Epidemiology of Pediatric Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) comprises of two chronic inflammatory conditions—Crohn’s disease (CD) and Ulcerative colitis (UC) with some overlap. They are thought to occur as an immune dysregulated response to either commensal gut flora or to environmental triggers, manifesting most commonly in the second and third decade of life. However, 25 % of these chronic digestive conditions start in the pediatric age group, with 4 % occurring in younger than 5 years of age; 10,000 new cases are being diagnosed annually. Increasing incidence of IBD is reported from across the world, with higher rates of increase for CD than UC. Environmental triggers like smoking, better living conditions (hygiene hypothesis), infectious agents, commensal bacteria, appendectomy, drugs, and dietary exposure have all been implicated as a potential cause for the increasing incidence of IBD across the world. Emerging data suggesting specific serum and immunogenetic markers has been reported predicting disease course and severity, and potentially response to therapy. This may enable us to individualize therapy, selecting aggressive biological medications for more complicated disease phenotype, minimizing exposure to toxicities and side effects. Utilization of newer disease descriptive techniques like geographical disease pattern analysis and geographical information systems spatial analytic technology, referred to as geocoding, may provide innovative ways of epidemiologic analysis, contributing to our understanding of these diseases. All of these newer descriptive tools place us at the threshold of exciting discoveries and insight into the pathogenesis of these intriguing conditions that afflict almost 1.2 million US residents, 100,000 of them being children.