Scientific Letter
2016: Inflammatory bowel disease epidemic in Asturias
2016: epidemia de enfermedad inflamatoria intestinal en Asturias
Alicia Isabel Pascual Pérez
, Juan José Díaz Martín, Santiago Jiménez Treviño, Carlos Bousoño García
Corresponding author
Sección de Gastroenterología, Hepatología y Nutrición Pediátrica, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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array:1 [ 0 => array:2 [ "paginaInicial" => "183" "paginaFinal" => "184" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Alicia Isabel Pascual Pérez, Juan José Díaz Martín, Santiago Jiménez Treviño, Carlos Bousoño García" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Alicia Isabel" "apellidos" => "Pascual Pérez" "email" => array:1 [ 0 => "Aliciapascual13@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Juan José" "apellidos" => "Díaz Martín" ] 2 => array:2 [ "nombre" => "Santiago" "apellidos" => "Jiménez Treviño" ] 3 => array:2 [ "nombre" => "Carlos" "apellidos" => "Bousoño García" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Sección de Gastroenterología, Hepatología y Nutrición Pediátrica, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "2016: epidemia de enfermedad inflamatoria intestinal en Asturias" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The term epidemic refers to the occurrence of a number of cases of a specific disease that exceeds the expected incidence in a given geographical area. The Hospital Universitario Central de Asturias (HUCA) is the regional referral centre for inflammatory bowel disease (IBD) for the paediatric population of the Autonomous Community of Asturias, Spain. Historically, the department of paediatric gastroenterology diagnosed an average of 2 new cases of IBD each year. However, in year 2016 the department diagnosed 15 new cases.</p><p id="par0010" class="elsevierStylePara elsevierViewall">With the aim of finding an explanation to this striking increase in incidence, we reviewed the health records of children (aged 0–14 years) that received a diagnosis of IBD in the paediatric gastroenterology outpatient clinics of the HUCA between December 2015 and January 2017. We summarised the epidemiological, clinical and laboratory characteristics of these cases and compared them with those from previous years.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Fifteen new cases were diagnosed in the period under study. The mean age at diagnosis was 10 years, and one patient had onset at the atypically early age of 19 months. In previous years, the outpatient clinics of the HUCA had managed 23 patients with a median age of 11 years, the youngest of whom was 2 years old. The increase in the incidence of IBD was of approximately 650%, from 2 per 100,000 to 2 per 10,000 inhabitants per year. In 2016, 46.7% of new cases were diagnosed in male patients compared to 74% in the group of cases diagnosed in previous years (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.03). In 2016, most of the patients that received the diagnosis resided in an urban area (66.6%), and Oviedo and Gijón were the cities where the incidence increased most, while in previous year, the distribution of cases was more dispersed throughout the entire region of Asturias. In 2016, Crohn disease (CD) accounted for 66.7% of the cases, and the most frequent presenting symptoms were bloody stools and abdominal pain. In previous years, the distribution of diagnostic categories was more even, with 52.2% of cases of CD, 43.5% of ulcerative colitis (UC) and 4.3% of indeterminate colitis (IC). In 2016, only one patient had a family history of IBD, while 46.7% had underlying diseases (57% asthma/allergy). The body weight was within the normal range in 73.3% of patients (body mass index between the 15th and the 85th percentiles), 1 patient was obese and 1 malnourished at the time of diagnosis. Eighty percent of patients had faecal calprotectin levels of 1000<span class="elsevierStyleHsp" style=""></span>μg/g or greater, while only 5 patients had an erythrocyte sedimentation rate of more than 20<span class="elsevierStyleHsp" style=""></span>mm/h and 3 a C-reactive protein level of more than 5<span class="elsevierStyleHsp" style=""></span>mg/dL. Also, 26.7% tested positive for anti-<span class="elsevierStyleItalic">Saccharomyces cerevisiae</span> or anti-neutrophil cytoplasmic antibodies. Only one patient had an albumin level of less than 