Table 5 - uploaded by Hasan M Isa
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Medications used in the management of 22 pediatric patients with Crohn's disease at the time of diagnosis and during follow-up.
Source publication
Objectives:
Our study aimed to report the epidemiology, clinical presentations, diagnostic and therapeutic approaches, and outcomes of Crohn's disease (CD) in pediatric patients in Bahrain.
Methods:
We conducted a retrospective review of the medical records of patients with CD diagnosed in the pediatric department, Salmaniya Medical Complex, Bah...
Context in source publication
Citations
... The most common theoretical cause of IBD is genetic which will lead to an immune reaction that can be triggered by environmental factors [10]. In Bahrain, the estimated annual incidence of pediatric CD was 1/10 5 /year (ranging from 0 to 5 patients) with a prevalence of 9.32 patients per 100,000 [11]. For pediatric UC, the estimated annual incidence was 1/10 5 /year (ranging from 0 to 6 patients) while the prevalence was found to be 16.3 patients per 100,000 [12]. ...
... Micronutrient deficiencies are seen more commonly in patients with CD as it mainly involves the terminal ileum and the colon [7,10,11,14,15,17]. Patients with a CD that is complicated with fistula, strictures, and surgical resection in small bowels, or during active disease are more prone to vitamin B12, folic acid, and fat-soluble vitamin deficiencies [10,14]. ...
... This could be explained by the role of iron therapy given to patients with UC to treat IDA prior to the diagnosis. Patients with UC usually present with bloody diarrhea compared to those with CD who usually present with recurrent abdominal pain as shown in our previous studies [11,12]. This bloody diarrhea might mandate earlier presentation to healthcare services, earlier diagnosis of IDA, and prompt treatment with iron supplementation. ...
Introduction
Inflammatory bowel diseases (IBD) are chronic diseases that can affect nutrient absorption leading to micronutrient deficiencies and biochemical abnormalities. This study aimed to assess certain serum micronutrients and nutritionally related biochemical markers levels in patients with pediatric IBD and to compare the actual levels and the prevalence of micronutrients deficiencies and biochemical abnormalities between patients with Crohn’s disease (CD) and those with ulcerative colitis (UC).
Methods
A retrospective cross-sectional study reviewing medical records of patients with IBD was conducted in the pediatric department, Salmaniya medical complex, Bahrain, from 1 January 1984 to 31 December 2021. Demographic data and laboratory results related to micronutrients and biochemical markers including full blood count, total protein, albumin, globulin, iron, ferritin, folic acid, vitamin B12, calcium, phosphorous,
magnesium, and vitamin D levels were collected upon presentation before starting the treatment. Nutritional deficiencies were compared based on sex, nationality, type of IBD, age at presentation, disease duration, weight at diagnosis, and inflammatory markers levels including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).
Results
Of 157 patients with pediatric IBD, 117 (74.5%) were included. Sixty-six (56.4%) patients were males. Sixty-six (56.4%) had CD and 51 (43.6%) had UC. No patient had indeterminant colitis. The mean age at presentation was 10.8±3.8 years. Most patients had one or more micronutrient deficiencies (n=110, 94%). Anemia was a common finding (n=79/116, 68.1%), with iron deficiency anemia (IDA) being predominant. Low iron levels were noted in 64/77 (83.1%) patients with a median of 5.0 (2.0-9.3) µmol/L (normal range, 11.6-31.3); isolated iron deficiency (ID) in 11/18 (61.1%) and IDA in 53/59 (89.8%) patients. Vitamin D deficiency was the second most common (n=45/61, 73.8%). Serum albumin, ferritin, calcium, phosphorous,
and magnesium were deficient in 29.2%, 27.8%, 31.7%, 12.5%, and 10%, respectively. One patient had vitamin B12 deficiency while none had folate deficiency. Patients with CD had significantly lower serum iron (5.4±5.6 versus 8.1±6.09 µmol//L, p=0.02) and lower serum protein (71.7±8.7 versus 75.4±9.9 g/L, p=0.043) but higher serum ferritin (45 (19-110.2) versus 21.3 (10.3-51.2) µg/L, p=0.046) compared to those with UC. Elevated ESR was noted in 62/105 (59.1%) patients while high CRP was found in 67/104 (64.4%). Patients with low iron had higher ESR (28 (17-47) versus 14 (10-33) mm/h, p=0.028) and higher CRP (13.3 (1.6-42) versus 1.8 (0.9-4.6) mg/L, p=0.019) levels compared to those with normal levels.
