Principal Investigator: Akash Pandey, MD at Arnold Palmer Hospital for Children
Background:
Inflammatory Bowel Disease (IBD) pathogenesis is thought to be influenced by a mix of genetics, intestinal microbiome, immune dysregulation, and environmental exposures(1). IBD may follow a seasonal pattern in its onset and exacerbations. Some studies have reported acute onset of symptoms of Crohn's Disease (CD) more frequently in January and July, whereas Ulcerative Colitis (UC) symptoms were more frequently reported in December(2). However, there are some studies showing conflicting data(3). Globally, a 2022 study looked at the effects of environmental factors such as temperature, weather, and seasons on IBD exacerbations in adults(4). Results of meta-analysis of seven studies showed a non-negligible to weak correlation for seasonal variation and IBD exacerbations, non-negligible to weak correlation within UC, and a weak positive correlation within CD(4). The study was limited by a lack of a clear definition of IBD exacerbation and information on disease location and medication, thereby contributing to the difficulty in interpretation of results(4). Additionally, a multicenter observational study from Japan looked at seasonality and newly diagnosed IBD cases and exacerbations, revealing that CD had higher proportionally diagnosed cases in the summer while UC had no clear association with seasons(5). Winter had the highest exacerbations(5). Interestingly, age appeared to represent an independent risk factor for seasonality and newly diagnosed IBD as well as exacerbations, specifically in patients aged 40 or less(5).
There is limited data in the pediatric population. A single center in Michigan found a seasonal trend in the onset of symptoms of IBD with the highest incidence in the fall and lowest in the summer(2). In 2014, a retrospective study of ImproveCareNow data from December 2008 to November 2010 examined seasonality and IBD and reported that the proportion of UC patients in continuous remission was highest in the summer and lowest in the winter and no significant pattern for CD (6).
At our institution at Arnold Palmer Hospital for Children, we analyzed data on 206 actively enrolled patients in ImproveCareNow from 2014-2024. While our results did not show a statistical difference in new diagnosis of IBD across the year, there were suggestive peaks in January, April, and October, particularly for CD. Overall, these inconsistencies highlight the importance of obtaining larger sample sizes and years of data for analysis. We are requesting access to de-identified ICN multicenter data to evaluate possible patterns in occurrence
of new diagnosis of IBD to be better prepared as clinicians for our patient population. While maintaining remission rates is ideal, we would like to review the months of newly diagnosed pediatric IBD to help clinicians to be more proactive in ordering studies for patients who present with symptoms resembling irritable bowel syndrome that may have early, mild symptoms of IBD that could be overlooked. If we identify certain months with higher IBD diagnoses, we can proactively screen patients. Early detection and intervention can improve the care of those with this lifelong condition and improve quality of life and enhancement of activities of daily living and overall well-being.
Purpose & Aims:
We aim to report the monthly variation in onset of IBD in pediatric patients and determine if this follows a specific pattern throughout the United States with regards to seasonality and geographic location to be better prepared as clinicians for providing care and support.
Contact: [email protected]
References
1. Kucharzik T, Maaser C, Lügering A, et al. Recent understanding of IBD pathogenesis: implications for future therapies. Inflamm Bowel Dis. 2006;12(11):1068-1083. doi:10.1097/01.mib.0000235827.21778.d5
2. Dharmaraj R, Jaber A, Arora R, Hagglund K, Lyons H. Seasonal variations in onset and exacerbation of inflammatory bowel diseases in children. BMC Res Notes. 2015;8:696. Published 2015 Nov 20. doi:10.1186/s13104-015-1702-y
3. Lewis JD, Aberra FN, Lichtenstein GR, Bilker WB, Brensinger C, Strom BL. Seasonal variation in flares of inflammatory bowel disease. Gastroenterology. 2004;126(3):665-673. doi:10.1053/j.gastro.2003.12.003
4. Moon SJ, Lee YC, Kim TJ, Kim K, Son HJ (2022) Effects of temperature, weather, seasons, atmosphere, and climate on the exacerbation of inflammatory bowel diseases: A systematic review and meta-analysis. PLOS ONE 17(12): e0279277. https://doi.org/10.1371/journal.pone.0279277
5. Araki M, Shinzaki S, Yamada T, Arimitsu S, Komori M, Shibukawa N, Mukai A, Nakajima S, Kinoshita K, Kitamura S, Murayama Y, Ogawa H, Yasunaga Y, Oshita M, Fukui H, Masuda E, Tsujii M, Hiyama S, Inoue T, Iijima H, Takehara T. Age at onset is associated with the seasonal pattern of onset and exacerbation in inflammatory bowel disease. J Gastroenterol. 2017 Nov;52(11):1149-1157. doi: 10.1007/s00535-017-1313-6. Epub 2017 Feb 6. PMID: 28168321.
6. Lee, G.J., Dotson, J.L., Kappelman, M.D., King, E., Pratt, J.M., Colletti, R.B., Bistrick, S., Burkam, J.L., Crandall, W.V. and ImproveCareNow Network (2014), Seasonality and Pediatric Inflammatory Bowel Disease. Journal of Pediatric Gastroenterology and Nutrition, 59: 25-28. https://doi.org/10.1097/MPG.0000000000000362