Day, Andrew S

Gasparetto, Marco

Guariso, Graziella

Henderson, Paul

Gastroenterology Research and Practice

English

PubMed

Apollo (Cambridge)

EditorialEpidemiology and Natural History of IBD in the Paediatric AgeGraziella Guariso,1 Marco Gasparetto,1 Andrew S. Day,2 and Paul Henderson31 Unit of Paediatric Gastroenterology, Department of Women and Children’s Health, University Hospital of Padova, Via Giustiniani 3,35128 Padova, Italy2 Department of Paediatrics, Paediatric Gastroenterology, University of Otago, 8011 Christchurch, New Zealand3Department of Gastroenterology and Nutrition, Royal Hospital for Sick Children, Edinburgh EH9 1LF, UKCorrespondence should be addressed to Graziella Guariso; guariso@pediatria.unipd.itReceived 11 May 2014; Accepted 11 May 2014; Published 28 May 2014Copyright © 2014 Graziella Guariso et al. This is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited.The inflammatory bowel diseases (IBD) are chronic inflam-matory conditions of the gastrointestinal tract characterisedby episodes of relapse and remission. Although the aetiologyof IBD is not fully elucidated, it is thought to be drivenby a combination of genetic susceptibility, environmentaltriggers, and alterations in the gut microbiome that stimulatea dysregulated inflammatory response.The two main forms of IBD, Crohn’s disease (CD) andulcerative colitis (UC), are diagnosed on the basis of clinicalsuspicion and laboratory, radiological, endoscopic, and histo-logical findings. It is not always possible to classify patients ashaving one of these two forms using the diagnostic tools avail-able, with the term inflammatory bowel disease-unclassified(IBD-U) currently used to categorize this subgroup present-ingwith chronic intestinal inflammationwith features of bothdiseases; many children persist with this diagnosis into adultlife. In contrast, the term indeterminate colitis is given tothe histopathological description of intestinal inflammationinvolving bowel resection material.Both CD and UC can present throughout the age range,including infancy, childhood, and adolescence. The num-ber patients diagnosed with IBD, including childhood, hasdramatically increased worldwide over the past 20 years.The reasons behind the rising incidence worldwide are notentirely clear.The currentmean prevalence of IBD in the gen-eral population of Western countries is estimated at 1/1,000inhabitants. At present, Scandinavia, Canada, and Scotlandhave the highest incidences of paediatric IBD worldwide;however, the reason for these high rates remains elusive.Although there are only few epidemiological data availableregarding developing countries, the incidence and prevalenceof IBD seem to be increasing over the past few decadespractically in all regions of theworld, indicating its emergenceas a global disease.The changing epidemiology of IBD across time andbetween geographic areas suggests that environmental fac-tors are likely playing a major role in modifying diseaseexpression.The rising incidence of IBD in developing nationsmay be linked to industrialization and a Western lifestyle,especially diet.Insight into the worldwide epidemiology of this diseaseis, thus, important to identify geographic patterns and timetrends. Recent findings will also make it possible to estimatethe global public health burden so that health care resourcescan be allocated and research can be targeted in specificgeographic regions. Information about environmental factorshypothetically affecting the incidence and prevalence of thisdisease may, finally, lead to preventative interventions wherepossible.Although less prevalent in infants and in very youngchildren, a number of case reports and small populationstudies have documented disease onset at very early ages.Underlying immune deficiency and monogenic disordershave been identified in a small subgroup of those diagnosedunder the age of 2. An intestinal IBD-like pattern has beenfound to be associated in these cases with systemic immun-odeficiency, within a complex scenariowhich can even lead tosevere life-threatening events. Consequently those under theHindawi Publishing CorporationGastroenterology Research and PracticeVolume 2014, Article ID 432807, 2 pageshttp://dx.doi.org/10.1155/2014/4328072 Gastroenterology Research and Practiceage of 6 should always have thorough investigation of otheraetiologies before a diagnosis of IBD is given.Assessing the incidence of IBD is complicated, as epi-demiological investigations have often ignored cases of IBD-U although they are considered as a distinct disease subtypeof IBD. IBD can also be difficult to recognize, particularlyin children when extraintestinal symptoms and signs (suchas iron deficiency, skin lesions, and liver pathology) arepredominant and in third world countries where medicalservices are lacking.The aim of this special issue is to review the current levelsof knowledge with regard to IBD epidemiology worldwideand to examine its natural history in paediatric patients. Themain topics of the issue include the most up-to-date defini-tions and classifications of paediatric IBD, the epidemiologyof IBD worldwide, the epidemiology and natural history ofpaediatric IBD, and the disease burdenwithin the general andpaediatric populations.We hope that readers of this special issue on paediatricIBDwill not only find accurate data and updated reviews, butalso consider the questions yet to be resolved such as diseasedistribution worldwide, its classification, and its impact onthe healthcare system.Graziella GuarisoMarco GasparettoAndrew S. DayPaul Henderson

Epidemiology and Natural History of IBD in the Paediatric Age.

