Gastroenterology. 2022 Apr;162(4):1147-1159.e4. doi: 10.1053/j.gastro.2021.12.282.Epub 2022 Jan 5.

M Ellen Kuenzig ¹, Stephen G Fung ², Luba Marderfeld ², Joyce W Y Mak ³, Gilaad G Kaplan ⁴, Siew C Ng ³, David C Wilson ⁵, Fiona Cameron ⁶, Paul Henderson ⁵, Paulo G Kotze ⁷, Jasmine Bhatti ⁸, Vixey Fang ⁹, Samantha Gerber ¹⁰, Evelyne Guay ¹¹, Supun Kotteduwa Jayawarden ¹², Leo Kadota ¹¹, Fernando Maldonado D ¹³, Jessica Amankwah Osei ¹⁴, Ryan Sandarage ¹², Amanda Stanton ¹⁵, Melissa Wan ¹⁶, InsightScope Pediatric IBD Epidemiology Group; Eric I Benchimol ¹⁷

Collaborators

InsightScope Pediatric IBD Epidemiology Group: 

Jasmine Bhatti, Samantha Gerber, Evelyne Guay, Supun K Jayawarden, Leo Kadota, Fernando Maldonado, Emma Maltus, Shoumak Bhattacharya, Jessica Osei, Ryan Sandarage, Amanda Stanton, Melissa Wan

Author information

¹SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada; CHEO Research Institute, Ottawa, Ontario, Canada.

²CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada; CHEO Research Institute, Ottawa, Ontario, Canada.

³Department of Medicine and Therapeutics, Institute of Digestive Disease, LKS Institute of Health Science, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.

⁴Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.

⁵Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Sick Children and Young People, Edinburgh, United Kingdom; Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom.

⁶Department of Pediatric Gastroenterology, Hepatology and Nutrition, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom.

⁷IBD Outpatients Clinic, Colorectal Surgery Unit, Catholic University of Paraná (PUCPR), Curitiba, Brazil.

⁸Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

⁹SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.

¹⁰Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.

¹¹Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

¹²Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

¹³Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Research Department, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada.

¹⁴Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

¹⁵Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.

¹⁶Public Health and Preventive Medicine Residency Program, Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.

¹⁷SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada; CHEO Research Institute, Ottawa, Ontario, Canada; Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. Electronic address: eric.benchimol@sickkids.ca.

Abstract

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 in individuals <21 years old over the first 2 decades of the 21st century.

Methods: We systematically reviewed studies indexed in MEDLINE, EMBASE, Airiti Library, and SciELO from January 2010 to February 2020 to identify population-based studies reporting the incidence and/or prevalence of IBD, Crohn's disease, ulcerative colitis, and/or IBD-unclassified. Data from studies published before 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: A total of 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 of 37, 84%) studies reported significant increases in incidence and all (7 of 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.