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Paediatric inflammatory bowel disease during a 44-year period in Copenhagen County: occurrence, course and prognosis – a population-based study from the Danish Crohn Colitis Database

Jakobsen, Christiana; Paerregaard, Andersa; Munkholm, Piab; Wewer, Vibekea

European Journal of Gastroenterology & Hepatology: November 2009 - Volume 21 - Issue 11 - p 1291-1301
doi: 10.1097/MEG.0b013e32832a4ed6
Original Articles: Inflammatory Bowel Disease

Aim To describe the development in incidence, disease localization, activity, surgery and prognosis in two Danish paediatric population-based inflammatory bowel disease (IBD) cohorts comparing the time periods 1962–1987 (period I) and 1998–2006 (period II).

Materials and methods Incident IBD patients below 15 years of age were included. Disease localization was classified according to the Montreal classification for ulcerative colitis (UC) patients and into small bowel, large bowel and small and large bowel combined for Crohn's disease (CD) patients. Disease activity and surgery in the first 2 years after diagnosis were assessed. Standardized cancer incidence rates and standardized mortality rates were calculated.

Results One hundred and nineteen IBD patients (77 UC and 42 CD) were included. Comparing periods II and I, the incidence rate ratios were 0.81 [95% confidence interval (CI): 0.5–1.4] and 15.6 (95% CI: 7.5–32.7) in UC and CD, respectively. The number of UC patients with extensive disease (E3) increased from period I to II (46.7 vs. 94.1%, P<0.001). No colectomies were performed in UC patients in period II compared with nine in period I (P = 0.13) within the first 2 years after diagnosis. For patients diagnosed in period I, the standardized cancer incidence rate for UC was 37.9 (95% CI: 4.6–136.7) after a median follow-up period of 26 years.

Conclusion We found a significant 15-fold increase in the incidence of CD and a significant increase in the number of UC patients with extensive disease in period II compared with period I. After a median follow-up time of 26 years, a possible increased risk of colorectal cancer in UC patients was detected.

aDepartment of Paediatrics, Hvidovre University Hospital

bDigestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark

Correspondence to Dr Christian Jakobsen, MD, Hvidovre University Hospital, Kettegaard Alle 30, Hvidovre 2650, Copenhagen, Denmark

Tel: +45 363 22607; fax: +45 363 23770; e-mail: christian.jakobsen@hvh.regionh.dk

Part of this article was presented at DDW in San Diego, California 17–22 May 2008 and published as an abstract in Gastroenterology 2008; 134:A-154

Received 13 January 2009 Accepted 12 February 2009

© 2009 Lippincott Williams & Wilkins, Inc.