加拿大不列颠哥伦比亚省南亚裔儿童炎症性肠病：一种独特的临床表型。

Pediatric Inflammatory Bowel Disease Among South Asians Living in British Columbia, Canada: A Distinct Clinical Phenotype.

作者信息

Carroll Matthew W, Hamilton Zachary, Gill Hira, Simkin Jonathan, Smyth Matthew, Espinosa Victor, Bressler Brian, Jacobson Kevan

机构信息

*Division of Gastroenterology, B.C. Children's Hospital, Vancouver, British Columbia, Canada; †Division of Pediatric GI and Nutrition, University of Alberta, Edmonton, Alberta, Canada; ‡Children and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada; §Division of Gastroenterology, St. Paul's Hospital, British Columbia, Canada; and ‖Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada.

出版信息

Inflamm Bowel Dis. 2016 Feb;22(2):387-96. doi: 10.1097/MIB.0000000000000651.

DOI:10.1097/MIB.0000000000000651

PMID:26752467

Abstract

BACKGROUND

Inflammatory bowel disease (IBD) incidence is increasing among low-risk populations. This study examined a cohort of Canadian South Asian (SA) children with IBD to determine if their disease course differed from non-SA (NSA) children.

METHODS

Children of SA ethnicity diagnosed with IBD between 1997 and 2012 were identified and compared with NSA children. Data on duration and the type of presenting symptoms, disease phenotype, corticosteroid exposure (CS), exclusive enteral nutrition use, time to commencement of immunomodulator (IM), biologic therapy, and surgical intervention were extracted.

RESULTS

Overall, 160 SA children were identified and compared with 783 NSA patients (Crohn's disease [CD]: 44% versus 72%; ulcerative colitis [UC]: 43% versus 21%; IBD-Unclassified: 13% versus 7%; P < 0.001). SA patients were predominantly second-generation Canadians (92%) and had shorter symptom duration (2 versus 4 months; P < 0.001). SA CD patients were less likely to have a parent with IBD (1% versus 14%; P = 0.003). SA patients had more extensive colonic disease (CD: 55% versus 35%; P = 0.005; UC: 77% versus 58%; P = 0.006); SA CD patients presented with more complicated disease (B2/B3: 39% versus 27%; P = 0.006) and UC patients presented with more severe disease (49% versus 23%; P < 0.001). In SA CD patients, CS use was higher (70% versus 58%; P = 0.045), and IM and biologic therapy were commenced earlier (P = 0.027; P = 0.047). SA UC patients were more likely to need CS and IM (P = 0.024; P < 0.001).

CONCLUSIONS

These data describe an ethnically unique clinical phenotype, where SA children have a higher proportion of UC, shorter symptom duration, more extensive colonic disease, and are more likely to require earlier escalation of therapy.

摘要

背景

炎症性肠病（IBD）在低风险人群中的发病率正在上升。本研究对一组患有IBD的加拿大南亚（SA）儿童进行了检查，以确定他们的疾病进程是否与非南亚（NSA）儿童不同。

方法

确定1997年至2012年间被诊断为IBD的南亚裔儿童，并与非南亚儿童进行比较。提取有关症状持续时间和类型、疾病表型、皮质类固醇暴露（CS）、全肠内营养使用情况、开始免疫调节剂（IM）、生物治疗和手术干预的时间的数据。

结果

总体而言，确定了160名南亚儿童，并与783名非南亚患者进行了比较（克罗恩病[CD]：44%对72%；溃疡性结肠炎[UC]：43%对21%；未分类的IBD：13%对7%；P<0.001）。南亚患者主要是第二代加拿大人（92%），症状持续时间较短（2个月对4个月；P<0.001）。南亚CD患者的父母患IBD的可能性较小（1%对14%；P = 0.003）。南亚患者的结肠疾病范围更广（CD：55%对35%；P = 0.005；UC：77%对58%；P = 0.006）；南亚CD患者表现出更复杂的疾病（B2/B3：39%对27%；P = 0.006），UC患者表现出更严重的疾病（49%对23%；P<0.001）。在南亚CD患者中，CS的使用更高（70%对58%；P = 0.045），IM和生物治疗开始得更早（P = 0.027；P = 0.047）。南亚UC患者更有可能需要CS和IM（P = 0.024；P<0.001）。