30<span class="elsevierStyleHsp" style=""></span>g/L. Thrombocytosis was present in 73.4% of cases. Except for one episode of severe colitis (Paediatric Ulcerative Colitis Activity Index [PUCAI]<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>65 points) in the child aged 19 months, activity index scores in all patients (PUCAI and Paediatric Crohn's Disease Activity Index [PCDAI]) reflected mild disease at the time of diagnosis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The causes of this increase in incidence have yet to be determined. The aetiology of IBD is multifactorial, and it is hypothesised that it results from the interaction of genetic vulnerability,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> various environmental factors and the intestinal microbiota. When IBD is diagnosed in children aged less than 6 years, it is considered very-early-onset IBD (VEOIBD). Furthermore, diagnosis in children aged less than 2 years requires ruling out monogenic forms of IBD, as these children exhibit more disseminated inflammation, higher rates of treatment resistance and rapid disease progression.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> In our patient aged 19 months, we ruled out immunodeficiencies that could present with an IBD-like phenotype (primary immunodeficiencies, autoinflammatory diseases, …). However, we cannot rule out a genetic basis in this case, as a genetic investigation was not performed in this patient as part of the initial evaluation due to the presenting phenotype and the very favourable response to standard treatment. There are numerous articles in the literature on the influence of environmental factors in IBD.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> There is an evidence of an association with diets rich in animal protein and additives, the excessive use of antibiotics and the increase in environmental pollution, among others, but the pathophysiology that underlies this association is not understood. We do know that antibiotic use can lead to dysbiosis in the intestinal microbiota, which in turn is associated with IBD.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> The SPIRIT study<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> (a multicentre study conducted between 1996 and 2009) found that the incidence of CD had tripled, the incidence of UC doubled, and a north-south gradient in the incidence of IBD. There is evidence of an association between vitamin D deficiency and IBD,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> which could partly explain the presence of this north-south gradient.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The increased incidence of IBD observed in our region in 2016 has the characteristics of an epidemic. Although we found no differences in the age at onset or disease severity, we did find a significant increase in the incidence of IBD in female patients. Performance of epidemiological studies would be useful to try to determine the underlying causes of this phenomenon.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pascual Pérez AI, Díaz Martín JJ, Jiménez Treviño S, Bousoño García C. 2016: epidemia de enfermedad inflamatoria intestinal en Asturias. An Pediatr (Barc). 2018;89:183–184.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The genetic background of inflammatory bowel disease: from correlation to causality" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "W. Venema" 1 => "M. Voskuil" 2 => "G. Dijkstra" 3 => "R. Weersma" 4 => "E. Festen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/path.4817" "Revista" => array:6 [ "tituloSerie" => "J Pathol" "fecha" => "2017" "volumen" => "241" "paginaInicial" => "146" "paginaFinal" => "158" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27785786" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phenotypic and genotypic characterisation of inflammatory bowel disease presenting before the age of 2 years" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Kammermeier" 1 => "R. Dziubak" 2 => "M. Pescarin" 3 => "S. Drury" 4 => "H. Godwin" 5 => "K. Reeve" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ecco-jcc/jjw118" "Revista" => array:6 [ "tituloSerie" => "J Crohns Colitis" "fecha" => "2017" "volumen" => "11" "paginaInicial" => "60" "paginaFinal" => "69" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27302973" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European Crohn's