Citation

Malham M, Jakobsen C, Hald M, Paerregaard A, Virta LJ, Kolho KL, Wewer V. Aliment. Pharmacol. Ther. 2019; 50(1): 106-107.

Affiliation

The Paediatric Department, Copenhagen University Hospital, Hvidovre, Denmark.

Copyright

(Copyright © 2019, John Wiley and Sons)

DOI

10.1111/apt.15318

PMID

31184387

Abstract

As stated in the editorial by Drs Banerjee and Gearry,1 the main result of the present study2 is the finding of an increased risk of cancer and mortality in pIBD with a surprisingly high risk of suicide. In contrast to the adult literature on this subject, the paediatric literature almost unambiguously reports an increased risk of cancer in pIBD3 and the main question is no longer if there's an increased risk but why. To better understand this subject, we need large cohort studies with follow‐up times of more than 10 years, mapping both exposure to different immunomodulators and biologic therapies and, perhaps more challenging, the disease activity. Only in this way will we understand the impact of a chronic, often insufficiently treated, inflammatory state of the gastrointestinal tract on the risk of adenocarcinomas. This is of interest, as it has been hypothesised that pIBD constitutes a more aggressive disease state than adult onset IBD,4, 5 which would explain the increased risk of colorectal cancer. However, to date this hypothesis remains unproven.

The most surprising result of our study is the increased risk of death due to suicide, most of which occurred after transition into adult care. Adolescent patients with IBD face different challenges as pre‐puberty and puberty are vulnerable periods of life with great inherent cognitive and physical challenges. Adolescents with IBD have increased school absence both due to symptoms and to medical appointments or hospitalisations. Consequently, the combination of a severe disease and adherence to medical and even surgical treatment, absence from school and an already difficult time of life means that they experience serious deteriorations in their health‐related quality of life, as also stated in the editorial ...

Language: en