Skip to main content
SpringerLink
Log in

Spectrum and trend of pediatric inflammatory bowel disease: A two-decade experience from northern India

  • Original Article
  • Published:
Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Pediatric inflammatory bowel disease (IBD) has been known to be a disease predominant in the west. There is scarcity of data on pediatric IBD (P-IBD) from northern India. The objective of our study was to analyze the clinical spectrum of P-IBD in northern India.

Methods

A retrospective analysis of 126 children (<18-year old) diagnosed with IBD from January 1999 to December 2019 was done on a pre-designed proforma. It was systematically entered in a MS Excel spreadsheet and analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0. The descriptive phenotypes of Ulcerative colitis (UC) and Crohn’s disease (CD) were revised according to the Paris classification.

Results

Of 126 children, UC was diagnosed in 76 (60.3%), CD in 44 (34.9%) and IBD-unclassified (IBD-U) in six (4.76%) patients. The mean age at diagnosis was 11.3 years; 38.8% were < 10 years with the male: female ratio of 1.6:1. Sixteen children (12.7%) had very early onset IBD (VEOBD). Overall, the median time to diagnosis in IBD was 12 months (interquartile range [IQR]: 3.25–24), which was as high as 52.5 months (IQR: 11–98) in CD. Pancolitis with bleeding per rectum and ileocolonic involvement with pain in abdomen were the commonest presentations in UC and CD, respectively. Stricturing disease was seen in 27% of CD cases. Relapses were seen in 46% (35/76) of U.C and 23% (10/44) of CD kids. Step-up treatment protocol was employed in them with the use of biologicals in 12% of cases. There was a 2.75-fold rise in the IBD cases in the last 10 years (2010-20). There was reduction in time to diagnosis (21 months vs. 90 months; p – 0.012) and empirical anti-tubercular therapy use (90% vs. 5.8%) in CD over two decades.

Conclusion

From our experience in a tertiary care centre in northern India, P-IBD is on the rise. UC is more common than CD. Pancolitis and ileocolonic disease are the commonest disease sites in UC and CD, respectively There is a significant delay in the time to diagnosis in CD. Stricturing disease was seen in a quarter of children with CD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Makharia GK, Ramakrishna BS, Abraham P, et al. Survey of inflammatory bowel disease in India. Indian J Gastroenterol. 2012;31:299–306.

    Article  PubMed  Google Scholar 

  2. Ahuja V, Tandon RK. Inflammatory bowel disease in the Asia-Pacific area: a comparison with developed countries and regional differences. J Dig Dis. 2010;11:134–47.

    Article  PubMed  Google Scholar 

  3. Sýkora J, Pomahačová R, Kreslová M, et al. Current global trends in the incidence of pediatric onset inflammatory bowel disease. World J Gastroenterol. 2018;24:2741–63.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Sathiyasekaran M, Raju BB, Shivabalan S, Rajarajan K. Pediatric Crohn’s disease in South India. Indian Pediatr. 2005;42:459–63.

    PubMed  Google Scholar 

  5. Avinash B, Dutta AK, Chacko A. Pediatric inflammatory bowel disease in South India. Indian Pediatr. 2009;46:639–40.

    CAS  PubMed  Google Scholar 

  6. Sathiyasekaran M, Bavanandam S, Sankarnarayanan S, et al. A questionnaire survey of pediatric inflammatory bowel disease in India. Indian J Gastroenterol. 2014;33:543–9.

    Article  PubMed  Google Scholar 

  7. Poddar U, Yachha SK, Srivastava A, Kumari N. Pediatric inflammatory bowel disease: Is it really uncommon in Asian children? JGH Open. 2020;4:860–6.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Levine A, Koletzko S, Turner D, et al. ESPGHAN revised Porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr. 2014;58:795–806.

    Article  CAS  PubMed  Google Scholar 

  9. Levine A, Griffiths A, Markowitz J, et al. Pediatric modification of the Montreal classification for inflammatory bowel disease: the Paris classification. Inflamm Bowel Dis. 2011;17:1314–21.

    Article  PubMed  Google Scholar 

  10. Banerjee R, Pal P, Nabi Z, et al. Very early onset inflammatory bowel disease in a South Asian country where inflammatory bowel disease is emerging: a distinct clinical phenotype from later onset disease. Intest Res. 2021;19:398–407.

    Article  PubMed  Google Scholar 

  11. Poddar U, Aggarwal A, Jayalakshmi K, et al. Higher prevalence of monogenic cause among very early onset inflammatory bowel disease in children: Experience from a tertiary care center from northern India. Inflamm Bowel Dis. 2023:254. https://doi.org/10.1093/ibd/izac254.

  12. Sauer CG, Kugathasan S. Pediatric inflammatory bowel disease: highlighting pediatric differences in IBD. Med Clin North Am. 2010;94:35–52.

