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



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.


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.


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.


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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  1. 1.

    , , et al. The changing pattern of Crohn’s disease incidence in northern France: a continuing increase in the 10- to 19-year-old age bracket (1988-2007). Aliment Pharmacol Ther 2011;33:1133–1142.

  2. 2.

    , , . Natural history of pediatric-onset inflammatory bowel disease: A systematic review. J Clin Gastroenterol 2012;46:581–589.

  3. 3.

    , , et al. Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in Wisconsin: A statewide population-based study. J Pediatr 2003;143:525–531.

  4. 4.

    , , et al. Natural history of pediatric Crohn’s disease: a population-based cohort study. Gastroenterology 2008;135:1106–1113.

  5. 5.

    , , et al. Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease. Gastroenterology 2008;135:1114–1122.

  6. 6.

    , , et al. IBD across the age spectrum—is it the same disease? Nat Rev Gastroenterol Hepatol 2013;11:88–98.

  7. 7.

    , , et al. Nutritional status and growth in pediatric Crohn's disease: a population-based study. Am J Gastroenterol 2010;105:1893–1900.

  8. 8.

    , , et al. Growth pattern in pediatric Crohn's disease is related to inflammatory status. J Pediatr Gastroenterol Nutr 2016;63:637–643.

  9. 9.

    , , et al. Risk factors for initial surgery in pediatric patients with Crohn’s disease. Gastroenterology 2006;130:1069–1077.

  10. 10.

    , , et al. Changing age demographics of inflammatory bowel disease in Ontario, Canada: A population-based cohort study of epidemiology trends. Inflamm Bowel Dis 2014;20:1761–1769.

  11. 11.

    , , et al. Changes in clinical characteristics, course, and prognosis of inflammatory bowel disease during the last 5 decades: a population-based study from Copenhagen, Denmark. Inflamm Bowel Dis 2007;13:481–489.

  12. 12.

    , , et al. Increasing incidence of pediatric inflammatory bowel disease in northern Stockholm County, 2002–2007. J Pediatr Gastroenterol Nutr 2013;57:29–34.

  13. 13.

    , , et al. Rising incidence of pediatric inflammatory bowel disease in Scotland. Inflamm Bowel Dis 2012;18:999–1005.

  14. 14.

    , , et al. Rapid rise in incidence of Irish pediatric inflammatory bowel disease. Arch Dis Child 2012;97:590–594.

  15. 15.

    , , et al. Incidence of inflammatory bowel disease in Finnish children, 1987–2003. Inflamm Bowel Dis 2006;12:677–683.

  16. 16.

    , , et al. Incidence of inflammatory bowel disease in northern France (1988-1990). Gut 1994;35:1433–1438.

  17. 17.

    , , et al. Opposite evolution in incidence of Crohn’s disease and ulcerative colitis in northern France (1988-1999). Gut 2004;53:843–848.

  18. 18.

    , , et al. Epidemiology of inflammatory bowel diseases: new insights from a French population-based registry (EPIMAD). Dig Liver Dis 2013;45:89–94.

  19. 19.

    , , et al. Incidence, clinical presentation and location at diagnosis of pediatric inflammatory bowel disease: a prospective population-based study in northern France (1988-1999). J Pediatr Gastroenterol Nutr 2005;41:49–55.

  20. 20.

    , , et al. Pediatric modification of the Montreal classification for inflammatory bowel disease: the Paris classification. Inflamm Bowel Dis 2011;17:1314–1321.

  21. 21.

    , . Confidence intervals for directly standardized rates: a method based on the gamma distribution. Stat Med 1997;16:791–801.

  22. 22.

    , , et al. Incidence of Crohn’s disease in Stockholm County 1955–1989. Gut 1997;41:480–486.

  23. 23.

    , , et al. Crohn’s disease in Olmsted County, Minnesota, 1940–1993: incidence, prevalence, and survival. Gastroenterology 1998;114:1161–1168.

  24. 24.

    . Inflammatory bowel disease incidence: up, down or unchanged? Gut 1998;42:309–311.

  25. 25.

    . Specificities of inflammatory bowel disease in childhood. Best Pract Res Clin Gastroenterol 2004;18:509–523.

  26. 26.

    , . Presenting features of inflammatory bowel disease in Great Britain and Ireland. Arch Dis Child 2003;88:995–1000.

  27. 27.

    , , et al. Prospective survey of childhood inflammatory bowel disease in the British Isles. Lancet 2001;357:1093–1094.

  28. 28.

    , , et al. A characterization in childhood inflammatory bowel disease, a new population-based inception cohort from South-Eastern Norway, 2005-07, showing increased incidence in Crohn’s disease. Scand J Gastroenterol 2009;44:446–456.

  29. 29.

    , , et al. Increasing incidence of pediatric inflammatory bowel disease in Ontario, Canada: evidence from health administrative data. Gut 2009;58:1490–1497.

  30. 30.

    , , et al. Changing pattern of pediatric inflammatory bowel disease in northern Stockholm 1990–2001. Gut 2003;52:1432–1434.

  31. 31.

    . Epidemiologic clues to inflammatory bowel disease. Curr Gastroenterol Rep 2010;12:495–501.

  32. 32.

    , , et al. Incidence and natural history of ulcerative colitis in the Uppsala Region of Sweden 2005-2009—results from the IBD Cohort of the Uppsala Region (ICURE). J Crohns Colitis 2013;7:e351–e357.

  33. 33.

    , , et al. Animal protein intake and risk of inflammatory bowel disease: The E3N prospective study. Am J Gastroenterol 2010;105:2195–2201.

  34. 34.

    , , et al. Antibiotics associated with increased risk of new-onset Crohn's disease but not ulcerative colitis: a meta-analysis. Am J Gastroenterol 2014;109:1728–1738.

  35. 35.

    , Evolution of antibiotic consumption in France from 2000 to 2013. Report of the French Agency for the Safety of Drugs and Health Products. November 2014.

  36. 36.

    , . Epidemiology of appendectomy surgery in France. e-Proceedings of the French National Academy of Surgery 2012;11:95–99.

  37. 37.

    , , et al. Epidemiology of inflammatory bowel disease: is there a shift towards onset at a younger age? J Pediatr Gastroenterol Nutr 2011;53:141–144.

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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


  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


  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).

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Correspondence to Corinne Gower-Rousseau.

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