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14. Incidence and phenotype at diagnosis in paediatric IBD patients – An ECCO-EpiCom study

J. Burisch1, D. Duricova2, N. Pedersen1, R. Salupere3, E. Tsianos4, M. Martinato5, O. Tighineanu6, V. Hernandez7, P. Lakatos8, P. Munkholm1, On behalf of the EpiCom Northern Italy center based in Crema, Cremona, Firenze, Forlì, Padova and Reggio Emilia, Italy, 1Herlev University Hospital, Department of Gastroenterology, Copenhagen, Denmark, 2Charles University, IBD Center ISCARE, Prague, Czech Republic, 3Tartu University Hospital, Division of Endocrinology and Gastroenterology, Tartu, Estonia, 4University Hospital, 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, Ioannina, Greece, 5On behalf of the EpiCom Northern Italy center based in Crema, Cremona, Firenze, Forlì, Padova and Reggio Emilia, Italy, 6Center of Mother and Child, Section of Pediatric Gastroenterology, Chisinau, Republic of Moldova, 7Complexo Hospitalario Universitario de Vigo, Gastroenterology Department, Vigo, Spain, 8Semmelweis University, 1st Department of Medicine, Budapest, Hungary

Background

The incidence of inflammatory bowel disease (IBD) is traditionally low in Eastern Europe. It has however recently become more prevalent in i.e. Hungary and Croatia. Furthermore, the incidence of paediatric IBD is increasing [1]. The reason for these changes remains unknown. The EpiCom-study was initiated in 31 centres from 14 Western and 8 Eastern European countries to investigate the differences in incidence and phenotype at diagnosis in Europe. 9 centres included paediatric patients.

Methods

A prospective, population-based, uniformly diagnosed by international diagnostic criteria, inception cohort of patients diagnosed with IBD within 1.1.2010–31.12.2010 and followed up until 1.1.2012 was created. Patients were entered in a web-based database, www.epicom-ecco.eu. Disease localization and behaviour was classified according to the Montreal classification.

Results

In total 43 paediatric patients were identified, of whom 26 (60%) were diagnosed as ulcerative colitis (UC), 14 (33%) as Crohn's disease (CD) and 3 (7%) as IBD type unclassified (IBDU). The centre specific incidence rates are shown in Table 1. The mean incidence rates for IBD, CD and UC were similar in Eastern and Western European centres [IBD: 5.4 (range: 0–8.1) vs. 5.1 (range: 2.9–8.0); UC: 2.0 (range: 0–2.7) vs. 1.3 (range: 0–2.7); CD: 2.0 (range: 0–4.7) vs. 2.7 (range: 2.3–5.6); IBDU: 0.0 (range: 0–4.0) vs. 0.0 (range: 0–2.7)]. Disease location and behaviour for CD and UC patients at diagnosis is shown in Table 2.

Table 1. Incidence of IBD (UC/CD/IBDU) in Europe
CentreIncidenceNo. of patients
 IBDUCCDIBDU 
Denmark, Funen7.12.44.70.06
Denmark, Herlev8.02.02.04.04
Greece, Ioanninia0.00.00.00.0
Italy, Northen Italy1.51.10.40.04
Spain, Vigo5.42.72.70.04
Czech Republic, Prague8.12.72.72.73
Estonia, Southern Estonia5.60.05.60.03
Hungary, Veszprem4.62.32.30.02
Moldova, Chisinau2.90.22.70.017
Table 2. Disease extent, location and phenotype at diagnosis
Western European centresEastern European centres
Disease extent at diagnosis  
 Proctitis25%6%
 Left-sided25%83%
 Extensive colitis50%11%
Disease location at diagnosis  
 L10%17%
 L212%50%
 L350%17%
 L40%0%
 L1–L3 + upper GI38%16%
Disease behaviour at diagnosis  
 B175%83%
 B20%17%
 B30%0%
 B1–B3 + perianal25%0%

Conclusion

The incidence of paediatric IBD remains low in Eastern and Western European centres. The incidence gradient found in the adult EpiCom-cohort [2] could not be re-established amongst paediatric patients.

1. Jakobsen C. et al, (2009), Paediatric inflammatory bowel disease during a 44-year period in Copenhagen County: occurrence, course and prognosis – a population-based study from the Danish Crohn Colitis Database.

2. Burisch J et al., (2012), Incidence of IBD and phenotype at diagnosis in Europe – first results from the EpiCom study.