IBD Rates Rising in Canada's Youngest Children

Bridget M. Kuehn

April 19, 2017

The incidence of inflammatory bowel disease (IBD) among children aged 5 years and younger in Canada increased a startling 7.2% per year between 1999 and 2010, according to a study published online April 18 in the American Journal of Gastroenterology. Similar increases are occurring in the United States, one expert said.

"These findings have important implications on the children, their families, and the health care system, because these children will live longer with the disease, have a more extensive disease phenotype, and result in higher direct costs for IBD care compared with adults," Eric Benchimol, MD, PhD, a pediatric gastroenterologist at the Children's Hospital of Eastern Ontario Inflammatory Bowel Disease Centre in Ottawa, Canada, and colleagues write. "In addition, the increasingly early age of onset implies early-life environmental triggers in at-risk patients."

The researchers analyzed administrative health data from five Canadian provinces to assess the incidence and prevalence of IBD among Canadian children aged 16 years or younger between 1999 and 2010. The five provinces (Alberta, Manitoba, Nova Scotia, Ontario, and Quebec) account for 79.2% of the country's population.

The study found an overall incidence of 9.68 cases per 100,000 children. The investigators found a stable 2.06% annual increase in childhood IBD cases in the overall population, which did not change significantly during the course of the study period. However, incidence increased among the youngest cohort of children, those aged 5 years or younger, by a dramatic 7.19% a year.

Some differences in the incidence and prevalence of IBD were found among the provinces. For example, IBD rates were higher in Nova Scotia, where more than half of the population traces its ancestry to the British Isles. Differences in the genetic makeup of the populations of the provinces may contribute to such differences, the authors write.

"The number of children under five being diagnosed with IBD is alarming because [such cases were] almost unheard of 20 years ago, and it is now much more common," Dr Benchimol said in a news release.

Canada has one of the highest rates of pediatric IBD in the world. The reasons for these escalating rates of childhood IBD are unclear, but changes in gut bacterial composition caused by a combination of environmental factors, such as early exposure to antibiotics, changes in diet, and reduced vitamin D levels, may be contributing.

The authors say more research is needed to understand what is driving these increases in incidence and how to prevent the disease.

"What our research tells us is that we need to focus future research on identification of triggers in young children with IBD, understand the biology behind changes resulting in the disease, and intervene to prevent the occurrence of IBD in this vulnerable age group," Dr Benchimol explained in the news release.

The United States is seeing a similar increase in IBD cases among the youngest children, Judith Kelsen, MD, program director of the Very Early Onset Inflammatory Bowel Disease Clinic at Children's Hospital of Philadelphia in Pennsylvania, told Medscape Medical News. She said improved diagnosis is unlikely to be the cause for the increase, but what is driving the increase is "the million-dollar question," she said.

She noted that pregnant women and their babies are exposed to a much different environment than in the past. Diets are different, people have access to clean water, and they are exposed to fewer parasites. These factors may be interacting with the genes that make people vulnerable to IBD in different ways than in the past.

"I think it's changing the microbiome," she said.

In the meantime, the researchers recommend that very young children diagnosed with IBD be referred to pediatric bowel disease specialists. Dr Kelsen agrees.

"Kids are late coming to us because no one thinks a baby can have IBD," she said. She explained that very young children may develop very severe disease quickly. In addition, because young children's immune systems are not yet mature, they require care from specialists. For example, some IBD medications may not be appropriate for children. She urged physicians to err on the side of caution and seek expert help early.

"If you see symptoms send the child to a referral center," Dr Kelsen said. "It's better to rule it out than miss it.

The study and its investigators received funding or financial support from Crohn's and Colitis Canada, the Ontario Early Research Fund: Early Researcher awards, the Canadian Children IBD Network, CHILD Foundation, and the Canadian Institutes of Health Research.

Am J Gastroenterol. Published online April 18, 2017. Full text

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