AIM: To examine the incidence and trends in pediatric inflammatory bowel diseases (IBDs) over 2000-2015 and project the incidence to 2018. METHODS: A 16-year prospective study of IBD patients < 19 years of age was conducted in the Czech Republic (the Pilsen region). All incident IBD cases within a well-defined geographical area were retrieved from a prospectively collected computerized clinical database. Historical Czech data were used for comparison (1990-2001). Our catchment population was determined from the census data. We calculated the incidence by relating the number of newly diagnosed cases to the size of the pediatric population-at-risk in each calendar year. Age/sex, disease type, place of residence, and race/ethnicity were identified. RESULTS: In total, 170 new IBD cases [105 Crohn's disease (CD), 48 ulcerative colitis (UC), and 17 IBD-unclassified (IBD-U)] were identified. The median age at IBD diagnosis was 14.2 years, 59.4% were males, and 97.1% were Caucasians. A male preponderance of IBD (P = 0.026) and CD (P = 0.016) was observed. With 109209 person-years in the catchment area, the average incidence of IBD per 100000 person-years was 10.0 (6.2 for CD, 2.8 for UC, and 1.0 for IBD-U) for children aged 0 to 19 years; for those aged 0 to 15 years, the incidence rate was 7.3 (4.6 for CD, 2.0 for UC, and 0.7 for IBD-U). An increase in incidence with age was observed (P = 0.0003). Over the 16-year period, the incidence increased for IBD patients (P = 0.01) and CD in particular (P < 0.0001), whereas the incidence for UC (P = 0.09) and IBD-U (P = 0.339) remained unchanged. IBD-projected data from 2016 to 2018 were 12.1, 12.3 and 12.6 per 100000 person-years, respectively. CONCLUSION: Pediatric-onset IBD incidence is around its highest point. The increase, which is particularly pronounced for CD, may be challenging to relate to causes of pediatric disease.

Jan Schwarz Josef Sýkora Dominika Cvalínová Renáta Pomahačová Department of Paediatrics Charles University Faculty of Medicine in Pilsen Faculty Hospital 30460 Pilsen Czech Republic

See more in PubMed

Molodecky NA, Kaplan GG. Environmental risk factors for inflammatory bowel disease. Gastroenterol Hepatol (N Y) 2010;6:339–346. PubMed PMC

Benchimol EI, Fortinsky KJ, Gozdyra P, Van den Heuvel M, Van Limbergen J, Griffiths AM. Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends. Inflamm Bowel Dis. 2011;17:423–439. PubMed

Benchimol EI, Guttmann A, Griffiths AM, Rabeneck L, Mack DR, Brill H, Howard J, Guan J, To T. Increasing incidence of paediatric inflammatory bowel disease in Ontario, Canada: evidence from health administrative data. Gut. 2009;58:1490–1497. PubMed

Muhvić-Urek M, Tomac-Stojmenović M, Mijandrušić-Sinčić B. Oral pathology in inflammatory bowel disease. World J Gastroenterol. 2016;22:5655–5667. PubMed PMC

Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, Benchimol EI, Panaccione R, Ghosh S, Barkema HW, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142:46–54.e42; quiz e30. PubMed

Urlep D, Blagus R, Orel R. Incidence Trends and Geographical Variability of Pediatric Inflammatory Bowel Disease in Slovenia: A Nationwide Study. Biomed Res Int. 2015;2015:921730. PubMed PMC

Larsen MD, Baldal ME, Nielsen RG, Nielsen J, Lund K, Nørgård BM. The incidence of Crohn’s disease and ulcerative colitis since 1995 in Danish children and adolescents & lt; 17 years - based on nationwide registry data. Scand J Gastroenterol. 2016;51:1100–1105. PubMed

Martín-de-Carpi J, Rodríguez A, Ramos E, Jiménez S, Martínez-Gómez MJ, Medina E. Increasing incidence of pediatric inflammatory bowel disease in Spain (1996-2009): the SPIRIT Registry. Inflamm Bowel Dis. 2013;19:73–80. PubMed

