Changes to Surgical and Hospitalization Rates of Pediatric Inflammatory Bowel Disease in Ontario, Canada (1994-2007)

Background: Recent advances have been made in the care of children with inflammatory bowel disease (IBD). We aimed to describe trends in medication use, associated health services, and outcomes (hospitalization and surgical rates) between 1994-2007 in children with IBD. Methods: Children <18 years diagnosed 1994-2004 with IBD living in Ontario were identified and grouped by era of diagnosis (1994-1997, 1998-2000, 2001-2004). We tested the association between era and hospitalizations and surgery. Medication use (in children on social assistance), and physician provider specialty were described. Results: IBD-related outpatient health services were increasingly provided by pediatric gastroenterologists, with decreasing care by adult gastroenterologists, surgeons, and generalists. Children diagnosed in 2001-2004 with Crohn's disease (CD) were more likely to use an immunomodulator within 3 years of diagnosis (P - 0.01). In all children with IBD, numbers of hospitalizations and physician visits remained stable over time; however, the age-adjusted odds of being hospitalized was higher in recent years for CD (adjusted odds ratio [aOR] 3.22, 95% confidence intervals [CI] 2.15-4.83) and ulcerative colitis (UC) (aOR 2.83 95% CI 1.55-5.19). Surgical rates within 3 years of diagnosis with CD decreased from 18.8% to 13.6% over time (P = 0.035). This decrease was significant in children with CD diagnosed >= 10 years old (aOR 0.67, 95% CI 0.48-0.93). No change was demonstrated in UC. Conclusions: Treatment changes in children with IBD between 1994-2007 (including increased immunomodulator use and increased outpatient care by pediatric gastroenterologists) were associated with reduced surgical rates in children with CD but not UC.