    Article  CAS  PubMed  Google Scholar 

  13. Lee HA, Suk JY, Choi SY, et al. Characteristics of pediatric inflammatory bowel disease in Korea: Comparison with EUROKIDS data. Gut Liver. 2015;9(6):756–60.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Benchimol EI, Fortinsky KJ, Gozdyra P, et al. Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends. Inflamm Bowel Dis. 2011;17:423–39.

    Article  PubMed  Google Scholar 

  15. Sonavane AD, Sonawane P, Amarapurkar DN. Inflammatory bowel disease across the age continuum: Similarity and Disparity. Indian J Pediatr. 2018;85:989–94. https://doi.org/10.1007/s12098-018-2665-5.

    Article  PubMed  Google Scholar 

  16. Banerjee R, Pal P, Hutfless S, et al. Familial aggregation of inflammatory bowel disease in India: prevalence, risks and impact on disease behavior. Intest Res. 2019;17:486–95. https://doi.org/10.5217/ir.2018.00174.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Srivastava A, Sathiyasekharan M, Jagadisan B, Bolia R, Peethambaran M, Mammayil G, et al. Paediatric inflammatory bowel disease in India: a prospective multicentre study. Eur J Gastroenterol Hepatol. 2020;10:1305–11. https://doi.org/10.1097/MEG.0000000000001859.

    Article  CAS  Google Scholar 

  18. Pituch-Zdanowska A, Banaszkiewicz A, Dziekiewicz M, Łazowska-Przeorek I, Gawrońska A, Kowalska-Duplaga K, Iwańczak B, Klincewicz B, Grzybowska-Chlebowczyk U, Walkowiak J, Albrecht P. Overweight and obesity in children with newly diagnosed inflammatory bowel disease. Adv Med Sci. 2016;61(1):28–31. https://doi.org/10.1016/j.advms.2015.07.004.

    Article  PubMed  Google Scholar 

  19. El Mouzan MI, Al Edreesi MH, Al-Hussaini AA, et al. Nutritional status of children with inflammatory bowel disease in Saudi Arabia. World J Gastroenterol. 2016;22:1854–8.

    Article  PubMed  PubMed Central  Google Scholar 

  20. De Bie CI, Paerregaard A, Kolacek S, et al. Disease phenotype at diagnosis in pediatric Crohn’s disease: 5-year analyses of the EUROKIDS Registry. Inflamm Bowel Dis. 2013;19:378–85.

    Article  PubMed  Google Scholar 

  21. Levine A, de Bie CI, Turner D, et al. Atypical disease phenotypes in pediatric ulcerative colitis: 5-year analyses of the EUROKIDS Registry. Inflamm Bowel Dis. 2013;19:370–7.

    Article  PubMed  Google Scholar 

  22. Van Limbergen J, Russell RK, Drummond HE, et al. Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease. Gastroenterology. 2008;135:1114–22.

    Article  PubMed  Google Scholar 

  23. Sauer CG, Kugathasan S. Pediatric inflammatory bowel disease: highlighting pediatric differences in IBD. Gastroenterol Clin N Am. 2009;38:611–28.

    Article  Google Scholar 

  24. Bhangale N, Desai D, Abraham P, Gupta T, Dhoble P, Joshi A. A prospective study of inflammatory bowel disease phenotypes in extremes of age and comparison with adults. Indian J Gastroenterol. 2023;42:404–10.

Download references

Acknowledgments

We thank Bhawna Garg for helping us with statistical analaysis of the data.

Author information

Authors and Affiliations

  1. Department of Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta – The Medicity Hospital, Sector – 38, Gurugram, 122 001, India

    Neelam Mohan, Shivani Deswal & Anubhuti Bhardwaj

Authors
  1. Neelam Mohan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shivani Deswal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anubhuti Bhardwaj
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SD – collected the data, drafted manuscript and reviewed literature; AB – collected data, reviewed literature and contributed to interpretation of results; NM – conceptualized the study, treated and followed up the patients and critically analyzed the manuscript for important intellectual content. She will act as guarantor of the raw data and the study. (drneelam@yahoo.com). All authors agreed to the final manuscript.

Corresponding author

Correspondence to Neelam Mohan.

Ethics declarations

Conflict of interest

NM, SD and AB declare that they have no conflict of interest.

Ethics statement

The study was performed conforming to the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

Disclaimer

The authors are solely responsible for the data and the content of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or printer/publishers are responsible for the results/findings and content of this article.

Ethical clearance 

Taken from institutional review board.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mohan, N., Deswal, S. & Bhardwaj, A. Spectrum and trend of pediatric inflammatory bowel disease: A two-decade experience from northern India. Indian J Gastroenterol 43, 208–214 (2024). https://doi.org/10.1007/s12664-023-01440-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12664-023-01440-x

Keywords

Search

Navigation