All issues > Volume 0(0);

Original Article

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

Pornthep Tanpowpong¹, Suporn Treepongkaruna¹  , James Huang^2,3, Kee Seang Chew⁴, Karen Mercado⁵, Almida Reodica⁶, Shaman Rajindrajith⁷, Wathsala Hathagoda⁷, Yoko Wong⁸, Way Seah Lee⁹, Marion Aw²

¹Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
²Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
³Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
⁴Department of Pediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
⁵Department of Pediatrics, Makati Medical Center, Manila, the Philippines
⁶Department of Pediatrics, The Medical City, Manila, the Philippines
⁷Department of Pediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
⁸Epidemiology, Singapore Clinical Research Institute, Singapore, Singapore
⁹Dr. Wu Lien Teh Center for Research in Communicable Disease, M Kandiah Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Selangor, Malaysia

Correspondence Suporn Treepongkaruna ,Email: suporn.tre@mahidol.ac.th

Received: August 2, 2024; Revised: September 27, 2024   Accepted: October 11, 2024.

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.

Keywords :Bloody stools; Endoscopy; Flare; Mucosal healing; Steroids