Children with IBD: A Shift in Hospitalization Rates

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Inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn’ disease, is a chronic inflammatory disorder of the gastrointestinal tract. The prevalence of children with IBD is high due to the early onset of the disease. More than 25% of people are diagnosed before the age of 18, with a rising incidence in pediatric populations (Rosen, 2015).

What is IBD and what are the differences between Crohn’s and colitis?

IBD is caused by a dysregulated mucosal immune response to the intestinal microflora in genetically predisposed hosts. Both ulcerative colitis and Crohn’s disease are usually characterized by diarrhea, rectal bleeding, abdominal pain, fatigue and weight loss. IBD can be debilitating and sometimes leads to life-threatening complications (Rosen, 2015).

There are many differences between the two subsets of IBD:

  • Location of inflammation: Inflammation is limited to the large intestine/colon with colitis, whereas with Crohn’s it can be anywhere in the GI tract
  • Pattern of inflammation: Inflamed areas are continuous with no patches in colitis, whereas with Crohn’s, patches of inflammation are found in large patches within the bowel
  • Appearance and location of inflammation: With colitis, inflammation manifests in the lower left abdomen, whereas with Crohn’s it occurs in the lower right abdomen. Ulcers penetrate the inner lining of the abdomen only with colitis, but in Crohn’s, they penetrate the entire thickness (several layers) of the abdominal lining
  • Bleeding: With colitis, bleeding is common during bowel movements, but not with Crohn’s (CDHF, n.d.)

How common is IBD in adolescents?

The occurrence of IBD in childhood is actually common enough that most pediatricians (and pediatric clinicians) will encounter at least one or two children with IBD in their general practice. Although children will often present with the classic symptoms of weight loss, abdominal pain, and bloody diarrhea, many may exhibit different symptoms, such as isolated poor growth, anemia, or other manifestations that don’t specifically relate to the gastrointestinal system (Rosen, 2015).

What shifts have we seen in children with IBD and hospitalization?

Modern, specialized care for children with inflammatory bowel disease may have resulted in changes in health services utilization. A study by Dheri and peers reported trends over time in health services utilization and surgery for children (those under the age of 18) with IBD and children without IBD.

Hospitalizations for children with IBD declined over time, with an annual percentage change of -2.5% versus children without IBD, for which the annual percentage change was -4.3%. However, the rate of IBD-specific outpatient visits after 2005 showed a 4.0% annual increase. IBD-specific emergency department visits did not change throughout this time. It was also noted that surgeries also decreased in children with IBS during this time frame. (Dheri, 2021).

Small child with an IV and bandaging on her hand holds on to an adult.

What caused the shift in the hospitalization rates of children with IBD?

From 2005 onward, the shift to a more significant number of outpatient visits was seen, which was described as a shift from in-patient hospital care towards greater ambulatory care. It was at this point that biologics such as infliximab (Remicade) emerged. Infliximab injection is used to reduce the symptoms of moderate-to-severely active Crohn’s disease and ulcerative colitis in adults and children who have been previously treated with other medicines but did not work well (Ogbru, 2019).

What are the long-term repercussions of this shift?

The prevalence of children with IBD continues to rise, which may potentially lead to a spike in the future burden on healthcare. Therefore, it is incredibly important that there is continued improvement in outpatient disease management for IBD-diagnosed children so that this shift may continue, and hospitals do not become overwhelmed with in-patient care, emergency department visits, and surgeries (Dheri, 2021).

References

CDHF. n.d. Inflammatory Bowel Disease (IBD) Digital Toolkit for the Newly Diagnosed. https://cdhf.ca/digestive-disorders/crohns-disease/ibd-digital-toolkit-for-the-newly-diagnosed/

Dheri, A. 2021. Shifting health care use from hospitalizations and surgeries to outpatient visits in children with inflammatory bowel disease: a population-based cohort study from Ontario, Canada. https://academic.oup.com/ecco-jcc/advance-article/doi/10.1093/ecco-jcc/jjab095/6279878

Ogbru, O. 2019. Infliximab (Remicade). https://www.medicinenet.com/infliximab/article.htm

Rosen, M. et al. 2015. Inflammatory Bowel Disease in Children and Adolescents. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4702263/