Conclusion
Patients with pediatric IBD are at risk of multiple micronutrient deficiencies and biochemical abnormalities. Iron and vitamin D deficiencies are the most frequent. Patients with CD are more prone to have lower serum iron and protein levels than those with UC. ID was associated with elevated inflammatory markers.
... Inflammatory bowel disease (IBD) is a chronic inflammatory condition that primarily affects the gastrointestinal (GI) tract and is further classified into ulcerative colitis (UC) and Crohn's disease (CD). [1] Although an exact etiology is lacking, IBD is considered an immune-mediated disease that causes dysregulation between https://doi.org/10.11005/jbm.2023. 30.1.59 ...
Background:
Inflammatory bowel disease (IBD) is a chronic inflammatory immune-mediated condition that affects the gastrointestinal system and alters bone growth and bone mineral density (BMD). Here we aimed to study the prevalence and predictors of a low BMD in pediatric patients with IBD.
Methods:
This retrospective cross-sectional analytical study included pediatric patients with IBD in whom BMD was evaluated using dual energy X-ray absorptiometry of the total body and lumbar spine. Osteoporosis was defined as a BMD Z-score ≤-2, osteopenia as -2 to -1, and normal as >-1. Clinical and laboratory findings were compared between patients with and without osteoporosis.
Results:
Of the 48 patients, 30 (62.5%) were males, 35 (72.9%) had Crohn's disease, and 13 (27.1%) had ulcerative colitis. The mean age at diagnosis was 9.9±2.8 years. The median age at the time of the BMD scans was 11.9 (interquartile range, 9.9-14.3) years. Total body BMD scans identified 13 (27.1%) and 16 (33.3%) patients with osteoporosis and osteopenia, respectively. Spinal BMD scans revealed that 17 (39.5%) and 14 (32.6%) patients had osteoporosis and osteopenia, respectively. A low body mass index (BMI) Z-score (p=0.038), ileocolonic disease location (p=0.008), and a low calcium level (p=0.008) were significant predictors of osteoporosis on the total body BMD scans. A low BMI Z-score (p=0.039), decreased hemoglobin level (p=0.018), low calcium level (p=0.033), and infliximab use (p=0.019) were significant predictors of osteoporosis on the spinal BMD scans.
Conclusions:
This study showed a high prevalence of low BMD among pediatric patients with IBD. A low BMI, ileocolonic disease location, low hemoglobin and calcium levels, and infliximab use were significantly associated with osteoporosis.
... These increases have been long established in North America and Europe [3,4]. As more data on the global incidence of IBD come to light, these rates are continuing to increase in North America [5,6] and Europe [7][8][9][10][11] and being mirrored [107,108], Faroe Islands [109], Finland [110,111], Iceland [11], Ireland [112], Norway [113], Sweden [114][115][116][117], United Kingdom (England [9], Scotland [118,119] Croatia [120], Italy [121], Malta [122], San Marino [123], Slovenia [124], Spain [10] a b c Fig. 6.2 Maps describing global patterns in the incidence of pediatric-onset (a) inflammatory bowel disease (IBD); (b) Crohn disease (CD); and (c) ulcerative colitis (UC) in other parts of the world, including in China [12], Bahrain [13,14], Israel [15], Libya [16], Singapore [17], and Saudi Arabia [18]. Incidence rates in Wisconsin, USA remained stable between 2000 and 2007 [19]. ...
