Features and Outcomes of Inflammatory Bowel Disease among Filipino Children in a Tertiary Hospital: An Eleven-year Review.

Abstract

Background: Inflammatory bowel disease (IBD), comprising Crohn's disease, ulcerative colitis, and IBD-unclassified, is a chronic relapsing inflammatory disorder of the gastrointestinal tract, with up to 25% of cases presenting in childhood or adolescence. Although historically uncommon in Asia, the incidence of pediatric IBD in the region has been increasing, and disease phenotype appears to differ from Western populations. In the Philippines, data on pediatric IBD remain limited, with no comprehensive local studies describing its clinical features, subtypes, and outcomes.

Objectives: To describe the clinico-demographic factors that are associated with remission and relapse rates in Filipino pediatric patients with IBD.

Methods: Retrospective review of records of patients <19 years old with IBD from January 2013 to December 2023 in a tertiary government hospital. The clinical, biochemical, imaging, endoscopic, and histologic features, treatment, and outcomes were obtained. Chi-square and T-tests were done to compare the variables and odds ratios to check for associations; significance level set at p <0.05.

Results: Forty-seven (47) children (mean age 11 ± 5.46 years; 64% males) had IBD. Median age at diagnosis was 13 (IQR 8years). Twelve (25%) were very early onset IBD (VEO-IBD). Median duration of symptoms was 9 (IQR 4-20) months. Bloody stools were more common in UC and IBDU than in CD. Active perianal disease was seen in 30% of CD patients. For induction, UC and IBDU patients used mostly steroids and 5-ASA, while CD patients used mostly exclusive enteral nutrition and steroids. Only 30 patients had at least a 1-year follow-up. Twenty-seven (57%) went into remission within one year. Five CD patients underwent surgery. There was no difference in the 1-year steroid-free remission among the subtypes. One-year relapse rate was significantly higher in UC than in CD. VEO-IBD was associated with not achieving 1-year steroid-free remission (OR 20.8; p value 0.045). One-year relapse rate was associated with diagnostic delay (OR 13.6; p value 0.034), presence of wasting (OR 12.6; p value 0.029), and pancolitis in UC (OR 75; p value 0.043).

Conclusion: The majority of pediatric IBD has CD, with 25% VEO-IBD. 30% of CD had active perianal disease. All subtypes responded similarly to steroids. A higher relapse rate was associated with diagnostic delay, wasting, and pancolitis in UC patients.