Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel.
SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada; Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada.
Clin Gastroenterol Hepatol. 2023 Sep;21(10):2639-2648.e6. doi: 10.1016/j.cgh.2022.10.026. Epub 2022 Nov 3.
BACKGROUND & AIMS: In this nationwide study from the Israeli Inflammatory Bowel Disease Research Nucleus, we aimed to describe the incidence of very early onset inflammatory bowel diseases (VEOIBDs) with a focus on infantile-onset disease and to compare management and disease course with older children.
Data were retrieved from the 4 Israeli Health Maintenance Organizations covering 98% of the population. Pediatric-onset IBD was categorized as follows: adolescent onset (10 to <18 y), early onset (6 to <10 y), VEOIBD (0 to <6 y), toddler onset (2 to <6 y), and infantile onset (<2 y).
A total of 5243 children with 35,469 person-years of follow-up evaluation, were diagnosed with IBD during 2005 to 2020: 4444 (85%) with adolescent onset, 548 (10%) with early onset, and 251 (4.8%) with VEOIBD, of whom 81 (1.5%) had infantile onset. The incidence of pediatric-onset IBD increased from 10.8 per 100,000 in 2005 to 15.3 per 100,000 in 2019 (average annual percentage change, 2.8%; 95% CI, 2.2%-3.4%), but that of VEOIBD remained stable (average annual percentage change, 0%; 95% CI, -2.5% to 2.6%). The infantile-onset and toddler-onset groups were treated less often with biologics (36% and 35%, respectively) vs the early onset (57%) and adolescent-onset groups (53%; P < .001). The time to steroid dependency was shorter in infantile-onset (hazard ratio [HR], 2.1; 95% CI, 1.5-2.9) and toddler-onset disease (HR, 1.6; 95% CI, 1.2-2.0) vs early onset and adolescent-onset disease, but time to hospitalizations, time to surgery, and growth delay were worse only in infantile-onset disease. In a multivariable model, infantile-onset patients had a higher risk for surgery (HR, 1.4; 95% CI, 1.1-1.9) and hospitalization (HR, 1.7; 95% CI, 1.2-2.4) than the toddler-onset group.
The incidence of VEOIBD remained stable. Infantile-onset IBD had worse outcomes than older children, while toddler onset had mostly similar outcomes, despite less frequent use of biologics.
本项来自以色列炎症性肠病研究核心的全国性研究旨在描述极早发性炎症性肠病（VEOIBD）的发病情况，重点关注婴儿期发病，并比较其与年长儿童的治疗和疾病进程。
从覆盖 98%人口的 4 家以色列健康维护组织中提取数据。儿科发病的 IBD 分为以下几类：青少年发病（10 岁＜年龄＜18 岁）、早发性发病（6 岁＜年龄＜10 岁）、VEOIBD（0 岁＜年龄＜6 岁）、幼儿发病（2 岁＜年龄＜6 岁）和婴儿发病（年龄＜2 岁）。
2005 年至 2020 年期间，共有 5243 名儿童接受了 35469 人年的随访评估，诊断为 IBD：4444 名（85%）为青少年发病，548 名（10%）为早发性发病，251 名（4.8%）为 VEOIBD，其中 81 名（1.5%）为婴儿发病。儿科发病 IBD 的发病率从 2005 年的每 100000 人 10.8 例增加到 2019 年的每 100000 人 15.3 例（平均年变化率，2.8%；95%CI，2.2%-3.4%），但 VEOIBD 的发病率保持稳定（平均年变化率，0%；95%CI，-2.5%至 2.6%）。与早发性和青少年发病组相比，婴儿发病和幼儿发病组接受生物制剂治疗的比例较低（分别为 36%和 35%）。与早发性和青少年发病组相比，婴儿发病（风险比[HR]，2.1；95%CI，1.5-2.9）和幼儿发病（HR，1.6；95%CI，1.2-2.0）的类固醇依赖时间更短，但住院时间、手术时间和生长延迟仅在婴儿发病时更差。在多变量模型中，与幼儿发病组相比，婴儿发病组的手术风险（HR，1.4；95%CI，1.1-1.9）和住院风险（HR，1.7；95%CI，1.2-2.4）更高。
VEOIBD 的发病率保持稳定。与年长儿童相比，婴儿发病的 IBD 结局更差，而幼儿发病的结局大多相似，尽管生物制剂的应用频率较低。