Henderson P, Hansen R, Cameron FL, Gerasimidis K, Rogers P, Bisset WM, Reynish EL, Drummond HE, Anderson NH, Van Limbergen J, et al. Rising incidence of pediatric inflammatory bowel disease in Scotland. Inflamm Bowel Dis. 2012;18:999–1005. PubMed

Agnarsson U, Björnsson S, Jóhansson JH, Sigurdsson L. Inflammatory bowel disease in Icelandic children 1951-2010. Population-based study involving one nation over six decades. Scand J Gastroenterol. 2013;48:1399–1404. PubMed

Burisch J, Pedersen N, Čuković-Čavka S, Brinar M, Kaimakliotis I, Duricova D, Shonová O, Vind I, Avnstrøm S, Thorsgaard N, et al. East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort. Gut. 2014;63:588–597. PubMed

Russel MG. Changes in the incidence of inflammatory bowel disease: what does it mean? Eur J Intern Med. 2000;11:191–196. PubMed

Legaki E, Gazouli M. Influence of environmental factors in the development of inflammatory bowel diseases. World J Gastrointest Pharmacol Ther. 2016;7:112–125. PubMed PMC

Vind I, Riis L, Jess T, Knudsen E, Pedersen N, Elkjaer M, Bak Andersen I, Wewer V, Nørregaard P, Moesgaard F, et al. Increasing incidences of inflammatory bowel disease and decreasing surgery rates in Copenhagen City and County, 2003-2005: a population-based study from the Danish Crohn colitis database. Am J Gastroenterol. 2006;101:1274–1282. PubMed

van der Zaag-Loonen HJ, Casparie M, Taminiau JA, Escher JC, Pereira RR, Derkx HH. The incidence of pediatric inflammatory bowel disease in the Netherlands: 1999-2001. J Pediatr Gastroenterol Nutr. 2004;38:302–307. PubMed

Pozler O, Maly J, Bonova O, Dedek P, Frühauf P, Havlickova A, Janatova T, Jimramovsky F, Klimova L, Klusacek D, et al. Incidence of Crohn disease in the Czech Republic in the years 1990 to 2001 and assessment of pediatric population with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2006;42:186–189. PubMed

Kolek A, Janout V, Tichý M, Grepl M. The incidence of inflammatory bowel disease is increasing among children 15 years old and younger in the Czech Republic. J Pediatr Gastroenterol Nutr. 2004;38:362–363. PubMed

IBD Working Group of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition. Inflammatory bowel disease in children and adolescents: recommendations for diagnosis--the Porto criteria. J Pediatr Gastroenterol Nutr. 2005;41:1–7. PubMed

Ashton JJ, Wiskin AE, Ennis S, Batra A, Afzal NA, Beattie RM. Rising incidence of paediatric inflammatory bowel disease (PIBD) in Wessex, Southern England. Arch Dis Child. 2014;99:659–664. PubMed

Ashton JJ, Coelho T, Ennis S, Batra A, Afzal NA, Beattie RM. Presenting phenotype of paediatric inflammatory bowel disease in Wessex, Southern England 2010-2013. Acta Paediatr. 2015;104:831–837. PubMed

Malmborg P, Grahnquist L, Lindholm J, Montgomery S, Hildebrand H. Increasing incidence of paediatric inflammatory bowel disease in northern Stockholm County, 2002-2007. J Pediatr Gastroenterol Nutr. 2013;57:29–34. PubMed

Hildebrand H, Finkel Y, Grahnquist L, Lindholm J, Ekbom A, Askling J. Changing pattern of paediatric inflammatory bowel disease in northern Stockholm 1990-2001. Gut. 2003;52:1432–1434. PubMed PMC

Lehtinen P, Ashorn M, Iltanen S, Jauhola R, Jauhonen P, Kolho KL, Auvinen A. Incidence trends of pediatric inflammatory bowel disease in Finland, 1987-2003, a nationwide study. Inflamm Bowel Dis. 2011;17:1778–1783. PubMed

Virta LJ, Saarinen MM, Kolho KL. Inflammatory Bowel Disease Incidence is on the Continuous Rise Among All Paediatric Patients Except for the Very Young: A Nationwide Registry-based Study on 28-Year Follow-up. J Crohns Colitis. 2017;11:150–156. PubMed

