Original Contribution | Published:

Inflammatory Bowel Disease

Dramatic Increase in Incidence of Ulcerative Colitis and Crohn’s Disease (1988–2011): A Population-Based Study of French Adolescents

The American Journal of Gastroenterology volume 113, pages 265272 (2018) | Download Citation

Abstract

Objectives:

Few data are available to describe the changes in incidence of pediatric-onset inflammatory bowel disease (IBD). The aim of this study was to describe changes in incidence and phenotypic presentation of pediatric-onset IBD in northern France during a 24-year period.

Methods:

Pediatric-onset IBD (<17 years) was issued from a population-based IBD study in France between 1988 and 2011. Age groups and digestive location were defined according to the Paris classification.

Results:

1,350 incident cases were recorded (8.3% of all IBD) including 990 Crohn’s disease (CD), 326 ulcerative colitis (UC) and 34 IBD unclassified (IBDU). Median age at diagnosis was similar in CD (14.4 years (Q1=11.8–Q3=16.0)) and UC (14.0 years (11.0–16.0)) and did not change over time. There were significantly more males with CD (females/males=0.82) than UC (females/males=1.25) (P=0.0042). Median time between onset of symptoms and IBD diagnosis was consistently 3 months (1–6). Mean incidence was 4.4/105 for IBD overall (3.2 for CD, 1.1 for UC and 0.1 for IBDU). From 1988–1990 to 2009–2011, a dramatic increase in incidences of both CD and UC were observed in adolescents (10–16 years): for CD from 4.2 to 9.5/105 (+126%; P<0.001) and for UC, from 1.6 to 4.1/105 (+156%; P<0.001). No modification in age or location at diagnosis was observed in either CD or UC.

Conclusions:

In this population-based study, CD and UC incidences increased dramatically in adolescents across a 24-year span, suggesting that one or more strong environmental factors may predispose this population to IBD.

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Acknowledgements

We thank the interviewing practitioners who collected data: N. Guillon, I. Rousseau, A Pétillon, B. Turck, P. Fosse, S. Auzou, M. Leconte, C. Le Gallo, D. Rime. The authors thank all adult and pediatric gastroenterologists who participated in this study. We also thank for its logistic help the European DigestScience Charity Foundation. This work is issued from the Epimad Registry. EPIMAD is supported by the Institut National de la Santé et de la Recherche Médicale (INSERM) and the Institut de Veille Sanitaire (InVS), and also received financial support from the François Aupetit Association. This work is also supported by the Conseil Régional Nord-Pas-de-Calais.

Author information

Affiliations

  1. Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille University Jeanne de Flandre Children's Hospital and Faculty of Medicine, Lille, France

    • Silvia Ghione
    • , Delphine Ley
    •  & Dominique Turck
  2. Public Health, Epidemiology and Economic Health, Epimad registry, Regional house of clinical research, Lille Hospital and University, Lille, France

    • Hélène Sarter
    •  & Corinne Gower-Rousseau
  3. Lille Inflammation Research International Center LIRIC—UMR 995 Inserm—“IBD and environmental factors: epidemiology and functional analyses”, Lille University, Lille, France

    • Hélène Sarter
    • , Delphine Ley
    • , Benjamin Pariente
    • , Dominique Turck
    •  & Corinne Gower-Rousseau
  4. Gastroenterology Unit, Epimad registry, Amiens Hospital and University, Amiens, France

    • Mathurin Fumery
  5. Gastroenterology Unit, Epimad registry, Rouen Hospital and University, Rouen, France

    • Laura Armengol-Debeir
    •  & Guillaume Savoye
  6. Department of Pediatrics, St Vincent de Paul Hospital and Lille Catholic University, Lille, France

    • Claire Spyckerelle
  7. Gastroenterology Unit, Epimad registry, Lille Hospital and University, Lille, France

    • Benjamin Pariente
  8. Gastroenterology Unit, Inserm U954, Nancy Hospital and University, Nancy, France

