Martins Adalberta Lima, Fróes Renata de Sá Brito, Zago-Gomes Maria da Penha
Pharmaceutical Assistance, Health Department of Espírito Santo, Vitoria 29052-210, Espírito Santo, Brazil.
Department of Gastroenterology, Gastromed, Rio de Janeiro 22640-100, Rio de Janeiro, Brazil.
World J Clin Pediatr. 2022 Jul 9;11(4):341-350. doi: 10.5409/wjcp.v11.i4.341.
Inflammatory bowel disease (IBD) can lead to social and economic impacts worldwide. In Brazil, where its adult prevalence is increasing, the epidemiology of the pediatric population is not well known, although there is a documented increase in pediatric IBD incidence worldwide. Brazil has continental dimensions, and Espírito Santo is a state of southeastern Brazil, the region with the highest demographic densities and is the economically most important in the country.
To assess the prevalence, incidence, phenotype and medications in a Southeastern Brazilian pediatric population.
Data were retrieved from the Public Medication-Dispensing System of the Department of Health in Espírito Santo state from documentation required to have access to highly expensive medication from August 1, 2012 to July 31, 2014. There were 1048 registered patients with IBD of all ages, and of these patients, the cases ≤ 17 years were selected. The data were obtained through the analysis of administrative requests for these medications and included medical reports, endoscopy exams, histopathology and imaging tests, which followed the Clinical Protocols and Therapeutic Guidelines of the Brazilian Government. Only confirmed cases of IBD were included in the study.
There were 55 pediatric patients/1048 registered patients (5.34%), with Crohn's disease (CD) representing 30/55 (55%), ulcerative colitis (UC) 24/55 (43.6%) and 1 unclassified IBD, a significant difference from adult patients ( = 0.004). The prevalence of IBD in pediatric patients was 5.02 cases/100.000 inhabitants; the incidence in 2014 was 1.36 cases/100.000 inhabitants. The mean age at diagnosis was 12.2 years (± 4.2). There were 7 children diagnosed up to 6 years old, 7 between 7 to 10 years old and 41 between 11 and ≤ 17 years old. There was no difference in the distribution of UC and CD between these age categories ( = 0.743). There was no difference in gender distribution in relation to adults. Children and adolescents with UC had a predominance of pancolitis, unlike adults ( = 0.001), and used aminosalicylates and immunomodulators for their treatment. Pediatric patients with CD did not present a difference in disease location but had a higher frequency of fistulizing behavior ( = 0.03) and perianal disease phenotype ( = 0.007) than adult patients. Patients with CD used more immunomodulators and biological therapy. Treatment with biological therapy was more frequently used in pediatric patients than in adults ( < 0.001).
Although the data from this study demonstrate that incidence and prevalence rates are low in southeastern Brazil, these data demonstrate the severity of IBD in pediatric patients, with the need for early diagnosis and therapy, avoiding serious damage.
炎症性肠病（IBD）在全球范围内会导致社会和经济影响。在巴西，其成人患病率呈上升趋势，尽管全球儿科IBD发病率有记录显示在增加，但该国儿科人群的流行病学情况尚不清楚。巴西幅员辽阔，圣埃斯皮里图州是巴西东南部的一个州，该地区人口密度最高，也是该国经济上最重要的地区。
评估巴西东南部儿科人群中IBD的患病率、发病率、表型及用药情况。
数据取自圣埃斯皮里图州卫生部公共药物配给系统，来源于2012年8月1日至2014年7月31日获取高价药物所需的文件。共有1048名各年龄段的IBD登记患者，其中选取了年龄≤17岁的病例。数据通过分析这些药物的行政申请获得，包括医学报告、内镜检查、组织病理学和影像学检查，这些均遵循巴西政府的临床协议和治疗指南。该研究仅纳入IBD确诊病例。
55名儿科患者/1048名登记患者（5.34%），其中克罗恩病（CD）占30/55（55%），溃疡性结肠炎（UC）占24/55（43.6%），1例未分类的IBD，与成年患者有显著差异（P = 0.004）。儿科患者中IBD的患病率为5.02例/100000居民；2014年发病率为1.36例/100000居民。诊断时的平均年龄为12.2岁（±4.2）。6岁及以下诊断出7名儿童，7至10岁有7名，11至17岁有41名。这些年龄组之间UC和CD的分布无差异（P = 0.743）。与成年人相比，性别分布无差异。与成年人不同（P = 0.001），UC患儿和青少年以全结肠炎为主，治疗使用氨基水杨酸酯类和免疫调节剂。CD儿科患者的疾病部位无差异，但与成年患者相比，瘘管形成行为（P = 0.03）和肛周疾病表型（P = 0.007）的发生率更高。CD患者使用更多免疫调节剂和生物疗法。儿科患者比成人更频繁地使用生物疗法进行治疗（P < 0.001）。
尽管本研究数据表明巴西东南部的发病率和患病率较低，但这些数据表明IBD在儿科患者中较为严重，需要早期诊断和治疗，以避免严重损害。
