The Phenotypic Spectrum of New-onset IBD in Canadian Children of South Asian Ethnicity: A Prospective Multi-Centre Comparative Study

J Dhaliwal; M W Carroll; J C deBruyn; A Ricciuto; E I Benchimol; S Lawrence; M Sherlock; W El-Matary; H Brill; P Church; E Wine; N Carman; A Muise; H Huynh; D R Mack; T D Walters; A M Griffiths; K Jacobson

doi:10.1093/ecco-jcc/jjab143

The Phenotypic Spectrum of New-onset IBD in Canadian Children of South Asian Ethnicity: A Prospective Multi-Centre Comparative Study

J Crohns Colitis. 2022 Feb 23;16(2):216-223. doi: 10.1093/ecco-jcc/jjab143.

Authors

J Dhaliwal^{1

2}, M W Carroll³, J C deBruyn⁴, A Ricciuto¹, E I Benchimol¹, S Lawrence⁵, M Sherlock⁶, W El-Matary⁷, H Brill^{6

8}, P Church¹, E Wine³, N Carman⁹, A Muise¹, H Huynh³, D R Mack⁹, T D Walters¹, A M Griffiths¹, K Jacobson⁵

Affiliations

¹ SickKids Hospital, University of Toronto, Toronto, ON, Canada.
² Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA.
³ Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada.
⁴ Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada.
⁵ British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
⁶ McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada.
⁷ Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
⁸ William Osler Health System, University of Toronto, Toronto, ON, Canada.
⁹ Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.

Abstract

Background: Canadian-born children of South Asian [SA] ethnicity develop inflammatory bowel disease [IBD] at similar rates to those among Caucasian children. We evaluated the variation in phenotypic spectrum of IBD in SA and Caucasian children in a national paediatric inception cohort of new-onset IBD.

Methods: Patients aged <17 years, enrolled in a Canadian nationwide inception cohort study, were included. Baseline demographic and IBD phenotypic features were compared between SA and Caucasian children. Longitudinal outcomes through 18 months of follow-up were compared matched by propensity scores.

Results: Of 1156 children enrolled over 2014 to 2019, 623 were Caucasian [98% and 88% parents Canadian born] and 114 SA [79% Canadian born, 87% parents SA born]. Fewer SAs have a first-degree relative with IBD, 6% vs 19% in Caucasians, p = 0.002. SAs present at a younger age, median age 11.4 years (interquartile range [IQR] 9.2-14.3) vs 13 years [IQR 10.9-15 years], p = 0.03 and more commonly with a UC/IBD-U [ulcerative colitis/IBD-unclassified] subtype [ratio of UC/IBD-U to CD 1.2:1 vs 1:1.8 for Caucasians, p <0.001]. Additionally, a greater proportion of SA CD patients present with colonic-only disease [colonic-only CD/UC/IBD-U in SAs 67% vs 57% for Caucasians, p = 0.001], and among those with CD, colonic CD in SAs 31% vs 23% in Caucasians, p = 0.20]. Perianal fistulising disease was also numerically more common in SAs (14 [27%] vs 64 [18%], p = 0.06]. Adjusting for differences in phenotypic presentation, anti-tumour necrosis factor [TNF] exposure, and time to initiation was similar, and two-thirds of children, whether anti-TNF exposed or naïve, were in corticosteroid-free clinical remission at 18 months irrespective of ethnicity.

Conclusions: The phenotypic spectrum of new-onset IBD in SA children differs from that of Caucasian children, but treatment and clinical course are similar within phenotypic subgroups.

Keywords: Crohn’s disease; Inflammatory bowel disease; South Asian; paediatric; phenotype; ulcerative colitis.

MeSH terms

Adolescent
Canada / epidemiology
Child
Cohort Studies
Colitis, Ulcerative* / therapy
Crohn Disease* / therapy
Ethnicity
Humans
Inflammatory Bowel Diseases*
Prospective Studies
Tumor Necrosis Factor Inhibitors

Substances

Tumor Necrosis Factor Inhibitors

Grants and funding

297862/CAPMC/ CIHR/Canada