    • Laurent Peyrin-Biroulet

Consortia

  1. The Epimad Group

    MEMBERS OF THE CONSORTIUM Andre JM, Antonietti M, Aouakli A, Armand A, Aroichane I, Assi F, Aubet JP, Auxenfants E, Ayafi-Ramelot F, Bankovski D, Barbry B, Bardoux N, Baron P, Baudet A, Bazin B, Bebahani A, Becqwort JP, Benet V, Benali H, Benguigui C, Ben Soussan E, Bental A, Berkelmans I, Bernet J, Bernou K, Bernou-Dron C, Bertot P, Bertiaux-Vandaële N, Bertrand V, Billoud E, Biron N, Bismuth B, Bleuet M, Blondel F, Blondin V, Bohon P, Boniface E, Bonnière P, Bonvarlet E, Bonvarlet P, Boruchowicz A, Bostvironnois R, Boualit M, Bouche B, Boudaillez C, Bourgeaux C, Bourgeois M, Bourguet A, Bourienne A, Branche J, Bray G, Brazier F, Breban P, Brihier H, Brung-Lefebvre V, Bulois P, Burgiere P, Butel J, Canva JY, Canva-Delcambre V, Capron JP, Cardot F, Carpentier P, Cartier E, Cassar JF, Cassagnou M, Castex JF, Catala P, Cattan S, Catteau S, Caujolle B, Cayron G, Chandelier C, Chantre M, Charles J, Charneau T, Chavance-Thelu M, Chirita D, Choteau A, Claerbout JF, Clergue PY, Coevoet H, Cohen G, Collet R, Colombel JF, Coopman S, Corvisart J, Cortot A, Couttenier F, Crinquette JF, Crombe V, Dadamessi I, Dapvril V, Davion T, Dautreme S, Debas J, Degrave N, Dehont F, Delatre C, Delcenserie R, Delette O, Delgrange T, Delhoustal L, Delmotte JS, Demmane S, Deregnaucourt G, Descombes P, Desechalliers JP, Desmet P, Desreumaux P, Desseaux G, Desurmont P, Devienne A, Devouge E, Devred M, Devroux A, Dewailly A, Dharancy S, Di Fiore A, Djeddi D, Djedir R, Dreher-Duwat ML, Dubois R, Dubuque C, Ducatillon P, Duclay J, Ducrocq B, Ducrot F, Ducrotte P, Dufilho A, Duhamel C, Dujardin D, Dumant-Forest C, Dupas JL, Dupont F, Duranton Y, Duriez A, El Achkar K, El Farisi M, Elie C, Elie-Legrand MC, Elkhaki A, Eoche M, Evrard D, Evrard JP, Fatome A, Filoche B, Finet L, Flahaut M, Flamme C, Foissey D, Fournier P, Foutrein- Comes MC, Foutrein P, Fremond D, Frere T, Fumery M, Gallet P, Gamblin C, Ganga-Zandzou PS, Gérard R, Geslin G, Gheyssens Y, Ghossini N, Ghrib S, Gilbert T, Gillet B, Godard D, Godard P, Godchaux JM, Godchaux R, Goegebeur G, Goria O, Gottrand F, Gower P, Grandmaison B, Groux M, Guedon C, Guillard JF, Guillem L, Guillemot F, Guimber D, Haddouche B, Hakim S, Hanon D, Hautefeuille V, Heckestweiller P, Hecquet G, Hedde JP, Hellal H, Henneresse PE, Heyman B, Heraud M, Herve S, Hochain P, Houssin-Bailly L, Houcke P, Huguenin B, Iobagiu S, Ivanovic A, Iwanicki-Caron I, Janicki E, Jarry M, Jeu J, Joly JP, Jonas C, Katherin F, Kerleveo A, Khachfe A, Kiriakos A, Kiriakos J, Klein O, Kohut M, Kornhauser R, Koutsomanis D, Laberenne JE, Laffineur G, Lagarde M, Lannoy P, Lapchin J, Lapprand M, Laude D, Leblanc R, Lecieux P, Leclerc N, Le Couteulx C, Ledent J, Lefebvre J, Lefiliatre P, Legrand C, Le Grix A, Lelong P, Leluyer B, Lenaerts C, Lepileur L, Leplat A, Lepoutre-Dujardin E, Leroi H, Leroy MY, Lesage JP, Lesage X, Lesage J, Lescanne-Darchis I, Lescut J, Lescut D, Leurent B, Levy P, Lhermie M, Lion A, Lisambert B, Loire F, Louf S, Louvet A, Luciani M, Lucidarme D, Lugand J, Macaigne O, Maetz D, Maillard D, Mancheron H, Manolache O, Marks-Brunel AB, Marti R, Martin F, Martin G, Marzloff E, Mathurin P, Mauillon J, Maunoury V, Maupas JL, Mesnard B, Metayer P, Methari L, Meurisse B, Meurisse F, Michaud L, Mirmaran X, Modaine P, Monthe A, Morel L, Mortier PE, Moulin E, Mouterde O, Mudry J, Nachury M, N’Guyen Khac E, Notteghem B, Ollevier V, Ostyn A, Ouraghi A, Ouvry D, Paillot B, Panien-Claudot N, Paoletti C, Papazian A, Parent B, Pariente B, Paris JC, Patrier P, Paupart L, Pauwels B, Pauwels M, Petit R, Piat M, Piotte S, Plane C, Plouvier B, Pollet E, Pommelet P, Pop D, Pordes C, Pouchain G, Prades P, Prevost A, Prevost JC, Quesnel B, Queuniet AM, Quinton JF, Rabache A, Rabelle P, Raclot G, Ratajczyk S, Rault D, Razemon V, Reix N, Revillon M, Richez C, Robinson P, Rodriguez J, Roger J, Roux JM, Rudelli A, Saber A, Savoye G, Schlosseberg P, Segrestin M, Seguy D, Serin M, Seryer A, Sevenet F, Shekh N, Silvie J, Simon V, Spyckerelle C, Talbodec N, Techy A, Thelu JL, Thevenin A, Thiebault H, Thomas J, Thorel JM, Tielman G, Tode M, Toisin J, Tonnel J, Touchais JY, Touze Y, Tranvouez JL, Triplet C, Turck D, Uhlen S, Vaillant E, Valmage C, Vanco D, Vandamme H, Vanderbecq E, Vander Eecken E, Vandermolen P, Vandevenne P, Vandeville L, Vandewalle A, Vandewalle C, Vaneslander P, Vanhoove JP, Vanrenterghem A, Varlet P, Vasies I, Verbiese G, Vernier-Massouille G, Vermelle P, Verne C, Vezilier-Cocq P, Vigneron B, Vincendet M, Viot J, Voiment YM, Wacrenier A, Waeghemaecker L, Wallez JY, Wantiez M, Wartel F, Weber J, Willocquet JL, Wizla N, Wolschies E, Zalar A, Zaouri B, Zellweger A, Ziade C.

