IBD Patients Diagnosed during Childhood Face Increased Mortality Risk

Children diagnosed with inflammatory bowel disease (IBD) have a significantly increased risk of death all the way through adulthood, a long-term follow-up study has found. 

Researchers identified 9,442 Swedish patients who were diagnosed with IBD at younger than 18 years old between 1964 and 2014 and 93,180 matched controls. Hazard ratios (HR) for death were evaluated separately for patients with ulcerative colitis (n = 4,671), Crohn’s disease (n = 3,780), and IBD unclassified (n = 991). 

Increased mortality in children with inflammatory bowel disease – https://t.co/qRySYr02Z5 #IBS #IBD #crohns

— Chronic Disease Coalition (@ChronicRights) October 23, 2018

At follow-up, there were 294 deaths (2.1/1000 person-years) among the patients with IBD and 940 in the control group (0.7/1000 person-years; adjusted HR, 3.2; 95% CI, 2.8–3.7). Ulcerative colitis patients had the highest HR (4.0; 95% CI, 3.4–4.7), followed by Crohn’s disease (2.3; 95% CI, 1.8–3.0) and IBD unclassified (2.0; 95% CI, 1.2–3.4). Among patients aged younger than 18 years, 27 IBD-related deaths occurred (HR 4.9; 95% CI, 3.0–7.7). HRs for death did not decrease during the study period (P = 0.90).  

In pediatric patients w/ Inflammatory Bowel Disease Unclassified #IBDU, 60% remain remained unclassified 2 years after diagnosis in this cohort study. Read more about the evolution of #IBDU in the this month’s #IBDJournal: https://t.co/Yib5YeliFD #IBD #pediatricIBD

— IBDJournal & CC360 (@IBDJournals) October 23, 2018

The most common cause of death was cancer. 

“It should be remembered that we’re talking small differences in number of deaths,” said lead study author Dr. Ola Olén, consultant and researcher at Karolinska Institutet’s Department of Medicine in Solna. “Most young people with IBD do not die earlier than their peers, but a few individuals with a severe case of IBD and serious complications such as cancer greatly elevate the relative risk.” 

In terms of #inflammatoryboweldisease treatment, the CALM trial was one of this year’s major advances #uegweek #crohns #colitis #IBD pic.twitter.com/fsGKtuBUYk

— The Lancet Gastroenterology & Hepatology (@LancetGastroHep) October 22, 2018

Despite developments of new drugs and treatment therapies, mortality risk has not decreased. 

“IBD therapy has improved greatly since the 1960s,” Dr. Olén said. “For one thing, we often now use new types of immunomodulating drugs. However, we couldn’t see that mortality rates have gone down since their introduction.” 

“Individuals who are diagnosed in childhood need to be monitored carefully,” he added. “Those who might especially benefit from being closely monitored to avoid fatal intestinal cancer are children with ulcerative colitis, who also have the chronic liver disease primary sclerosing cholangitis.” 

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Sources: Karolinska Institutet, Gastroenterology