Spectrum and trend of pediatric inflammatory bowel disease in northern India

Pediatric inflammatory bowel disease (IBD) has traditionally been more prevalent in Western countries, and there is limited data on pediatric IBD (P-IBD) in northern India. A recent study aimed to examine the clinical characteristics of P-IBD in this region.

This was a retrospective analysis conducted on 126 children under 18 years of age diagnosed with IBD from 1999 to 2019. Data were collected using a pre-designed proforma, entered into an MS Excel spreadsheet, and analyzed with SPSS version 21.0. The phenotypes of Ulcerative Colitis (UC) and Crohn’s Disease (CD) were categorized according to the Paris classification.

It was noted that 60.3% of the children were diagnosed with UC, 34.9% with CD, and 4.76% with IBD-unclassified (IBD-U). The average age at diagnosis was 11.3 years – with 38.8% diagnosed before 10; the male-to-female ratio was 1.6:1. Further, 12.7% of the children had very early onset IBD (VEO-IBD). The median time to diagnosis for all IBD cases was 12 months, but for CD, it was notably higher at 52.5 months. The most common presentations were pancolitis – with rectal bleeding in UC, and ileocolonic involvement – with abdominal pain in CD. Additionally, 27% of the CD cases exhibited strictures. Relapses occurred in 46% of UC patients and 23% of CD patients. 

The records showed that a step-up treatment protocol was used, with biologicals administered in 12% of cases. The last decade (2010-2020) encountered a 2.75-fold rise in IBD cases – with a reduction in the time to diagnosis (21 months versus 90 months), and a significant decrease in empirical anti-tubercular therapy use in CD (5.8% versus 90%).

From the findings, it was inferred that northern India experienced a rising incidence of P-IBD during the study period––with UC being more prevalent than CD. The most common disease sites were pancolitis in UC and ileocolonic disease in CD. Further, evidence suggested significant delays in CD diagnoses, while stricturing disease was observed in a quarter of CD cases.

Source: Mohan N, Deswal S, Bhardwaj A. Indian Journal of Gastroenterology. 2024 Feb;43(1):208-14.