and colitis organisation topical review on environmental factors in IBD" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Maaser" 1 => "E. Langholz" 2 => "A. Gordon" 3 => "J. Burisch" 4 => "P. Ellul" 5 => "V. Hernández" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ecco-jcc/jjw223" "Revista" => array:6 [ "tituloSerie" => "J Crohns Colitis" "fecha" => "2017" "volumen" => "11" "paginaInicial" => "905" "paginaFinal" => "920" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28039310" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The association between the gut microbiota and the inflammatory bowel disease activity: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Prosberg" 1 => "F. Bentsen" 2 => "I. Vind" 3 => "A.M. Petersen" 4 => "L.L. Gluud" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/00365521.2016.1216587" "Revista" => array:6 [ "tituloSerie" => "Scand J Gastroenterol" "fecha" => "2016" "volumen" => "51" "paginaInicial" => "1407" "paginaFinal" => "1415" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27687331" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increasing incidence of pediatric inflammatory bowel disease in Spain (1996–2009): the SPIRIT Registry" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Martín de Carpi" 1 => "A. Rodríguez" 2 => "E. Ramos" 3 => "S. Jiménez" 4 => "M.J. Martínez-Gómez" 5 => "E. Medina" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ibd.22980" "Revista" => array:6 [ "tituloSerie" => "Inflamm Bowel Dis" "fecha" => "2013" "volumen" => "19" "paginaInicial" => "73" "paginaFinal" => "80" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22535573" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vitamin D deficiency associated with disease activity in patients with inflammatory bowel diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Torki" 1 => "A. Gholamrezaei" 2 => "L. Mirbagher" 3 => "M. Danesh" 4 => "S. Kheiri" 5 => "M. 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|---|---|---|---|
| 2024 November | 8 | 8 | 16 |
| 2024 October | 39 | 39 | 78 |
| 2024 September | 45 | 32 | 77 |
| 2024 August | 48 | 55 | 103 |
| 2024 July | 44 | 27 | 71 |
| 2024 June | 32 | 28 | 60 |
| 2024 May | 33 | 22 | 55 |
| 2024 April | 34 | 25 | 59 |
| 2024 March | 32 | 18 | 50 |
| 2024 February | 24 | 28 | 52 |
| 2024 January | 21 | 14 | 35 |
| 2023 December | 16 | 16 | 32 |
| 2023 November | 24 | 29 | 53 |
| 2023 October | 21 | 21 | 42 |
| 2023 September | 20 | 21 | 41 |
| 2023 August | 17 | 12 | 29 |
| 2023 July | 28 | 30 | 58 |
| 2023 June | 24 | 24 | 48 |
| 2023 May | 27 | 26 | 53 |
| 2023 April | 14 | 13 | 27 |
| 2023 March | 22 | 21 | 43 |
| 2023 February | 24 | 17 | 41 |
| 2023 January | 15 | 19 | 34 |
| 2022 December | 30 | 28 | 58 |
| 2022 November | 57 | 38 | 95 |
| 2022 October | 37 | 40 | 77 |
| 2022 September | 32 | 32 | 64 |
| 2022 August | 35 | 54 | 89 |
| 2022 July | 38 | 47 | 85 |
| 2022 June | 38 | 36 | 74 |
| 2022 May | 48 | 41 | 89 |
| 2022 April | 46 | 40 | 86 |
| 2022 March | 62 | 53 | 115 |
| 2022 February | 55 | 22 | 77 |
| 2022 January | 48 | 30 | 78 |
| 2021 December | 39 | 40 | 79 |
| 2021 November | 41 | 40 | 81 |
| 2021 October | 57 | 72 | 129 |
| 2021 September | 26 | 42 | 68 |
| 2021 August | 23 | 54 | 77 |
| 2021 July | 29 | 45 | 74 |
| 2021 June | 34 | 49 | 83 |
| 2021 May | 36 | 44 | 80 |
| 2021 April | 58 | 52 | 110 |
| 2021 March | 45 | 41 | 86 |
| 2021 February | 28 | 23 | 51 |
| 2021 January | 32 | 25 | 57 |
| 2020 December | 30 | 20 | 50 |
| 2020 November | 24 | 16 | 40 |
| 2020 October | 20 | 20 | 40 |
| 2020 September | 31 | 29 | 60 |
| 2020 August | 24 | 13 | 37 |
| 2020 July | 7 | 16 | 23 |
| 2020 June | 25 | 4 | 29 |
| 2020 May | 17 | 16 | 33 |
| 2020 April | 18 | 20 | 38 |
| 2020 March | 21 | 8 | 29 |
| 2020 February | 15 | 12 | 27 |
| 2020 January | 24 | 14 | 38 |
| 2019 December | 31 | 13 | 44 |
| 2019 November | 23 | 3 | 26 |
| 2019 October | 28 | 9 | 37 |
| 2019 September | 18 | 8 | 26 |
| 2019 August | 23 | 9 | 32 |
| 2019 July | 29 | 29 | 58 |
| 2019 June | 23 | 11 | 34 |
| 2019 May | 21 | 11 | 32 |
| 2019 April | 25 | 13 | 38 |
| 2019 March | 19 | 16 | 35 |
| 2019 February | 35 | 15 | 50 |
| 2019 January | 25 | 17 | 42 |
| 2018 December | 33 | 22 | 55 |
| 2018 November | 58 | 26 | 84 |
| 2018 October | 64 | 19 | 83 |
| 2018 September | 128 | 32 | 160 |
| 2018 August | 0 | 2 | 2 |
| 2018 July | 0 | 2 | 2 |
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