P170. Paediatric inflammatory bowel disease in Greece: 30 years experience of a single center
K. Dimakou1, I. Pachoula1, G. Chouliaras1, I. Panayotou1, I. Orfanou2, E. Lagona2, E. Roma-Giannikou1
11st Department of Paediatrics, University of Athens, Athens, Greece, Paediatric Gastroenterology Unit, Athens, Greece; 21st Department of Paediatrics, University of Athens, Athens, Greece, Athens, Greece
Background: During the last 30 years, significant advances have been made in the care of children with inflammatory bowel disease (IBD). In this study we aimed to describe trends in clinical presentation, management and outcomes in children with IBD in Greece during the last three decades.
Methods: The medical records of children with IBD referred to one paediatric gastroenterology unit from January 1981 to August 2011 were reviewed retrospectively.
Results: 483 children with IBD (50.2% male) with a mean age at diagnosis of 9.6 years (range 6m-18 y) were included. Ulcerative colitis (UC) was diagnosed in 267 (55.2%), Crohn's disease (CD) in 167 (34.5%) and IBD unclassified (IBDU) in 49 (10.1%). Children diagnosed with UC and IBDU were younger than those with CD (mean age at diagnosis 9.2 y and 8.9 y vs 10.5 y, p < 0.01 and p = 0.028 respectively). The commonest presenting symptoms were bloody stools (81.3%) and diarrhoea (61.5%). Extraintestinal symptoms were more common in children with CD compared to those with UC (fever 32.3% vs 8.9% p < 0.01, arthritis 12.0% vs 1.5% p < 0.01, weight loss 33.1% vs 17.3% p < 0.01, failure to thrive 10.5% vs 3.7% p = 0.016, anaemia 32.2% vs 18.7% p = 0.021). Most of the patients received 5ASA (96.6%) and steroids (77.0%), about half (50.2%) were treated with thiopurines and 14% with biological agents. Steroids and immunomodulators were used more often for the treatment of patients with CD in comparison to those with UC (steroids 94.3% vs 68.8% p < 0.01, thiopurines 76.5% vs 35.5% p < 0.01, biological agents 31.9% vs 3.0% p < 0.01). Ten percent of the children with IBD underwent surgical intervention. In order to assess temporal trends in paediatric IBD, the cohort was divided in three subgroups according to the date of diagnosis; Group A: 19811989, Group B: 19901999 and Group C: 2000-August 2011. During the last two decades a significant increase of CD (Group A 18.5% Group B 23.8% Group C 48.8% p < 0.01) compared to first decade with parallel decrease of UC (Group A 79.6% Group B 71.9% Group C 33.2% p < 0.001) was observed. A significant decrease of mean age at diagnosis in CD patients during the last decade Group A (11.4 y) and Group C (9.9 y) p = 0.043 was noticed.
Conclusions: More than half of the children with IBD needed treatment with steroids and immunomodulators, a fact indicating the severity of the disease. Patients with UC and IBDU are younger at diagnosis than children with CD. A significant increase of CD with parallel decrease of UC during the last decade in Greece was found.