EPIDEMIOLOGY OF INFLAMMATORY BOWEL DISEASE IN PEDIATRIC PATIENTS

Transcription

1 EPIDEMIOLOGY OF INFLAMMATORY BOWEL DISEASE IN PEDIATRIC PATIENTS ERIC BENCHIMOL, MD, PhD, FRCPC Associate Professor of Pediatrics and Epidemiology, University of Ottawa Pediatric Gastroenterologist, CHEO IBD Centre, Children s Hospital of Eastern Ontario Senior Scientist and Program Director, CHEO Research Institute Core Scientist, ICES

2 DISCLOSURES I have no conflicts of interest to disclose.

3 WORLDWIDE EPIDEMIOLOGY Ng et al. Lancet 2017; 390:

4 WHAT IS VEO-IBD? Montreal Classification Under 17 Pediatric Cohort Slide courtesy of Dr. Aleixo Muise.

5 WHAT IS VEO-IBD? Montreal Classification Under 17 Pediatric Cohort Paris Modification Under 10 Evidence of a distinct phenotype Slide courtesy of Dr. Aleixo Muise.

6 WHAT IS VEO-IBD? Montreal Classification Paris Modification Under 17 Pediatric Cohort Under 10 Evidence of a distinct phenotype VEO-IBD Under 6 More colonic involvement Long-term outcomes??? Slide courtesy of Dr. Aleixo Muise.

7 WHAT IS VEO-IBD? Montreal Classification Paris Modification Under 17 Pediatric Cohort Under 10 Evidence of a distinct phenotype VEO-IBD Under 6 More colonic involvement Long-term outcomes??? Infants diagnosed under 1 year of age are very unique subset of VEO-IBD Infantile IBD Slide courtesy of Dr. Aleixo Muise.

8 ONTARIO, CANADA ONTARIO CROHN S AND COLITIS COHORT ( ) Standardised incidence per 100,000 person years *** *** ** ** *** * p<0.05 ** p<0.001 *** p< Age (years) Percentage change in IBD incidence per year Percentage change per year IBD incidence per 100,000 PYs CD incidence per 100,000 PYs UC incidence per 100,000 PYs Benchimol et al., Inflamm Bowel Dis 2014; 20(10):

9 CANADIAN GASTRO-INTESTINAL EPIDEMIOLOGY CONSORTIUM Standardised incidence (per 100,000 population) Alberta Manitoba Nova Scotia Ontario Quebec Benchimol, et al., Am J Gastroenterol 2017; 112(7):

10 CANADIAN GASTRO-INTESTINAL EPIDEMIOLOGY CONSORTIUM Standardised incidence (per 100,000 population) Alberta Manitoba Nova Scotia Ontario Quebec Benchimol, et al., Am J Gastroenterol 2017; 112(7):

11 CANADA: INCIDENCE RATE CHANGE Province Age group Incidence rate change (95% CI) % weight IBD Alberta Manitoba Nova Scotia Ontario Quebec Subtotal (I 2 =84.3%, p=0.000) ( , ) ( , ) ( , ) (0.0466, ) (0.0094, ) ( , ) years incidence rate change by type of IBD Benchimol, et al., Am J Gastroenterol 2017; 112(7):

12 CANADA: INCIDENCE RATE CHANGE (0-5y) Province Age group Incidence rate change (95% CI) % weight IBD Alberta Nova Scotia Ontario Quebec Subtotal (I 2 =9.5%, p=0.346) ( , ) ( , ) (0.0455, ) ( , ) (0.0282, ) CD Alberta Ontario Quebec Subtotal (I 2 =0.0%, p=0.838) ( , ) ( , ) ( , ) ( , ) UC Alberta Ontario Quebec Subtotal (I 2 =0.0%, p=0.501) ( , ) ( , ) ( , ) ( , ) years incidence rate change by type of IBD Benchimol, et al., Am J Gastroenterol 2017; 112(7):

13 EPIMAD: CROHN S DISEASE TRENDS Standardised incidence rates (events/100,000) p< p= Age category (years) Chouraki V et al. Aliment Pharm Ther 2011;33:

14 SCOTLAND: VEO-IBD TRENDS p< NS Adjusted incidence of A1a CD and NCC per 100,000 population at risk p= NS Crohn's disease Non-Crohn's colitis Epoch Henderson P et al. ECCO 2015 oral abstract OP027. Slide courtesy of David Wilson

15 VEO-IBD: PROGRESSION Baumgart and Sandborn, Lancet 2012; 380:

16 VEO-IBD: CD SURGERY Benchimol, et al. Gastroenterology 2014;147(4):

17 OTHER VEO-IBD COHORTS: SCOTLAND Henderson, et al. BSPGHAN Annual Meeting 2015 Slide courtesy of Dr. David Wilson

18 OTHER VEO-IBD COHORTS: SCOTLAND Henderson, et al. BSPGHAN Annual Meeting 2015 Slide courtesy of Dr. David Wilson

19 VEO-IBD: UC SURGERY 1.0 Survival probability Onset at <6 years vs 10 years: Females: HR 0.88, 95% CI: Males: HR 0.42, 95% CI: Age category (years) <6 10 and older Time (years) Benchimol, et al. Gastroenterology 2014;147(4):

20 WHAT DOES THE FUTURE HOLD?

21 RISING FUTURE BURDEN 270,000 in 2018 (0.7%) 400,000 In 2030 (1.0%) 3% per year Coward, et al. JCAG 2018; 1(Suppl 2): Manuscript submitted for publication.

22 RISING FUTURE BURDEN Coward, et al. JCAG 2018; 1(Suppl 2): Manuscript submitted for publication.

23 PEDIATRIC IBD EPIDEMIOLOGY Canada (per 100,000) USA (per 100,000) Canada (raw number) 4,730 7,254 12,647 USA** (raw number)

24 PEDIATRIC IBD EPIDEMIOLOGY Canada (per 100,000) USA (per 100,000) Canada (raw number) * ,730 7,254 12,647 USA** (raw number) *In people <20 years, from: Kappelman et al., Clin Gastroenterol Hepatol 2008;135:

25 PEDIATRIC IBD EPIDEMIOLOGY Canada (per 100,000) USA (per 100,000) Canada (raw number) USA** (raw number) * ,730 7,254 12,647 52,043 52,611 84, ,103 *In people <20 years, from: Kappelman et al., Clin Gastroenterol Hepatol 2008;135: **Based on estimated population of children <18 years according to childstats.gov

26 CONCLUSIONS Pediatric IBD is increasing internationally Rates are rising most rapidly in young children Children with disease onset <10y: More often have colonic involvement More inflammatory, less stricturing UC: More mild endoscopic findings Rising prevalence may result in strain on the health system

27 QUESTIONS? ACKNOWLEDGEMENTS: IBD Impact Report impactreport