Perminow G, Brackmann S, Lyckander LG, Franke A, Borthne A, Rydning A, Aamodt G, Schreiber S, Vatn MH. A characterization in childhood inflammatory bowel disease, a new population-based inception cohort from South-Eastern Norway, 2005-07, showing increased incidence in Crohn’s disease. Scand J Gastroenterol. 2009;44:446–456. PubMed

Grieci T, Bütter A. The incidence of inflammatory bowel disease in the pediatric population of Southwestern Ontario. J Pediatr Surg. 2009;44:977–980. PubMed

Kugathasan S, Judd RH, Hoffmann RG, Heikenen J, Telega G, Khan F, Weisdorf-Schindele S, San Pablo W, Perrault J, Park R, et al. Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in Wisconsin: a statewide population-based study. J Pediatr. 2003;143:525–531. PubMed

Abramson O, Durant M, Mow W, Finley A, Kodali P, Wong A, Tavares V, McCroskey E, Liu L, Lewis JD, et al. Incidence, prevalence, and time trends of pediatric inflammatory bowel disease in Northern California, 1996 to 2006. J Pediatr. 2010;157:233–239.e1. PubMed

Auvin S, Molinié F, Gower-Rousseau C, Brazier F, Merle V, Grandbastien B, Marti R, Lerebours E, Dupas JL, Colombel JF, et al. Incidence, clinical presentation and location at diagnosis of pediatric inflammatory bowel disease: a prospective population-based study in northern France (1988-1999) J Pediatr Gastroenterol Nutr. 2005;41:49–55. PubMed

Castro M, Papadatou B, Baldassare M, Balli F, Barabino A, Barbera C, Barca S, Barera G, Bascietto F, Berni Canani R, et al. Inflammatory bowel disease in children and adolescents in Italy: data from the pediatric national IBD register (1996-2003) Inflamm Bowel Dis. 2008;14:1246–1252. PubMed

Buderus S, Scholz D, Behrens R, Classen M, De Laffolie J, Keller KM, Zimmer KP, Koletzko S. Inflammatory bowel disease in pediatric patients: Characteristics of newly diagnosed patients from the CEDATA-GPGE Registry. Dtsch Arztebl Int. 2015;112:121–127. PubMed PMC

de Bie CI, Paerregaard A, Kolacek S, Ruemmele FM, Koletzko S, Fell JM, Escher JC. Disease phenotype at diagnosis in pediatric Crohn’s disease: 5-year analyses of the EUROKIDS Registry. Inflamm Bowel Dis. 2013;19:378–385. PubMed

Kaplan GG. The global burden of IBD: from 2015 to 2025. Nat Rev Gastroenterol Hepatol. 2015;12:720–727. PubMed

Di Domenicantonio R, Cappai G, Arcà M, Agabiti N, Kohn A, Vernia P, Biancone L, Armuzzi A, Papi C, Davoli M. Occurrence of inflammatory bowel disease in central Italy: a study based on health information systems. Dig Liver Dis. 2014;46:777–782. PubMed

Phavichitr N, Cameron DJ, Catto-Smith AG. Increasing incidence of Crohn’s disease in Victorian children. J Gastroenterol Hepatol. 2003;18:329–332. PubMed

Henderson P, Rogers P, Gillett P, Wilson D. The epidemiology and natural history of paediatric inflammatory bowel disease in a UK region: a prospective 14-year study. Arch Dis Child. 2012;97:A53.2–A54.

