Pediatric IBD in Croatia

Pediatric IBD in Croatia

Inflammatory bowel disease (IBD) is relatively common in Europe and North America and is associated with an increasing incidence and prevalence. The authors of this study evaluated the incidence of pediatric IBD in Croatia. Europe has been noted to have a latitude effect regarding IBD in which northern European countries have increased IBD compared to European countries near the Mediterranean, and this study evaluated for a north-south variant in regards to pediatric IBD presentation in Croatia as well.

This prospective, multicenter study evaluated all children (defined as younger than 18 years of age) with IBD in Croatia over a one-year period between 2016 and 2017 via an on-line database. The database maintained basic demographic data as well as anthropometrics, gastrointestinal symptoms, extraintestinal disease manifestations, Paris Classification, laboratory and endoscopic findings, therapies, and Pediatric Crohn’s Disease Activity Index (PCDAI) and Pediatric Ulcerative Colitis Activity Index (PUCAI) scoring. All patients had data entered at diagnosis and at 6 and 12 months after IBD diagnosis.

In total, 51 pediatric patients were diagnosed with IBD during this time period for which 19 patients (37.3%) were diagnosed with Crohn’s disease, 28 patients (54.9%) were diagnosed with ulcerative colitis, and 4 patients (8%) were diagnosed with inflammatory bowel disease – unclassified (IBD-U). The median age at IBD diagnosed was 14.8 years (range 5.4-17.8 years), and all IBD types were more common in male patients. The incidence of new pediatric IBD cases was 7.05 / 100,000 children with the highest incidence of IBD subtypes consisting of ulcerative colitis (3.87 cases / 100,000 children). The lowest incidence of overall pediatric IBD (estimated at 4.5 – 4.85 cases / 100,000 children) was noted in southern Croatian counties (specifically, Dubrovnik-Neretva and Split-Dalmatia counties) while the highest incidence of pediatric IBD was noted in the most northern county of Croatia (Međimurje County) at 22.8 cases / 100,000 children. In terms of all new IBD cases, 41 children were from northern Croatian counties (with a resultant pediatric IBD incidence of 8.38 cases / 100,000) and 10 children were from southern Croatian counties (with a pediatric IBD incidence of 4.26 cases / 100,000 children).

The authors of this study comment that the incidence of pediatric IBD in Croatia appears to fit into the north-south gradient of IBD consistent with other parts of Europe, and there appears to be a distinct north-south gradient of pediatric IBD in Croatia itself. The reasons for these findings are unclear, and more research is needed to determine if infectious, genetic, economic, or other factors may explain these findings.

Editor’s note: A map of counties of Croatia can be found at:

Ivkovic L, Hojsak I, Trivic I, Sila S, Hrabac P, Konjik V, Senecic-Cala I, Palcevski G, Despot R, Zaja O, Kolacek S. Incidence and geographical variability of pediatric inflammatory bowel disease in Croatia: data From the Croatian national registry for children with inflammatory bowel disease. Clinical Pediatrics 2020; 59: 1182-1190.

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