Incidence, management and outcomes of very early onset inflammatory bowel diseases and infantile-onset disease: an epi-IIRN study.
Atia O., Benchimol EI., Ledderman N., Greenfeld S., Kariv R., Weisband YL., Matz E., Ollech J., Dotan I., Assa A., Shouval DS., Uhlig HH., Muise AM., Olén O., Kuenzig ME., Kaplan GG., Turner D.
BACKGROUND: In this nationwide study from the epi-IIRN, we aimed to describe the incidence of very early-onset inflammatory bowel diseases (VEOIBD) with a focus on infantile-onset disease and to compare management and disease course with older children. METHODS: Data were retrieved from the four Israeli Health-Maintenance-Organizations covering 98% of the population. Pediatric-onset IBD was categorized as: adolescent-onset (10-<18 years), early-onset (6-<10 years), VEOIBD (0-<6 years), toddler-onset (2-<6 years), and infantile-onset (<2 years). RESULTS: A total of 5,243 children with 35,469 person-years of follow-up were diagnosed with IBD during 2005-2020: 4,444 (85%) adolescent-onset, 548 (10%) early-onset, and 251 (4.8%) VEOIBD, of whom 81 (1.5%) infantile-onset. The incidence of pediatric-onset IBD increased from 10.8/100,000 in 2005 to 15.3/100,000 in 2019 (average annual percent change [AAPC] 2.8% [95%CI 2.2%-3.4%]), but that of VEOIBD remained stable (AAPC 0% [95%CI -2.5%-2.6%]). The infantile-onset and toddler-onset groups were treated less often with biologics (36% and 35%, respectively) vs early-onset (57%) and adolescent-onset (53%; p<0.001). Time to steroid-dependency was shorter in infantile-onset (HR 2.1 [95%CI 1.5-2.9]) and toddler-onset disease (HR 1.6 [95%CI 1.2-2.0]) vs. early-onset and adolescent-onset, but time to hospitalizations, time to surgery and growth delay were worse only in infantile-onset disease. In a multivariable model, infantile-onset patients had higher risk for surgery (HR 1.4 [95%CI 1.1-1.9]) and hospitalization (HR 1.7 [95%CI 1.2-2.4]) than the toddler-onset group. CONCLUSION: The incidence of VEOIBD remained stable. Infantile-onset IBD had worse outcomes than older children while the toddler-onset had mostly similar outcomes, despite less frequent use of biologics.