The changing epidemiology of paediatric inflammatory bowel disease
Bibliographic record
Abstract
We read with great interest the article by Chouraki et al.1 presenting data on incident cases of inflammatory bowel disease (IBD) diagnosed through the EPIMAD study in four well-defined regions of Northern France. The study covered a large population of nearly six million people, demonstrating an overall increase in the incidence rate of Crohn’s disease, especially with regard to the 10- to 19-year-old age group. The study raises several important issues regarding the exploration of the incidence of paediatric IBD. First, although the investigators had previously detailed their diagnostic criteria,2 these are not the universally accepted standards – notably the age-limits used were not those described in either the Montreal3 or the Paris classification.4 Secondly, the classification of ileal lesions with caecal involvement as L3 disease rather than L1 make comparisons with other studies difficult, and subsequently limits the impact of the described increase in extensive disease (L3 + L4). It is also not clear whether the reported increase was a result of the 10% rise in ‘complete gut investigation’ or to changes in the rate of successful ileal intubation. It is also of interest that the study reports no instances of isolated L4 disease, which have been shown to be a small but significant group in other cohorts.5 Thirdly, the paucity of data on IBD-type unclassified (IBDU) suggests that the overall incidence of IBD may in fact be significantly higher. In our recent study, we attempted to circumvent this issue by sub-analysing a group of ‘non-Crohn’s colitis’ patients (combining UC and IBDU), allowing direct comparison between cohorts.6 The continued increase in the incidence of Crohn's disease in the adolescent population described here and also recently within our cohort is certainly of interest. As Chouraki et al. suggest, future research should focus on gene–environmental interactions and factors such as diet in this age group. Declaration of personal interests: PH is funded by a Medical Research Council project grant for PICTS (G0800675). Declaration of funding interests: None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.018 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".