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Seasonality and Pediatric Inflammatory Bowel Disease

Lee, Grace J.*; Dotson, Jennifer L.*; Kappelman, Michael D.; King, Eileen; Pratt, Jesse M.; Colletti, Richard B.§; Bistrick, Sarah*; Burkam, Jennifer L.||; Crandall, Wallace V.*; for the ImproveCareNow Network

Journal of Pediatric Gastroenterology & Nutrition: July 2014 - Volume 59 - Issue 1 - p 25–28
doi: 10.1097/MPG.0000000000000362
Original Articles: Gastroenterology

Objectives: Seasonal and geographic variations of inflammatory bowel disease (IBD) exacerbations have been described in adults, with inconsistent findings. We sought to determine whether disease activity in pediatric-onset IBD is associated with a seasonal pattern.

Methods: We examined children with Crohn disease (CD) and ulcerative colitis (UC) using data from the ImproveCareNow Collaborative between December 2008 and November 2010. We compared the proportion of patients in continuous remission for all recorded visits in each season. We also compared the distribution of all recorded visits with a physician global assessment (PGA) of remission or active disease across seasons.

Results: A total of 1325 patients with CD (6102 visits) and 587 patients with UC (2394 visits) were included. The proportion of patients with UC in continuous remission during each season was highest in the summer (67%) and lowest in the winter (55%) (P = 0.01). A similar pattern was found for CD but was not significant. Similarly, the proportion of visits in remission was highest in the summer and lowest in the winter for both UC (29%, 21%; P < 0.001) and CD (28%, 23%; P < 0.001); however, the distribution of visits with active disease was not significantly different across seasons.

Conclusions: The higher proportion of patients with UC in continuous remission in the summer may be related to the higher proportion of remission visits in the summer, because the proportion of visits with active disease was similar across seasons. These findings do not support any strong associations between season of the year and disease activity in pediatric IBD.

*Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH

Division of Gastroenterology and Hepatology, Department of Pediatrics, University of North Carolina at Chapel Hill

Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

§Department of Pediatrics, University of Vermont, Burlington

||Department of Pediatrics, Nationwide Children's Hospital/Ohio State University, Columbus.

Address correspondence and reprint requests to Grace Jennifer Lee, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205 (e-mail:

Received 15 August, 2013

Accepted 28 February, 2014

Participating ImproveCareNow centers and their physician leaders are as follows: Advocate Lutheran General Children's Hospital, James Berman; Children's Healthcare of Atlanta/Emory Children's Center, Bess T. Schoen; Barbara Bush Children's Hospital at Maine Medical Center, Rebecca Carey; Inova Pediatric Digestive Disease Center, Ian Leibowitz/Lynn Duffy; Massachusetts General Children's Hospital, George Russell/Esther Israel; Nationwide Children's Hospital, Wallace Crandall/Brendan Boyle; Oakland Children's Hospital, Sabina Ali; Oklahoma University Medical Center, John Grunow; Pediatric Gastroenterology and Nutrition Associates, Howard Baron; University of North Carolina at Chapel Hill, Michael Kappelman; UT Southwestern Medical Center, Ashish Patel; Vermont Children's Hospital, Richard Colletti.

The present project was supported by a grant from the Agency for Healthcare Research and Quality (R01 HS020024).

The authors report no conflicts of interest.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,