Outcome of Pediatric Inflammatory Bowel Disease in Asian Children: A Multinational One-year Follow-up Study.

Abstract

Background: Epidemiological data on pediatric inflammatory bowel disease (PIBD) have been reported in Asian countries. However, short-term follow-up data, especially in Southeast Asian countries, are limited.

Purpose: Analyze and compare the baseline and 1-year follow-up (1FU) data for PIBD in Asian children.

Methods: The multinational network included patients with PIBD (aged <19 years) in five Asian countries (Malaysia, Philippines, Singapore, Sri Lanka, and Thailand). The diagnosis of PIBD requires gastrointestinal endoscopy. The patients' demographics, clinical information, disease-related outcomes, and treatment data at 1FU were collected.

Results: In 1995-2021, 368 patients were enrolled (CD, 56.8%; UC, 38%; and IBD-unclassified, 5.2%). At 1FU, symptoms including diarrhea, bloody stools, and nausea/vomiting subsided in <3%, while abdominal pain persisted in 10.5% of patients with CD and 7.1% of patients with UC. Assessment endoscopy was performed at 1FU in 38% of CD and 31% of UC cases, of which 21% and 23% showed mucosal healing, respectively. Oral prednisolone was administered to 55.3% of patients at diagnosis and 26.8% at 1FU, while infliximab was administered to 2.5% and 7.2% of patients at diagnosis and 1FU, respectively. Independent factors of 1-year clinical remission for CD were oral prednisolone (odds ratio [OR], 0.20; 95% confidence interval [CI], 0.06-0.68), antibiotic use (OR, 0.09; 95% CI, 0.01-0.54), and immunomodulator use (OR, 5.26; 95% CI, 1.52-18.22). A history of weight loss at diagnosis was the only independent risk factor of an IBD flare by 1FU (OR, 2.01; 95% CI, 1.12-3.63).

Conclusion: The proportion of children with PIBD and abdominal pain at 1FU remained high. The rates of repeat endoscopy and infliximab use were suboptimal with high rates of systemic corticosteroid use. Quality improvement based on the aforementioned predictors may enhance PIBD care in this geographic region or similar settings.