Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2022; 28(17): 1830-1844
Published online May 7, 2022. doi: 10.3748/wjg.v28.i17.1830
Epidemiological characteristics of Asian children with inflammatory bowel disease at diagnosis: Insights from an Asian-Pacific multi-centre registry network
James Guoxian Huang, Yoko Kin Yoke Wong, Kee Seang Chew, Pornthep Tanpowpong, Karen Sophia Calixto Mercado, Almida Reodica, Shaman Rajindrajith, Kai-Chi Chang, Yen-Hsuan Ni, Suporn Treepongkaruna, Way-Seah Lee, Marion Margaret Aw
James Guoxian Huang, Marion Margaret Aw, Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore 119228, Singapore
James Guoxian Huang, Marion Margaret Aw, Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
Yoko Kin Yoke Wong, Epidemiology, Singapore Clinical Research Institute, Singapore 138669, Singapore
Kee Seang Chew, Way-Seah Lee, Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur 50603, Malaysia
Pornthep Tanpowpong, Suporn Treepongkaruna, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Karen Sophia Calixto Mercado, Department of Pediatrics, Makati Medical Centre, Manila 1229, Philippines
Almida Reodica, Department of Pediatrics, The Medical City, Manila 0900, Philippines
Shaman Rajindrajith, Department of Pediatrics, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
Kai-Chi Chang, Yen-Hsuan Ni, Department of Pediatrics, National Taiwan University Hospital, Taipei 100229, Taiwan
Author contributions: Huang JG, Wong YKY, Chew KS, Tanpowpong P, Calixto Mercado KS, Reodica A, Rajindrajith S, Chang KC, Ni YH, Treepongkaruna S, Lee WS, and Aw MM were involved in the conception of the work and data collection; Wong YKY was involved in the data interpretation; Huang JG, Wong YKY, Treepongkaruna S, Lee WS, and Aw MM contributed to the article drafting; Huang JG, Treepongkaruna S, Lee WS, and Aw MM were involved in the critical revision of the article; and all authors were involved in final approval of the published version.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer. Ethics approval for the storage of anonymised clinical data on a multi-centre central data registry hosted by the Singapore Clinical Research Institute was granted by the National Healthcare Group (NHG) Domain Specific Review Board (Approval letter for study code NUH/2019-00060 dated 23rd January 2020), followed by a separate ethics approval for data extraction and analysis (Approval letter for study code 2019/00751 dated 20th October 2021 to 19th October 2022).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at james_huang@nuhs.edu.sg on reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: James Guoxian Huang, MBBS, Assistant Professor, Doctor, Staff Physician, Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore 119228, Singapore. james_huang@nuhs.edu.sg
Received: November 3, 2021
Peer-review started: November 3, 2021
First decision: December 26, 2021
Revised: January 3, 2022
Accepted: March 25, 2022
Article in press: March 25, 2022
Published online: May 7, 2022
Processing time: 177 Days and 1.2 Hours
Abstract
BACKGROUND

There remains a dearth of Asian epidemiological literature for paediatric inflammatory bowel disease (PIBD).

AIM

To describe the presenting features of PIBD from 7 Asia-Pacific pediatric gastroenterology centers via a central standardised electronic data platform.

METHODS

Clinical, endoscopic and radiologic data at diagnosis from the registry were extracted between 1st January 1995 to 31st December 2019. Disease phenotypic characteristics were classified as per the Paris classification system.

RESULTS

There was a distinct rise in new PIBD cases: Nearly half (48.6%) of the cohort was diagnosed in the most recent 5 years (2015-2019). The ratio of Crohn’s disease (CD):Ulcerative colitis (UC):IBD-Unclassified was 55.9%:38.3%:5.8%. The mean age was 9.07 years with a high proportion of very early onset IBD (VEO-IBD) (29.3%) and EO-IBD (52.7%). An over-representation of the Indian/South Asian ethnic group was observed which accounted for 37.0% of the overall Singapore/Malaysia subcohort (6.8%-9.0% Indians in census). Indian/South Asian CD patients were also most likely to present with symptomatic perianal disease (P = 0.003). CD patients presented with significantly more constitutional symptoms (fever, anorexia, malaise/fatigue and muscle-wasting) than UC and higher inflammatory indices (higher C-reactive protein and lower albumin levels).

CONCLUSION

We observed a high incidence of VEO-IBD and an over-representation of the Indian ethnicity. South Asian CD patients were more likely to have symptomatic perianal disease.

Keywords: Asia; Inflammatory bowel disease; Paediatrics; Crohn’s disease; Ulcerative colitis; Registry

Core Tip: We describe the presenting features of paediatric inflammatory bowel disease (IBD) in 7 paediatric gastroenterology centers across six Asia-Pacific regions via a centrally-hosted electronic data capture platform. Clinical, endoscopic and radiologic data of 311 paediatric patients diagnosed with IBD between 1995 and 2019 were extracted. The ratio of Crohn’s (CD):Ulcerative colitis:IBD-Unclassified was 55.9%:38.3%:5.8%. The mean age was 9.07 years with a high proportion of very early onset IBD (VEO-IBD) and EO-IBD. An over-representation of the Indian/South Asian ethnic group was observed in the multiethnic subpopulations of Singapore and Malaysia. Patients of Indian/South Asian ethnicity were also most likely to present with symptomatic perianal CD.