Inflammatory bowel disease in children and adolescents

Understanding the demographic and socioeconomic determinants of morbidity in Eastern Uganda: a retrospective analysis of the Iganga-Mayuge health and demographic surveillance data

Introduction

Understanding the determinants of disease burden is imperative in enhancing population health outcomes. This study uses data from the Iganga-Mayuge Health and Demographic Surveillance Site, to understand demographic and socioeconomic factors influencing morbidity.

Methods

We analysed secondary data from 2018 to 2023. We employed graphs and tables to present morbidity patterns across different sociodemographic factors and applied mixed-effects multinomial multivariate logistic regression model to understand the correlates of morbidity.

Results

The findings reveal a predominant prevalence of malaria, lower respiratory tract infections, coryza, gastric acid-related and urinary tract infections, collectively constituting 83% of diagnosed diseases. Noteworthy demographic variations, particularly gender and age, significantly impact disease distribution, revealing higher diagnosis rates among females. Additionally, socioeconomic factors, including education and wealth status, contribute to discernible differences in disease burden.

Conclusion

This research provides crucial insights into the implications of demographic and socioeconomic factors on disease burden in Uganda. The results contribute to evidence-based policy-making, highlighting the necessity for targeted interventions addressing specific health challenges encountered by diverse populations. The study advocates for continuous assessment of the epidemiological landscape to inform more tailored and effective health strategies, ultimately enhancing resilience in disease control efforts.

Comparison of longstanding pediatric-onset and adult-onset Crohn's disease

INTRODUCTION

Limited information is available on the characteristics of longstanding Crohn's disease with onset in childhood or adolescence.

MATERIALS AND METHODS

In this retrospective study, 224 patients with pediatric-onset Crohn's disease were compared to a group of patients with disease diagnosed as adults.

RESULTS

More than 50% of the patients in the pediatric-onset group were followed for more than a decade, with a mean follow-up of 12.2 years. There were 96 male (42.9%) and 128 female (57.1%) patients. Most had disease diagnosed in adolescence. The female predominance, similar to adult-onset disease, was noted only among patients with disease diagnosed in adolescence (13-19 years), not in childhood. Disease most often involved both ileum and colon (128 of 224; 57.1%). Isolated ileal or colonic disease was less common. Upper gastrointestinal tract disease was present in 42 of 224 (18.8%) patients. The incidence of strictures (28.6%) and penetrating complications (46.4%) was similar to that of adults followed for the same period of time.

CONCLUSION

In pediatric-onset Crohn's disease, female-predominance emerges during adolescence. Pediatric-onset disease is more extensive than adult-onset disease. When followed for an extended period of time, it has high rates of disease complexity, with strictures and penetrating complications similar to adult-onset disease.

Anorexia nervosa complicating inflammatory bowel disease

Two cases of inflammatory bowel disease, occurring in adolescence and complicated by anorexia nervosa, are presented. The management of the bowel disease with corticosteroids appeared to precipitate the eating disorder in one case whereas covert withdrawal of steroid treatment led to life threatening complications of inflammatory bowel disease in the other. The difficulties of managing two serious conditions, each ideally treated in a specialist centre, are discussed and the dangers of treating adolescents with shape modifying drugs are highlighted.

Abdominal abscesses in adolescents with Crohn's disease

Little information is available about the development of abdominal abscesses in adolescents with Crohn's disease. We report the clinical presentation of five adolescents with Crohn's disease who developed this complication. The mean time from diagnosis until development of an abdominal abscess was 1.7 years. The admitting diagnosis was an acute abdomen in two patients and recurrent Crohn's disease in the other three. No features of the clinical presentation or laboratory data distinguished this group from other adolescents with Crohn's disease. The use of ultrasound and CT scanning was helpful in making this diagnosis preoperatively. Those patients with active Crohn's disease who do not respond promptly to medical therapy should be evaluated for the development of this complication.

Long term prognosis of Crohn's disease with onset in childhood and adolescence

The long term outcome has been determined in 67 children with Crohn's disease whose symptoms started at or before 16 years of age. The mean period of follow up was 15.0 years (range 1.5-47 years). The number of children diagnosed in each quinquennium has not increased. Nearly all patients had gastrointestinal symptoms at presentation, but in some cases these were only elicited on careful enquiry. Only four children presented with growth retardation alone. Twenty one per cent of the children had diffuse small bowel disease at onset or during the period of review and posed major problems in management with high morbidity and mortality. They were generally treated medically to suppress disease activity and surgical intervention was restricted to resection of local stricture formation. The outcome in distal ileal +/- right colonic disease was similar to that in the adult. Patients with colonic disease (27% of total) were treated medically but 83% required surgical resection after a mean interval of only four years (range 0-9 years). Growth failure occurred in 21 children (height and weight less than 3rd centile) and 11 of these had a period of catch up growth; 10 after resection (ileal +/- right colon resected, eight; colonic resection, two) and one after medical treatment. Ten have permanent growth and height retardation, of whom four had diffuse small bowel disease and three had early recurrence after surgical resection. Nine children have died during the period of review, of whom six had diffuse small bowel disease. Despite the high morbidity, 38 of the 58 survivors are now well with no evidence of recurrent disease. A further 14 are well, but with radiological evidence of residual (colon, three; diffuse small bowel, eight) or recurrent (three) disease. Only six have symptomatic disease at present.

The effect of disease, drug, and diet on whole body protein metabolism in adolescents with Crohn disease and growth failure

The effect of chronic inflammation, corticosteroid therapy, and nutritional supplementation on whole body protein metabolism and growth was determined in adolescent males with Crohn disease and growth failure. Body protein status was characterized in six patients and in five healthy, age-matched controls by nitrogen balance, whole body potassium (measured as 40K), urinary creatinine excretion, and [15N]glycine turnover studies. The patients subsequently received an intragastric nutritional supplement that increased dietary protein and energy intakes by 40% for seven months. Follow-up anthropometric measurements were obtained in both groups of adolescents. Our results demonstrated that lean body mass (40K) and muscle mass (creatinine) were significantly reduced in the patients compared to the controls, despite similar nitrogen balances between both groups. Whole body nitrogen flux, rates of protein synthesis and breakdown, and net protein retention were no different between those patients with chronic inflammation, while receiving corticosteroid therapy, and their controls. Long-term nutritional supplementation significantly improved linear and ponderal growth velocities in the patients such that growth rates were commensurate with those of the healthy controls. We conclude that chronic inflammation and corticosteroid therapy are not associated with detectable alterations in protein metabolic processes at the whole body level. Rather, dietary insufficiency appears to be primarily responsible for growth failure in adolescents with Crohn disease.