Ileal; ¶ CD- Harvey Bradshaw score, UC – Sutherland disease activity index;
# <3rd IAP centile for height and/or weight for age; **Fischer’s exact test for categorical variables ,
Mann-Whitney U test for continuous variables, Two tailed P value of £ 0.05 was considered significant.
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Population based studies from the West show the
incidence of pediatric IBD to be 7 per 100,000 per year(3). In a study on
739 pediatric IBD patients in UK, the median delay from onset of symptoms
to diagnosis was 5 months with delays being more common in CD(4). Delay in
diagnosis (15 months) in our series suggests lack of awareness and/or poor
availability of diagnostic facilities.
Pediatric IBD is a challenging clinical entity
requiring early diagnosis and therapy to avoid nutritional impairment and
growth retardation.
References
1. Ouyang Q, Tandon R, Goh KL, Pan GZ, Fock KM, Fiocchi
C, et al. Management consensus of inflammatory bowel disease for
the Asia-Pacific region. J Gastroenterol Hepatol 2006; 21: 1772-1782.
2. Stange EF, Travis SP, Vermeire S, Beglinger C,
Kupcinkas L, Geboes K, et al. European evidence based consensus on
the diagnosis and management of Crohn’s disease: definitions and
diagnosis. Gut 2006; 55 Suppl 1: i1-15.
3. 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: 525-531.
4. Sawczenko A, Sandhu BK. Presenting features of
inflammatory bowel disease in Great Britain and Ireland. Arch Dis Child
2003; 88: 995-1000. |
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