Orel R, Kamhi T, Vidmar G, Mamula P. Epidemiology of pediatric chronic inflammatory bowel disease in central and western Slovenia, 1994-2005. J Pediatr Gastroenterol Nutr. 2009;48:579–586. PubMed

Chouraki V, Savoye G, Dauchet L, Vernier-Massouille G, Dupas JL, Merle V, Laberenne JE, Salomez JL, Lerebours E, Turck D, et al. The changing pattern of Crohn’s disease incidence in northern France: a continuing increase in the 10- to 19-year-old age bracket (1988-2007) Aliment Pharmacol Ther. 2011;33:1133–1142. PubMed

Lakatos PL. Recent trends in the epidemiology of inflammatory bowel diseases: up or down? World J Gastroenterol. 2006;12:6102–6108. PubMed PMC

Turunen P, Kolho KL, Auvinen A, Iltanen S, Huhtala H, Ashorn M. Incidence of inflammatory bowel disease in Finnish children, 1987-2003. Inflamm Bowel Dis. 2006;12:677–683. PubMed

Jakobsen C, Paerregaard A, Munkholm P, Wewer V. Environmental factors and risk of developing paediatric inflammatory bowel disease -- a population based study 2007-2009. J Crohns Colitis. 2013;7:79–88. PubMed

Sincić BM, Vucelić B, Persić M, Brncić N, Erzen DJ, Radaković B, Mićović V, Stimac D. Incidence of inflammatory bowel disease in Primorsko-goranska County, Croatia, 2000-2004: A prospective population-based study. Scand J Gastroenterol. 2006;41:437–444. PubMed

Su HY, Gupta V, Day AS, Gearry RB. Rising Incidence of Inflammatory Bowel Disease in Canterbury, New Zealand. Inflamm Bowel Dis. 2016;22:2238–2244. PubMed

Heyman MB, Kirschner BS, Gold BD, Ferry G, Baldassano R, Cohen SA, Winter HS, Fain P, King C, Smith T, et al. Children with early-onset inflammatory bowel disease (IBD): analysis of a pediatric IBD consortium registry. J Pediatr. 2005;146:35–40. PubMed

Lakatos L, Lakatos PL. Is the incidence and prevalence of inflammatory bowel diseases increasing in Eastern Europe? Postgrad Med J. 2006;82:332–337. PubMed PMC

Lovasz BD, Lakatos L, Horvath A, Pandur T, Erdelyi Z, Balogh M, Szipocs I, Vegh Z, Veres G, Müller KE, et al. Incidence rates and disease course of paediatric inflammatory bowel diseases in Western Hungary between 1977 and 2011. Dig Liver Dis. 2014;46:405–411. PubMed

Müller KE, Lakatos PL, Arató A, Kovács JB, Várkonyi Á, Szűcs D, Szakos E, Sólyom E, Kovács M, Polgár M, Nemes É, Guthy I, Tokodi I, Tóth G, Horváth Á, Tárnok A, Csoszánszki N, Balogh M, Vass N, Bódi P, Dezsőfi A, Gárdos L, Micskey E, Papp M, Cseh Á, Szabó D, Vörös P, Veres G. Incidence, Paris classification, and follow-up in a nationwide incident cohort of pediatric patients with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2013;57:576–582. PubMed

Karolewska-Bochenek K, Lazowska-Przeorek I, Albrecht P, Grzybowska K, Ryzko J, Szamotulska K, Radzikowski A, Landowski P, Krzesiek E, Ignys I, et al. Epidemiology of inflammatory bowel disease among children in Poland. A prospective, population-based, 2-year study, 2002-2004. Digestion. 2009;79:121–129. PubMed

Sawczenko A, Sandhu BK. Presenting features of inflammatory bowel disease in Great Britain and Ireland. Arch Dis Child. 2003;88:995–1000. PubMed PMC

Kim BJ, Song SM, Kim KM, Lee YJ, Rhee KW, Jang JY, Park SJ, Yoon CH. Characteristics and trends in the incidence of inflammatory bowel disease in Korean children: a single-center experience. Dig Dis Sci. 2010;55:1989–1995. PubMed

Wrobel I, Butzner J, Nguyen N, Withers G, Nelson K. Epidemiology of Pediatric IBD in a Population-based Cohort in Southern Alberta, Canada (1983-2005) J Pediatr Gastroenterol Nutr. 2006;43:S54–S55. PubMed

Regional Incidence of Inflammatory Bowel Disease in a Czech Pediatric Population: 16 Years of Experience (2002-2017)

Current global trends in the incidence of pediatric-onset inflammatory bowel disease