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Dhaliwal J, Carroll MW, deBruyn JC, Ricciuto A, Benchimol EI, Lawrence S, Sherlock M, El-Matary W, Brill H, Church P, Wine E, Carman N, Muise A, Huynh H, Mack DR, Walters TD, Griffiths AM, Jacobson K. The Phenotypic Spectrum of New-onset IBD in Canadian Children of South Asian Ethnicity: A Prospective Multi-Centre Comparative Study. J Crohns Colitis 2021; 16:216-223. [PMID: 34379117 PMCID: PMC8864632 DOI: 10.1093/ecco-jcc/jjab143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Canadian-born children of South Asian [SA] ethnicity develop inflammatory bowel disease [IBD] at similar rates to those among Caucasian children. We evaluated the variation in phenotypic spectrum of IBD in SA and Caucasian children in a national paediatric inception cohort of new-onset IBD. METHODS Patients aged <17 years, enrolled in a Canadian nationwide inception cohort study, were included. Baseline demographic and IBD phenotypic features were compared between SA and Caucasian children. Longitudinal outcomes through 18 months of follow-up were compared matched by propensity scores. RESULTS Of 1156 children enrolled over 2014 to 2019, 623 were Caucasian [98% and 88% parents Canadian born] and 114 SA [79% Canadian born, 87% parents SA born]. Fewer SAs have a first-degree relative with IBD, 6% vs 19% in Caucasians, p = 0.002. SAs present at a younger age, median age 11.4 years (interquartile range [IQR] 9.2-14.3) vs 13 years [IQR 10.9-15 years], p = 0.03 and more commonly with a UC/IBD-U [ulcerative colitis/IBD-unclassified] subtype [ratio of UC/IBD-U to CD 1.2:1 vs 1:1.8 for Caucasians, p <0.001]. Additionally, a greater proportion of SA CD patients present with colonic-only disease [colonic-only CD/UC/IBD-U in SAs 67% vs 57% for Caucasians, p = 0.001], and among those with CD, colonic CD in SAs 31% vs 23% in Caucasians, p = 0.20]. Perianal fistulising disease was also numerically more common in SAs (14 [27%] vs 64 [18%], p = 0.06]. Adjusting for differences in phenotypic presentation, anti-tumour necrosis factor [TNF] exposure, and time to initiation was similar, and two-thirds of children, whether anti-TNF exposed or naïve, were in corticosteroid-free clinical remission at 18 months irrespective of ethnicity. CONCLUSIONS The phenotypic spectrum of new-onset IBD in SA children differs from that of Caucasian children, but treatment and clinical course are similar within phenotypic subgroups.
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Affiliation(s)
- J Dhaliwal
- SickKids Hospital, University of Toronto, Toronto, ON, Canada,Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - M W Carroll
- Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | - J C deBruyn
- Alberta Children’s Hospital, University of Calgary, Calgary, AB, Canada
| | - A Ricciuto
- SickKids Hospital, University of Toronto, Toronto, ON, Canada
| | - E I Benchimol
- SickKids Hospital, University of Toronto, Toronto, ON, Canada
| | - S Lawrence
- British Columbia Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - M Sherlock
- McMaster Children’s Hospital, McMaster University, Hamilton, ON, Canada
| | - W El-Matary
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - H Brill
- McMaster Children’s Hospital, McMaster University, Hamilton, ON, Canada,William Osler Health System, University of Toronto, Toronto, ON, Canada
| | - P Church
- SickKids Hospital, University of Toronto, Toronto, ON, Canada
| | - E Wine
- Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | - N Carman
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - A Muise
- SickKids Hospital, University of Toronto, Toronto, ON, Canada
| | - H Huynh
- Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | - D R Mack
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - T D Walters
- SickKids Hospital, University of Toronto, Toronto, ON, Canada
| | - A M Griffiths
- SickKids Hospital, University of Toronto, Toronto, ON, Canada
| | - K Jacobson
- British Columbia Children’s Hospital, University of British Columbia, Vancouver, BC, Canada,Corresponding author: Dr Kevan Jacobson, MBBCh, FRCPC, FCP, AGAF, CAGF, British Columbia’s Children’s Hospital and Child and Family Research Institute, University of British Columbia, 4480 Oak Street, Room K4-184, Vancouver, BC V6H 3V4, Canada. Tel.: 604-875-2332 ext 1;
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