The global epidemiology of pediatric inflammatory bowel disease (IBD) is evolving rapidly: continuing to increase in areas with previously reported high incidence and prevalence and emerging in regions where it was either low or not reported. Yet, there remains a paucity of data on the epidemiology of IBD in many low- and middle-income countries. The pathogenesis of IBD is complex and is rooted in the interactions between a person’s genetics, microbiome, environmental risk factors triggering an inappropriate response. Accordingly, many environmental risk factors studied in IBD (e.g., smoking, diet, air pollution) are believed to influence risk by modifying the intestinal microbiome. The rapid growth of IBD among children, their limited number of environmental exposures, and the role of early-life exposures in shaping the intestinal microbiome, coupled with differing risks across ethnocultural groups migrating from regions of low to high risk, provide important opportunities to understand the pathogenesis of IBD.
... [3] In Bahrain, PIBD has risen from 1 per 100,000 person-years to 2.25/100,000 person-years after the year 2008. [5] In Saudi Arabia, by contrast, the annual reported incidence has been as low as 0.47/100,000 person-years. [6] However, globally, there seems to be an increasing trend in the incidence of IBD. ...
... Our study design is comparable to the study by El Mouzan et al. [6] from Saudi Arabia and Al Qabandi et al. [3] from Kuwait with regard to the age category of children being less than 14 years. The Omani incidence is closer to the incidence in Saudi Arabia of 0.47 per 10 5 children, [5] rather than Al-Kuwait with an incidence of 2.16/100,000 person-years [3] from the AGR. The incidence in Oman is also far below that of European countries, for example, Norway, where the incidence is 3/100,000 person-years and Spain (Asturias), where the incidence is 0.3/100,000 person-years. ...
... Perianal disease was the highest in our cohort (40.9%). [3,5] The incidence of perianal disease was 37% in Israel, 13% [22] in Saudi Arabia, 6.8% [20] in Turkey, [23] and 15% in Europe (<16 years). [24] The younger age at presentation as well as the higher occurrence of perianal disease might indicate more aggressive PIBD in the Omani population. ...
Background:
Pediatric inflammatory bowel disease (PIBD) has been documented all over the world, and there is now a large body of clinical, pathological, and treatment knowledge and protocols in place in many countries. There is currently limited knowledge on the prevalence and pathology of PIBD in Omani population. The aim of this study is to report the incidence and clinical features of PIBD in Oman.
Methods:
This was a retrospective, cross-sectional, multicenter study carried out on all children <13 years of age between January 1, 2010 and December 31, 2021.
Results:
Fifty-one children were identified, 22 males (43.1%) and 29 females (56.9%), who were mostly from the Muscat region of Oman. The median incidence in the country was 0.57 (confidence interval [CI]: 0.31-0.64) per 105 children for inflammatory bowel disease (IBD), 0.18 (CI: 0.07-0.38) per 105 children for ulcerative colitis (UC), and 0.19 (CI: 0.12-0.33) per 105 children for Crohn's disease (CD). There was a significant increase in the incidence of all PIBD types after the year 2015. Bloody diarrhea was the most common symptom, followed by abdominal pain. Perianal disease affected nine children (40.9%) with CD.
Conclusion:
The incidence of PIBD in Oman is lower than in some neighboring Gulf countries but similar to that of Saudi Arabia. An alarming upward trend was noted from the year 2015. Large-scale population-based studies are required to investigate the possible causes of this increasing incidence.
... Incidence variations with the west-east and north-south falling gradients have been observed across the European continent and within individual countries [5,6] . Over the past three decades, developing countries are reporting more cases of pediatric onset IBD, with a few incidence studies emerging from this part of the world [7][8][9][10] . In the Kingdom of Saudi Arabia (KSA), the incidences, time trends, and clinical and laboratory profiles of pediatric IBD have been reported on a national basis [11][12][13][14][15][16][17] . ...
Background:
Incidence and severity variations of inflammatory bowel disease (IBD) have been reported from Western populations between continents and regions of the same countries. However, no data were available from other countries.
Aim:
To investigate the regional differences in the IBD profiles of pediatric patients from the Kingdom of Saudi Arabia.
Methods:
Data from a national multicenter IBD study were used. The incidence, time trend, and clinical presentation of Crohn's disease (CD) and ulcerative colitis (UC) in the Central region (CR), Western region (WR), and Eastern region (ER) were analyzed and compared. Statistical analysis included Poisson regression analysis for incidence variation and Chi-square test for demographic and clinical parameters. A P < 0.05 was considered significant.
