Inflammatory bowel disease in children and adolescents in Italy: data from the pediatric national IBD register (1996-2003).
ABSTRACT The purpose was to assess in Italy the clinical features at diagnosis of inflammatory bowel disease (IBD) in children.
In 1996 an IBD register of disease onset was established on a national scale.
Up to the end of 2003, 1576 cases of pediatric IBD were recorded: 810 (52%) ulcerative colitis (UC), 635 (40%) Crohn's disease (CD), and 131 (8%) indeterminate colitis (IC). In the period 1996-2003 an increase of IBD incidence from 0.89 to 1.39/10(5) inhabitants aged <18 years was observed. IBD was more frequent among children aged between 6 and 12 years (57%) but 20% of patients had onset of the disease under 6 years of age; 28 patients were <1 year of age. Overall, 11% had 1 or more family members with IBD. The mean interval between onset of symptoms and diagnosis was higher in CD (10.1 months) and IC (9 months) versus UC (5.8 months). Extended colitis was the most frequent form in UC and ileocolic involvement the most frequent in CD. Upper intestinal tract involvement was present in 11% of CD patients. IC locations were similar to those of UC. Bloody diarrhea and abdominal pain were the most frequent symptoms in UC and IC, and abdominal pain and diarrhea in CD. Extraintestinal symptoms were more frequent in CD than in UC.
The IBD incidence in children and adolescents in Italy shows an increasing trend for all 3 pathologies. UC diagnoses exceeded CD.
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ABSTRACT: BACKGROUND: Anatomical progression of pediatric inflammatory bowel disease is under-reported. The aim of this work was to examine possible changes in the anatomical distribution of IBD in pediatric patients at diagnosis and at follow up. METHODS: In a retrospective cohort study, the medical records of children with inflammatory bowel disease were examined. Patients who had at least 2 endoscopic/colonoscopic examinations were included. Primary outcome was histopathological progression based on histopathological examination of biopsies taken during endoscopic and colonoscopic bowel examination. Factors predictive of disease progression were also examined. RESULTS: A total of 98 patients fulfilled inclusion criteria (49 female, 54 with ulcerative colitis, range 2 -- 17 years, mean age at diagnosis was 10.6 years, SD +/- 3.67), the mean duration of follow up was 32.9 months (range 0.1 -- 60 months, SD +/- 8.54). In the ulcerative colitis group, 41% had disease progression and none of the examined variables (age, gender, laboratory markers, growth and disease activity at diagnosis) appeared to effect disease progression. In the Crohn's disease group, 75% had disease progression. Girls (OR = 0.13, 95% CI 0.02 -- 0.79) and patients with high erythrocytic sedimentation rate (OR=0.942, 95% CI 0.894 -- 0.99) were predictive for disease progression. CONCLUSIONS: Despite maximum therapy, the majority of children with Crohn's disease appeared to have histopathological disease progression. Female sex and high erythrocytic sedimentation rate seemed to be predictive for disease progression. None of the factors analyzed seemed predictive of disease progression in ulcerative colitis.BMC Pediatrics 10/2012; 12(1):162. · 1.98 Impact Factor
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ABSTRACT: OBJECTIVES:: Adolescence is a tough age for patients with inflammatory bowel disease (IBD), as they transition from child to adult medicine. Although a better understanding of the experience of illness and therefore a better response to the patient's needs have often been stressed, no studies have yet investigated the paediatricians' insight into their IBD adolescent patients. METHODS:: A group of adolescents (aged 12-19) diagnosed with IBD was administered a questionnaire listing 22 items of concern. They were asked to rank each item on a 5-point scale according to the degree of impact on the quality of their everyday life. The same questionnaire was administered to a group of paediatricians experienced in treating IBD and to a group of paediatric residents. Paediatricians and residents were asked to estimate how much each item would affect the quality of an average patient's life, according to the same scale. The questionnaire was also used in a face-to-face approach, asking a paediatrician to apply the estimation to an individual patient, instead of an average imaginary one. RESULTS:: Fifteen paediatric gastroenterologists, eleven paediatric residents and twenty-eight patients (female:male = 16:12; median age 16.3 years) took part in the study. The majority of patients suffered from Crohn Disease (17 vs. 11 with Ulcerative Colitis). We found only six items overlapping when comparing the top ten items ranked by patients and paediatricians. The patients' number one concern occupies the ninth position in the paediatricians' list. The number one item for paediatricians is not even mentioned in the patients' top ten list. Overall, both paediatricians' and residents' rankings were significantly higher than those given by patients. CONCLUSIONS:: We found a significant misalignment in the estimation of health concerns between IBD adolescent patients and their paediatricians. A better insight into IBD patients' worries and concerns is crucial for the improvement of the patient's quality of life and disease outcome.Journal of pediatric gastroenterology and nutrition 02/2013; · 2.18 Impact Factor
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ABSTRACT: Background. The number of patients of all age brackets diagnosed with Inflammatory Bowel Disease (IBD) has risen dramatically worldwide over the past 50 years. IBD's changing epidemiology suggests that environmental factors play a major role in modifying disease expression. Aim. To review studies carried out worldwide analyzing IBD epidemiology. Methods. A Medline search indicating as keywords "Inflammatory Bowel Disease," "epidemiology," "natural history," "Crohn's Disease," "Ulcerative Colitis," and "IBD Unclassified" was performed. A selection of clinical cohort and systematic review studies that were carried out between 2002 and 2013 was reviewed. Studies referring to an earlier date were also considered whenever the data were relevant to our review. Results. The current mean prevalence of IBD in the total population of Western countries is estimated at 1/1,000. The highest prevalence and incidence rates of IBD worldwide are reported from Canada. Just as urbanization and socioeconomic development, the incidence of IBD is rising in China. Conclusions. Multicenter national registers and international networks can provide information on IBD epidemiology and lead to hypotheses about its causes and possible management strategies. The rising trend in the disease's incidence in developing nations suggests that its epidemiological evolution is linked to industrialization and modern Westernized lifestyles.Gastroenterology Research and Practice 01/2013; 2013:829040. · 1.62 Impact Factor