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Competing interests

Guarantor of the article: Corinne Gower-Rousseau, MD, PhD.

Specific author contributions: Silvia Ghione: concept and study design, acquisition and interpretation of data; drafting of the manuscript. Hélène Sarter: data management, interpretation of data, statistical analysis. Mathurin Fumery: concept and study design, Interpretation of data; drafting and critical revision of the manuscript. Laura Armengol-Debeir: interpretation of data; drafting and critical revision of the manuscript. Guillaume Savoye: initiation of the study; interpretation of data; drafting and critical revision of the manuscript. Delphine Ley: interpretation of data; critical revision of the manuscript. Claire Spyckerelle: interpretation of data. Benjamin Pariente: interpretation of data; critical revision of the manuscript. Laurent Peyrin-Biroulet: interpretation of data; drafting and critical revision of the manuscript. Dominique Turck: initiation of the study; interpretation of data; drafting and critical revision of the manuscript. Corinne Gower-Rousseau: concept and study design; interpretation of data; drafting and critical revision of the manuscript.

Potential competing interests: Mathurin Fumery has served as speaker for Abbvie France, Ferring France, Takeda France and MSD France. Guillaume Savoye has served as speaker for MSD France, Ferring France, Abbvie France and Vifor France. Benjamin Pariente has served as consultant for Abbvie, Biogaran, and Pfizer. Benjamin Pariente has served as speaker for Abbvie, Ferring, Takeda, Hopsira, Biogaran, and MSD. Laurent Peyrin-Biroulet has served as consultant for Merck, Abbvie, Janssen, Genentech, Mitsubishi, Ferring, Norgine, Tillots, Vifor, Therakos, Pharmacosmos, Pilège, BMS, UCB-pharma, Hospira, Celltrion, Takeda, Biogaran, Boerhinger-Ingelheim, Lilly, Pfizer, HAC-Pharma, Index Pharmaceuticals. Laurent Peyrin-Biroulet has served as speaker for Merck, Abbvie, Takeda, Janssen, Ferring, Norgine, Tillots, Vifor, Therakos, Mitsubishi, HAC-pharma. Corinne Gower-Rousseau has served as speaker for Abbvie France, Takeda France, Ferring International, Janssen International and MSD France. The remaining authors declare no conflict of interest.

Funding support: This work is issued from the Epimad Registry. EPIMAD is supported by the Institut National de la Santé et de la Recherche Médicale (INSERM) and the Institut de Veille Sanitaire (InVS), and also received financial support from the François Aupetit Association. This work is also supported by the Conseil Régional Nord-Pas-de-Calais.

Ethics approval: The study protocol has been approved by the French Ministry of Health according to the regulation of the registries in general population (Number n° 97107 for CCTIRS and 983792 for the CNIL).

Corresponding author

Correspondence to Corinne Gower-Rousseau.

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DOI

https://doi.org/10.1038/ajg.2017.228

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