TORONTO — Canada has one of the highest rates of pediatric inflammatory bowel disease in the world, and the number of young children being diagnosed with the lifelong disease has risen dramatically, a study has found.
Researchers found cases of inflammatory bowel disease, or IBD, in children under age five went up by 7.2 per cent each year between 1999 and 2010. IBD primarily includes Crohn's disease and ulcerative colitis — conditions that affect the digestive tract and cause chronic diarrhea, blood in the stool, abdominal pain and weight loss.
Crohn's is known as the "cheek-to-cheek disease" because it can cause destructive inflammation throughout the gastrointestinal tract from the mouth to the anus, but is often confined to the lower part of the small intestine and the colon. Ulcerative colitis affects only the large intestine, or colon.
"The number of children under five being diagnosed with IBD is alarming because it was almost unheard of 20 years ago and it is now much more common," said lead author Dr. Eric Benchimol, a pediatric gastroenterologist at the Children's Hospital of Eastern Ontario in Ottawa.
The researchers, members of the Canadian Gastro-Intestinal Epidemiology Consortium, analyzed health records in five Canadian provinces to identify children under age 16 who were diagnosed with IBD between 1999 and 2010. The five provinces — Alberta, Manitoba, Ontario, Quebec and Nova Scotia — account for almost 80 per cent of Canada's population.
Benchimol said that in most provinces the rate of new IBD diagnoses in children under 16 was relatively stable, at about two per cent per year. Still, over the almost two decades covered by the study, that incremental annual increase means the overall number of kids living with Crohn's or colitis has jumped by about 60 per cent.
"Whereas the rate in which children under five years old rose was about seven per cent per year — and that was very highly significant," he said.
An estimated 600 to 650 Canadian children are diagnosed with IBD every year, and almost 3,000 children under age 16 are currently living with the disease.
The exact cause of IBD isn't known, but researchers believe a combination of predisposing genetics and environmental factors is likely to blame. They hypothesize that alterations in the bacterial composition of the gut from early exposure to antibiotics, eating the typical high-fat, sugar-rich North American diet, and low levels of vitamin D may trigger the disease.
Jennifer Klatt's son Matthew O'Halloran began developing symptoms, including bloody diarrhea, just before his second birthday. He was eventually diagnosed with Crohn's disease.
"When Matthew was young, he did have antibiotics several times for ear infections," recalled Klatt, a teacher in Brockville, Ont. "That could have been a trigger."
Now 15, Matthew continues to takes medications and is careful about his diet to prevent IBD flare-ups, which can lead to activity-disrupting chronic diarrhea and other symptoms, said Klatt. Her son is a goalie on a local hockey team and is studying Grade 10 piano.
"He's just gotten to the age now where he knows if he does something, he is going to pay the consequences," she said of eating certain foods that can ignite the inflammation.
"He is going to have more frequent bathroom trips. He'll have cramping, bloating and gas — all the different signs and symptoms," said Klatt, adding that it's important to be open about the life-altering effects of IBD, which affects an estimated 250,000 Canadians.
"It's a disease that's kind of an embarrassing disease, which is why we talk about it and why we want to educate people to remove some of the stigma."
Mina Mawani, president and CEO of Crohn's and Colitis Canada, said IBD symptoms have a huge impact on children and youth because they cause interruptions in school, work and relationships.
But Crohn's and colitis "aren't talked about, they're very much like invisible diseases," she said. "You may look at somebody and they look completely healthy, but internally there's a war raging inside in their intestines."
Mawani said the new study confirms the incidence of Crohn's and colitis is climbing in Canada.
"Families new to Canada are developing Crohn's and colitis for the very first time, often within the first generation. So this type of research is really important because we really want to find out why this is happening."
Benchimol said some immigrant populations, primarily South Asians from countries such as India, Pakistan and Sri Lanka, develop high rates of IBD after coming to Canada. He said they likely have the genetic underpinnings that predispose them to IBD and adopting a western diet and lifestyle is the tipping point for the disease.
He said the study, published in the American Journal of Gastroenterology, underscores the need to focus future research on identifying potential triggers in young children and intervening to prevent its occurrence.
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Sheryl Ubelacker, The Canadian Press