The Emerging Crisis: Accelerating Incidence of Paediatric IBD in the UAE

A groundbreaking study published in the BMJ's Frontline Gastroenterology journal has shed light on the rapidly rising rates of paediatric inflammatory bowel disease (pIBD) in the United Arab Emirates. Conducted at Sheikh Khalifa Medical City (SKMC) in Abu Dhabi, the retrospective analysis of 146 patients diagnosed between 2012 and 2024 reveals a 341% increase in new cases from the earlier period (2012-2017) to the later years (2018-2024). This surge, with an incidence rate ratio (IRR) of 1.22 per year (p<0.0001), underscores an 'accelerating burden' phase consistent with global trends but particularly stark in this high-income Middle Eastern context.

Crohn's disease (CD), accounting for 58.9% of cases, drove much of the increase (IRR 1.25, p<0.0001, 517% rise), while ulcerative colitis (UC) rose more modestly (34.2% of cases, IRR 1.14). The median age at diagnosis was 11 years, with patients presenting later in recent years—a trend observed across both CD and UC subgroups. Over half (58.2%) were Emirati nationals, highlighting the local impact amid a diverse expatriate population.

This data fills a critical gap, as prior UAE-specific pIBD epidemiology was scarce, positioning SKMC's findings as a benchmark for regional healthcare planning.

What is Paediatric Inflammatory Bowel Disease?

Paediatric inflammatory bowel disease (pIBD) refers to chronic, relapsing inflammation of the gastrointestinal tract occurring before age 18. It encompasses Crohn's disease (CD), which can affect any part of the digestive tract with transmural inflammation, and ulcerative colitis (UC), limited to the colon and rectum with mucosal involvement. A small subset is IBD-unclassified (IBD-U). Unlike adult-onset IBD, pIBD often presents with more extensive disease, growth impairment risks, and requires long-term multidisciplinary management to mitigate developmental impacts.

In the UAE study, CD predominated with a 1.7:1 ratio over UC, mirroring patterns in newly industrializing regions. Symptoms at diagnosis included abdominal pain (67%), diarrhoea (63%), and weight loss (42%), with CD patients showing elevated C-reactive protein (CRP) levels (23.1 mg/L) and hypoalbuminaemia (29 g/L), indicative of systemic inflammation.

Extraintestinal manifestations (EIMs) affected 34.2%, most commonly dermatological (13.7%) and articular (11%), complicating care further.

Clinical Phenotypes: Complex Disease Patterns Dominate

The Paris classification revealed aggressive phenotypes. For CD, 68.6% were ileocolonic (L3), 44.2% perianal, and 48.8% complicated (stricturing B2 or penetrating B3), with 10.5% upper GI involvement (L4). Temporal shifts showed rising ileal (L1) disease (p=0.032) and declining ileocolonic forms (p=0.008). UC was predominantly extensive/pancolitis (E3, 78%), associated with more frequent bloody stools (88%) and diarrhoea (78%).

• CD Location Breakdown: L3 (68.6%), L1 (14%), L2 (10.5%), L4a/b (10.5% combined).
• CD Behaviour: B1 inflammatory (51.2%), B2 (27.9%), B3 (20.9%).
• UC Extent: E3 (78%), E2 (16%), E1 (6%).

Genetic testing in 15 high-risk cases identified pathogenic variants in 33.3% (e.g., LRBA, MEFV), suggesting monogenic contributions in a subset, warranting expanded screening in UAE's consanguineous populations.

Treatment Landscape: High Reliance on Advanced Therapies

UAE clinicians demonstrated proactive management, with immunomodulators used in 83.7% CD and 88% UC cases (azathioprine predominant). Biologics exposure was remarkably high—76.7% in CD (infliximab first-line 84.8%) and 58% in UC—initiated earlier in CD (median 2 months post-diagnosis vs. 9 months for UC, p=0.001). Corticosteroids were more common in UC induction (92% vs. 52.3% CD).

Surgery rates were low (8.9%), mainly resections in CD (12.8%). Lower serum albumin predicted first biologic failure in CD (OR 0.89 per g/L, p=0.027), guiding therapeutic decisions. This top-down approach reflects resource-rich settings but raises questions on sustainability and long-term outcomes.

Factors Driving the Rise: Environmental and Genetic Influences

The UAE's pIBD surge aligns with global patterns, transitioning from emergence to acceleration in high-income areas. Urbanization, Westernized diets, and microbiome alterations are implicated, alongside improved diagnostics like endoscopy and calprotectin testing. Family history (14.4%) and consanguinity may amplify genetic risks, with MEFV variants common in Arab populations linked to IBD-like presentations.

In the Middle East, prior studies note higher prevalence among emigrants (165/100,000 vs. natives), suggesting gene-environment interactions.

Implications for UAE Healthcare and Paediatric Care

With diagnoses rising over 300% in a decade, pIBD strains UAE's advanced healthcare system. SKMC's data calls for national registries, multidisciplinary IBD centres, and equitable access beyond Abu Dhabi/Dubai. Growth faltering risks in children necessitate nutrition-focused interventions like exclusive enteral nutrition (used in only 7% CD cases).

Read the full BMJ study here.

Role of UAE Universities in Advancing pIBD Research

UAE higher education institutions are pivotal in addressing this burden. Mohammed Bin Rashid University (MBRU) offers pediatric gastroenterology fellowships training specialists in IBD management. Khalifa University and UAE University (UAEU) support genomic research, crucial given the study's monogenic findings. Collaborations like SKMC-Cincinnati Children's enhance training and trials, fostering homegrown expertise.

Prospective students interested in higher ed jobs in paediatric gastroenterology or research can explore opportunities at UAE medical schools. For career advice, visit higher ed career advice.

Global Context: UAE Fits Emerging Trends

Worldwide, pIBD incidence has risen 4-fold in recent decades, with CD accelerating fastest in Asia/Middle East. UAE's patterns—CD dominance, perianal disease—resemble Israel/Jordan cohorts, contrasting Western UC predominance. This 'four-stage' evolution (emergence, acceleration, compounding, hyper-endemic) positions UAE for proactive interventions.

Challenges and Future Directions

Challenges include biologic costs, access disparities, and limited long-term data. Recommendations: National pIBD registry, early screening protocols, and trials for de-escalation. UAE universities can lead in microbiome/genetic studies tailored to Arab genomes.

Photo by David Trinks on Unsplash

• Expand genetic testing for monogenic IBD.
• Promote nutrition therapy over steroids.
• Integrate AI for phenotype prediction.

Call to Action: Opportunities in UAE Medical Research

This study spotlights the need for more specialists. Explore UAE higher ed opportunities, university jobs, or rate my professor for mentors. Visit higher-ed-jobs and career advice to join the fight against pIBD.