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P330. Epidemiology of pediatric chronic inflammatory bowel disease in Serbia, 2005–2009

A. Boskovic, I. Kitic, D. Prokic, I. Stankovic, D. Savic

Mother and Child Health Care Institute, Belgrade, Serbia

Background: The aim of this study was to determine the epidemiological and clinical characteristics of inflammatory bowel disease (IBD) in children hospitalized in Mother and Child Health Care Institute, Serbia during a 5-year period (2005–2009).

Materials and Methods: The medical records of patients with newly diagnosed IBD during the period of 2005–2009 were retrospectively reviewed.

Results: In the 5-year study period, 66 children received new diagnoses of IBD, 69% had Crohn disease (CD), 36% had ulcerative colitis (UC), and 4.5% had indeterminate colitis (IC). The patients with allergic colitis, microscopic collagenous colitis and lymphocytic colitis are excluded from this study. The diagnosis of IBD was based on clinical picture, laboratory findings (CRP, Se, Tr, etc.), serological markers (antisaharomices antibody – ASCA, perinuclear antineutrophyl anticitiplasmic antibody-pANCA), endoscopic evaluation, histological assessment of mucosal biopsy specimens, and radiological findings (small bowel barium follow-through). All of the patients underwent colonoscopy, the terminal ileum has been successfully examined in approximately 97% of patients. Upper GI endoscopy was also routinely performed in all patients. Of 66 children, 36 (54%) were male and 30 (45%) were female. The male-to-female ratio was 1.1 to 1 for CD, and 1.7 to 1 for UC; there was a slight predominance of male patients with UC. The age distribution in IBD patients was 78% for 10–18 years old, two patients less than 3 years old (3%), with cumulative percent 21% for less then 10 years old. The most common type of CD at presentation was inflammatory (71%). Pancolitis was the most frequent form of UC (66%). Almost half of the patients had a severe form of CD at its onset 69% (PCDAI > 300). Five patients with CD (12.5%) had skin extraintestinal manifestations (Erythema nodosum, Pyoderma gangrenosum, Stomatitis aphtosa), all with highly positive ASCA antibody. Six of eight patients with penetrating form of CD (62%) had negative ASCA antibody. Three of them with UC and positive pANCA antibody (4.5%) had a PSC. Thromboembolic complication had been confirmed in one girl with UC and positive pANCA antibody. All of them had medical treatment by ECCO protocol, 8 patients with CD (5 with structuring form and 3 with penetrating form of CD) and 2 patients with UC underwent surgical treatment.

Conclusion: The incidence of IBD in childhood is rising in Serbia. IBD is also common in age less then three. The most common type of IBD is Crohn disease. The most common type of CD is inflammatory. There was a slight predominance of male patients with UC. Pancolitis is the most frequent form of UC. Exstraintestinal manifestations of IBD are rare in childhood, but usually connected with inflammatory type of CD and highly positive ASCA antibody.