Results:
The prevalence of positive family history was lower in children with CD from the ER than the CR or the WR. Consanguinity rate was higher in children with CD and UC from the CR and the ER, respectively. The incidences and time trends of CD and UC were not significantly different between regions. In the ER, a significantly higher percentage of children with CD presented with abdominal pain (P < 0.001), blood in stools (P = 0.048), stricturing or penetrating disease (P = 0.029), higher erythrocyte sedimentation rate (P < 0.001), higher C-reactive protein (P < 0.001), higher anemia (P = 0.017), and lower albumin level (P = 0.014). For children with UC from the ER, a significantly higher percentage presented with anemia (P = 0.006) and a lower percentage with pancolitis (P < 0.001).
Conclusion:
The most important finding is the identification of significantly more severe presentation of CD in the ER of the Kingdom of Saudi Arabia. Prospective studies are needed to explain such variations.
... 1 We agree that the rate of extraintestinal manifestations (EIMs) in our cohort is low (8%) compared to that reported worldwide. [2][3][4][5] However, the prevalence of EIMs in patients with inflammatory bowel disease (IBD) is variable. 4 A study from Hungary reported EIMs in 30% of 331 patients with Crohn's disease (CD), another study from Pakistan reported EIMs in 7% of 56 patients with IBD. ...
... 5 Similar to our study where only major EIMs were considered, oral manifestations were not considered as a major EIMs in other studies. 2,3,6,7 In our study, if we added minor EIMs, the prevalence would reach 28.8%. 2 The low rate of EIMs in our study could be probably explained by the correlation between CD severity and the tendency to develop EIMs. As those patients with EMIs in our study were already having a severe type of CD. 2 Genetic and environmental effects specific to both the pediatric and adult Bahraini population may also play a role in the low prevalence of EIMs. ...
... 2,3,6,7 In our study, if we added minor EIMs, the prevalence would reach 28.8%. 2 The low rate of EIMs in our study could be probably explained by the correlation between CD severity and the tendency to develop EIMs. As those patients with EMIs in our study were already having a severe type of CD. 2 Genetic and environmental effects specific to both the pediatric and adult Bahraini population may also play a role in the low prevalence of EIMs. ...
... I n the July 2018 issue of the Oman Medical Journal, Isa et al interestingly described the epidemiology, clinical picture, diagnostic and therapeutic features, and outcomes of pediatric Crohn's disease (CD) in Bahrain. 1 It is well-known that inflammatory bowel diseases (IBDs), including CD, are associated with a variety of extraintestinal manifestations (EIMs) that might be the early manifestation of the disease itself. The autoimmune mechanisms leading to EIMs have been suggested to be related to many factors, including genetic susceptibility, antigenic display of autoantigen, aberrant self-recognition, and immunopathogenetic autoantibodies against organ-specific cellular antigens shared by the colon and extra-colonic organs. 2 Microbes might also play an important role, probably via molecular mimicry. 2 Globally, 30% of patients with IBDs develop EIMs and the clinical spectrum of these EIMs varies from mild transitory to very severe lesions, sometimes more incapacitating than the intestinal disease itself. ...
... These included the following: eye involvement, arthritis, and clubbing each in one patient; and erythema nodosum in two patients. 1 The low rate of EIMs (8%) compared to 30% reported worldwide 3 is interesting and the following three points could plausibly explain that discrepancy. ...
Background
The worldwide incidence of Crohn disease (CD) in childhood and adolescence has an increasing trend, with significant differences between different geographic regions and individual countries. This includes an increase in the incidence of CD in countries and geographic regions where CD was not previously prevalent. In response to the increasing incidence, the pediatric care landscape is facing growing challenges.
Objective
This systematic review and meta-analysis were undertaken to comprehensively delineate the incidence rates of CD in pediatric populations across different countries and to explore potential influencing factors.
Methods
We performed a systematic review of PubMed and Embase (via Ovid) for studies from January 1, 1970, to December 31, 2019. In addition, a manual search was performed in relevant and previously published reviews. The results were evaluated quantitatively. For this purpose, random effects meta-analyses and meta-regressions were performed to investigate the overall incidence rate and possible factors influencing the incidence.
