Sanjay Gandhi Postgraduate Institute Medical Sciences, Lucknow, Uttar Pradesh.
Kanchikamakoti Child Trust Hospital, Chennai.
Eur J Gastroenterol Hepatol. 2020 Oct;32(10):1305-1311. doi: 10.1097/MEG.0000000000001859.
Paediatric inflammatory bowel disease (PIBD) is increasing across the world. However, information from India is sparse. This multicentre study evaluated the demographics, clinical phenotype and outcome of PIBD from India.
Data of children (≤18 years) with PIBD were collected using a proforma containing details of demographics, clinical profile, extraintestinal manifestations (EIM), investigations, disease extent and treatment.
Three hundred twenty-five children [Crohn's disease: 65.2%, ulcerative colitis: 28.0%, IBD unclassified (IBDU): 6.7%, median age at diagnosis: 11 (interquartile range 6.3) years] were enrolled. 6.9% children had family history of IBD. Pancolitis (E4) was predominant in ulcerative colitis (57.8%) and ileocolonic (L3, 55.7%) in Crohn's disease. Perianal disease was present in 10.9% and growth failure in 20.9% of Crohn's disease cases. Steroids were the initial therapy in 84.2%, 5-amino salicylic acid in 67.3% and exclusive enteral nutrition (EEN) in 1.3% cases. Overall, immunomodulators and biologics were given to 84.3 and 17.9% cases, respectively, and 2.9% cases underwent surgery. Very early onset IBD (VEOIBD) was seen in 60 (19.2%) children. IBDU was commoner in the VEOIBD than the older-PIBD (18/60 vs 4/253; P < 0.001). VEOIBD-Crohn's disease patients more often had isolated colonic disease than the older Crohn's disease (45.4% vs 11.8%; P < 0.001). Prevalence of perianal disease, EIM, therapeutic requirements and outcome were not different between VEOIBD and older-PIBD.
Disease location and phenotype of PIBD in Indian children is similar to the children from the west. However, the therapeutic options of EEN, biologics and surgery are underutilized. VEOIBD accounted for 19.2% of PIBD.
小儿炎症性肠病（PIBD）在全球范围内呈上升趋势。然而，来自印度的信息却很少。本多中心研究评估了来自印度的 PIBD 的人口统计学、临床表型和结果。
使用包含人口统计学、临床特征、肠外表现（EIM）、检查、疾病程度和治疗详细信息的表格收集小儿（≤18 岁）PIBD 数据。
共纳入 325 例患儿[克罗恩病：65.2%，溃疡性结肠炎：28.0%，IBD 未分类（IBDU）：6.7%，中位诊断年龄：11（四分位距 6.3）岁]。6.9%的患儿有 IBD 家族史。溃疡性结肠炎以全结肠炎（E4）为主（57.8%），克罗恩病以回结肠（L3）为主（55.7%）。肛周疾病见于 10.9%的克罗恩病病例，生长发育迟缓见于 20.9%的克罗恩病病例。84.2%的患儿初始治疗使用类固醇，67.3%使用 5-氨基水杨酸，1.3%使用完全肠内营养（EEN）。总体而言，84.3%和 17.9%的患儿分别接受了免疫调节剂和生物制剂治疗，2.9%的患儿接受了手术。325 例患儿中，60 例（19.2%）为非常早发性 IBD（VEOIBD）。VEOIBD 中 IBDU 比年长 PIBD 更常见（18/60 比 4/253；P<0.001）。VEOIBD-克罗恩病患者中孤立性结肠疾病的发生率高于年长克罗恩病患者（45.4%比 11.8%；P<0.001）。VEOIBD 和年长 PIBD 之间肛周疾病、EIM、治疗需求和结果无差异。
印度儿童 PIBD 的疾病部位和表型与西方儿童相似。然而，EEN、生物制剂和手术等治疗选择的利用率较低。VEOIBD 占 PIBD 的 19.2%。
