epidemiology of inflammatory bowel disease in … - fda - pediatric ibd... @cheoibd. eric benchimol,...

Evidence Guiding Health Carewww.cheo-ibd.ca@CHEOibd

ERIC BENCHIMOL, MD, PhD, FRCPCAssociate Professor of Pediatrics and Epidemiology,

University of Ottawa

Pediatric Gastroenterologist, CHEO IBD Centre,Children’s Hospital of Eastern Ontario

Senior Scientist and Program Director, CHEO Research Institute

Core Scientist, ICES

EPIDEMIOLOGY OFINFLAMMATORY BOWEL DISEASE

IN PEDIATRIC PATIENTS

Evidence Guiding Health Care

DISCLOSURES

• I have no conflicts of interest to disclose.


WORLDWIDE EPIDEMIOLOGY

Ng et al. Lancet 2017; 390: 3769-78.


Montreal Classification

Under 17Pediatric Cohort

Slide courtesy of Dr. Aleixo Muise.www.neopics.org

WHAT IS VEO-IBD?


WHAT IS VEO-IBD?



Paris Modification

Under 10Evidence of a distinct

phenotype



WHAT IS VEO-IBD?



Paris Modification

Under 10Evidence of a

distinct phenotype

VEO-IBD

Under 6More colonic involvementLong-term

outcomes???



WHAT IS VEO-IBD?



Paris Modification

Under 10Evidence of a

distinct phenotype

VEO-IBD

Under 6More colonic involvementLong-term

outcomes???


Infants diagnosed under 1 year of age are very unique subset of VEO-IBD –“Infantile IBD”


0

Stan

dard

ised

inci

denc

e pe

r 100

,000

per

son

year

s

IBD incidenceper 100,000 PYs

CD incidenceper 100,000 PYs

UC incidenceper 100,000 PYs

Percentage changeper year

* p<0.05** p<0.001

*** p<0.0001

5

10

15

20

25

30

35

40

0

12

2

4

6

8

10

Percentage change in IBD

incidence per year0–9 10–19 20–29 30–39 40–49 50–59 60–69 70–79 80–89

Age (years)

***

***

**

** ***

ONTARIO, CANADAONTARIO CROHN’S AND COLITIS COHORT (1999-2008)

Benchimol et al., Inflamm Bowel Dis 2014; 20(10): 1761-9.


0

Stan

dard

ised

inci

denc

e(p

er 1

00,0

00 p

opul

atio

n)

4

8

16

1999 2010

20

18

2

6

10

14

12

2009200820072006200520042003200220012000

Alberta

Manitoba

Nova Scotia

Ontario

Quebec

Benchimol, et al., Am J Gastroenterol 2017; 112(7): 1120-34

CANADIAN GASTRO-INTESTINAL EPIDEMIOLOGY CONSORTIUM


CANADA:INCIDENCE RATE CHANGE

0.5 – 15.9 years incidence rate change by type of IBD0

AlbertaManitobaNova ScotiaOntarioQuebecSubtotal (I2=84.3%, p=0.000)

IBD

Province

0 – 15.90 – 15.90 – 15.90 – 15.90 – 15.9

Age group

8.126.625.289.909.1639.09

% weight

0.0168 (-0.0099, 0.0435)-0.0138 (-0.0518, 0.0242)-0.0079 (-0.0575, 0.0417)0.0578 (0.0466, 0.0690)0.0278 (0.0094, 0.0462)0.0210 (-0.0058, 0.0478)

Incidence ratechange (95% CI)

-0.152 -0.152



CANADA:INCIDENCE RATE CHANGE (0-5y)

0.5 – 4.9 years incidence rate change by type of IBD0

AlbertaNova ScotiaOntarioQuebecSubtotal (I2=9.5%, p=0.346)

AlbertaOntarioQuebecSubtotal (I2=0.0%, p=0.838)

AlbertaOntarioQuebecSubtotal (I2=0.0%, p=0.501)

IBD

CD

UC

Province0.5 – 4.90.5 – 4.90.5 – 4.90.5 – 4.9

0.5 – 4.90.5 – 4.90.5 – 4.9

0.5 – 4.90.5 – 4.90.5 – 4.9

Age group14.251.5033.325.9655.03

6.159.364.8520.37

3.4720.091.0424.60

% weight0.0596 (-0.0174, 0.1366)0.1166 (-0.1207, 0.3540)0.0959 (0.0455, 0.1463)