Results
A qualitative synthesis of 74 studies was performed, with 72 studies included in the meta-analyses and 52 in the meta-regressions. The results of our meta-analysis showed significant heterogeneity between the individual studies, which cannot be explained by a sample effect alone. Our findings showed geographical differences in incidence rates, which increased with increasing distance from the equator, although no global temporal trend was apparent. The meta-regression analysis also identified geographic location, UV index, and Human Development Index as significant moderators associated with CD incidence.
Conclusions
Our results suggest that pediatric CD incidence has increased in many countries since 1970 but varies widely with geographic location, which may pose challenges to the respective health care systems. We identified geographic, environmental, and socioeconomic factors that contribute to the observed heterogeneity in incidence rates. These results can serve as a basis for future research. To this end, implementations of internationally standardized and interoperable registries combined with the dissemination of health data through federated networks based on a common data model, such as the Observational Medical Outcomes Partnership, would be beneficial. This would deepen the understanding of CD and promote evidence-based approaches to preventive and interventional strategies as well as inform public health policies aimed at addressing the increasing burden of CD in children and adolescents.
Trial Registration
PROSPERO International prospective register of systematic reviews CRD42020168644; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=168644
International Registered Report Identifier (IRRID)
RR2-10.1136/bmjopen-2020-037669
Background & Aims
The incidence of inflammatory bowel disease (IBD) is increasing internationally, particularly in nations with historically low rates. Previous reports of the epidemiology of pediatric-onset IBD identified a paucity of data. We systematically reviewed the global trends in incidence and prevalence of IBD diagnosed <21 years over the first two decades of the 21st century.
Methods
We systematically reviewed studies indexed in MEDLINE, EMBASE, Airiti Library, and SciELO from 01/2010 to 02/2020 to identify population-based studies reporting the incidence and/or prevalence of IBD, Crohn’s disease (CD), ulcerative colitis (UC), and/or IBD-unclassified (IBDU). Data from studies published prior to 2000 were derived from a previously published systematic review. We described the geographic distribution and trends in children of all ages and limiting to very early onset (VEO) IBD.
Results
131 studies from 48 countries were included. The incidence and prevalence of pediatric-onset IBD is highest in Northern Europe and North America and lowest in Southern Europe, Asia, and the Middle East. Among studies evaluating trends over time, most (31/37, 84%) studies reported significant increases in incidence and all (7/7) reported significant increases in prevalence. Data on the incidence and prevalence of VEO-IBD are limited to countries with historically high rates of IBD. Time trends in the incidence of VEO-IBD were visually heterogeneous.
Conclusions
Rates of pediatric-onset IBD continue to rise around the world and data are emerging from regions where it was not previously reported. However, there remains a paucity of data on VEO-IBD and on pediatric IBD from developing and recently developed countries.
Background and study aim
The prevalence of nutritional disorders in Saudi children with inflammatory bowel diseases (IBDs) has been reported using the World Health Organization (WHO) reference. Our aim was to provide more accurate definition of the prevalence of nutritional impairment in Saudi children with IBDs based on the national growth reference and to demonstrate the effect of using a reference from other populations on the prevalence rates.
Patients and Methods
Weight, height, and body mass index data, from the multicenter study of IBDs in Saudi children and adolescents, were plotted on the new Saudi national growth reference. Statistical analyses included frequency calculations and z-test for proportions to investigate the significance of the difference in prevalence. A p-value of < 0.05 was considered significant.
Results
Among a total of 374 patients, 119 (32%) had ulcerative colitis (UC) and 255 (68%) had Crohn’s disease (CD). Compared with the WHO reference, the Saudi national reference produced a significantly lower prevalence of thinness in patients with UC (24% vs. 8%, p = 0.001), CD (35% vs. 20%, p = 0.002), and of short stature in patients with CD (28% vs. 11%, p < 0.001). The difference in the prevalence of overweight was not significant.
Conclusions
We provide more accurate prevalence estimate of nutritional disorders in Saudi children with IBDs based on national reference. The use of the WHO reference overestimated the prevalence of thinness and short stature in Saudi children. Prevalence estimates based on references from other populations should be interpreted with caution.