Graziella Guariso

Marco Gasparetto

Andrew S. Day

Paul Henderson

Crossref

EditorialEpidemiology and Natural History of IBD in the Paediatric AgeGraziella Guariso,1 Marco Gasparetto,1 Andrew S. Day,2 and Paul Henderson31 Unit of Paediatric Gastroenterology, Department of Women and Children’s Health, University Hospital of Padova, Via Giustiniani 3,35128 Padova, Italy2 Department of Paediatrics, Paediatric Gastroenterology, University of Otago, 8011 Christchurch, New Zealand3Department of Gastroenterology and Nutrition, Royal Hospital for Sick Children, Edinburgh EH9 1LF, UKCorrespondence should be addressed to Graziella Guariso; guariso@pediatria.unipd.itReceived 11 May 2014; Accepted 11 May 2014; Published 28 May 2014Copyright © 2014 Graziella Guariso et al. This is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited.The inflammatory bowel diseases (IBD) are chronic inflam-matory conditions of the gastrointestinal tract characterisedby episodes of relapse and remission. Although the aetiologyof IBD is not fully elucidated, it is thought to be drivenby a combination of genetic susceptibility, environmentaltriggers, and alterations in the gut microbiome that stimulatea dysregulated inflammatory response.The two main forms of IBD, Crohn’s disease (CD) andulcerative colitis (UC), are diagnosed on the basis of clinicalsuspicion and laboratory, radiological, endoscopic, and histo-logical findings. It is not always possible to classify patients ashaving one of these two forms using the diagnostic tools avail-able, with the term inflammatory bowel disease-unclassified(IBD-U) currently used to categorize this subgroup present-ingwith chronic intestinal inflammationwith features of bothdiseases; many children persist with this diagnosis into adultlife. In contrast, the term indeterminate colitis is given tothe histopathological description of intestinal inflammationinvolving bowel resection material.Both CD and UC can present throughout the age range,including infancy, childhood, and adolescence. The num-ber patients diagnosed with IBD, including childhood, hasdramatically increased worldwide over the past 20 years.The reasons behind the rising incidence worldwide are notentirely clear.The currentmean prevalence of IBD in the gen-eral population of Western countries is estimated at 1/1,000inhabitants. At present, Scandinavia, Canada, and Scotlandhave the highest incidences of paediatric IBD worldwide;however, the reason for these high rates remains elusive.Although there are only few epidemiological data availableregarding developing countries, the incidence and prevalenceof IBD seem to be increasing over the past few decadespractically in all regions of theworld, indicating its emergenceas a global disease.The changing epidemiology of IBD across time andbetween geographic areas suggests that environmental fac-tors are likely playing a major role in modifying diseaseexpression.The rising incidence of IBD in developing nationsmay be linked to industrialization and a Western lifestyle,especially diet.Insight into the worldwide epidemiology of this diseaseis, thus, important to identify geographic patterns and timetrends. Recent findings will also make it possible to estimatethe global public health burden so that health care resourcescan be allocated and research can be targeted in specificgeographic regions. Information about environmental factorshypothetically affecting the incidence and prevalence of thisdisease may, finally, lead to preventative interventions wherepossible.Although less prevalent in infants and in very youngchildren, a number of case reports and small populationstudies have documented disease onset at very early ages.Underlying immune deficiency and monogenic disordershave been identified in a small subgroup of those diagnosedunder the age of 2. An intestinal IBD-like pattern has beenfound to be associated in these cases with systemic immun-odeficiency, within a complex scenariowhich can even lead tosevere life-threatening events. Consequently those under theHindawi Publishing CorporationGastroenterology Research and PracticeVolume 2014, Article ID 432807, 2 pageshttp://dx.doi.org/10.1155/2014/4328072 Gastroenterology Research and Practiceage of 6 should always have thorough investigation of otheraetiologies before a diagnosis of IBD is given.Assessing the incidence of IBD is complicated, as epi-demiological investigations have often ignored cases of IBD-U although they are considered as a distinct disease subtypeof IBD. IBD can also be difficult to recognize, particularlyin children when extraintestinal symptoms and signs (suchas iron deficiency, skin lesions, and liver pathology) arepredominant and in third world countries where medicalservices are lacking.The aim of this special issue is to review the current levelsof knowledge with regard to IBD epidemiology worldwideand to examine its natural history in paediatric patients. Themain topics of the issue include the most up-to-date defini-tions and classifications of paediatric IBD, the epidemiologyof IBD worldwide, the epidemiology and natural history ofpaediatric IBD, and the disease burdenwithin the general andpaediatric populations.We hope that readers of this special issue on paediatricIBDwill not only find accurate data and updated reviews, butalso consider the questions yet to be resolved such as diseasedistribution worldwide, its classification, and its impact onthe healthcare system.Graziella GuarisoMarco GasparettoAndrew S. 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