-0.0188 (-0.1379, 0.1003)0.0719 (0.0282, 0.1156)

0.0566 (-0.0606, 0.1738)0.0314 (-0.0637, 0.1265)0.0031 (-0.1289, 0.1351)0.0323 (-0.0322, 0.0967)

0.0732 (-0.0828, 0.2292)0.0606 (-0.0043, 0.1255)-0.1111 (-0.3964, 0.1742)0.0551 (-0.0035, 0.1138)

Incidence ratechange (95% CI)

-0.396 0.396



EPIMAD:CROHN’S DISEASE TRENDS

0

Stan

dard

ised

inci

denc

e ra

tes

(eve

nts/

100,

000)

5

10

15

1988–1990

0 – 910 – 19

20 – 2930 – 39≥40

1991–1993 1994–1996 1997–1999 2000–2002 2003–2005 2006–2007

p<0.0001

p=0.02

Age category (years)

Chouraki V et al. Aliment Pharm Ther 2011;33:1133-42.


SCOTLAND:VEO-IBD TRENDS

1981

-1985

1986

-1990

1991

-1995

2003

-2007

2008

-2013

0

1

2

3Crohn's disease

Non-Crohn's colitis

p<0.0001 NS

p=0.002 NS

Epoch

Adj

uste

d in

cide

nce

of A

1a C

D a

nd N

CC

per 1

00,0

00 p

opul

atio

n at

risk

Henderson P et al. ECCO 2015 oral abstract OP027.Slide courtesy of David Wilson


VEO-IBD: PROGRESSION

Baumgart and Sandborn, Lancet 2012; 380:1590-1605.


VEO-IBD: CD SURGERY

Benchimol, et al. Gastroenterology 2014;147(4):803-13.


OTHER VEO-IBD COHORTS: SCOTLAND

Henderson, et al. BSPGHAN Annual Meeting 2015Slide courtesy of Dr. David Wilson


Henderson, et al. BSPGHAN Annual Meeting 2015Slide courtesy of Dr. David Wilson

OTHER VEO-IBD COHORTS: SCOTLAND


VEO-IBD: UC SURGERY

Benchimol, et al. Gastroenterology 2014;147(4):803-13.

Onset at <6 years vs ≥10 years:Females: HR 0.88, 95% CI: 0.47‒1.63Males: HR 0.42, 95% CI: 0.21–0.85

0

Surv

ival

pro

babi

lity

0.4

0.8

0

1.0

0.2

0.6

2015105

6–9.9<610 and older

Time (years)

Age category (years)


WHAT DOES THE FUTURE HOLD?


RISING FUTURE BURDEN

Coward, et al. JCAG 2018; 1(Suppl 2): 49-50.Manuscript submitted for publication.

3% ↑ per year

270,000in 2018(0.7%)

400,000In 2030(1.0%)


RISING FUTURE BURDEN

Coward, et al. JCAG 2018; 1(Suppl 2): 49-50.Manuscript submitted for publication.


PEDIATRIC IBD EPIDEMIOLOGY2003-2004 2008 2018 2030

Canada(per 100,000)

62 101 159

USA(per 100,000)

Canada(raw number)

4,730 7,254 12,647

USA**(raw number)



Canada(per 100,000)

62 101 159

USA(per 100,000)

71* 71 115 181

Canada(raw number)

4,730 7,254 12,647

USA**(raw number)

*In people <20 years, from: Kappelman et al., Clin Gastroenterol Hepatol 2008;135:1907-13



Canada(per 100,000)

62 101 159

USA(per 100,000)

71* 71 115 181

Canada(raw number)

4,730 7,254 12,647

USA**(raw number)

52,043 52,611 84,870 138,103

*In people <20 years, from: Kappelman et al., Clin Gastroenterol Hepatol 2008;135:1907-13**Based on estimated population of children <18 years according to childstats.gov


CONCLUSIONS• Pediatric IBD is increasing internationally

Rates are rising most rapidly in young children

• Children with disease onset <10y: More often have colonic involvement More inflammatory, less stricturing UC: More mild endoscopic findings

• Rising prevalence may result in strain on the health system


QUESTIONS?

ACKNOWLEDGEMENTS:

IBD Impact Reporthttp://crohnsandcolitis.ca/impactreport

epidemiology of inflammatory bowel disease in … - fda - pediatric ibd... @cheoibd. eric benchimol,...

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