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Gastral antral biopsy in the differentiation of pediatric colitides
P S Kundhal1, M O Stormon, M Zachos
1Department of Pediatrics, Division of Gastroenterology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
Insights
Gastric antral biopsies aid in differentiating pediatric Crohn's disease (CD) from ulcerative colitis (UC) when colon inflammation is unclear. Focal gastritis in antral biopsies can help confirm CD diagnosis in children.
Area of Science:
- Gastroenterology
- Pediatric Gastroenterology
- Inflammatory Bowel Disease
Background:
- Differentiating Crohn's disease (CD) from ulcerative colitis (UC) can be challenging, especially when inflammation is limited to the colon.
- Accurate diagnosis is crucial for effective treatment and management of pediatric chronic colitides.
Purpose of the Study:
- To assess the utility of baseline gastric antral biopsies in distinguishing between pediatric CD and UC.
- To evaluate if upper endoscopy findings can improve diagnostic accuracy in cases of indeterminate colitis.
Main Methods:
- A historical cohort study included 39 children and adolescents with colitis and normal small bowel radiography.
- Patients underwent concurrent upper endoscopy and colonoscopy before treatment.
- Antral histological findings were compared between groups diagnosed with colonic CD, UC, or indeterminate colitis.
Main Results:
- Granulomatous inflammation in antral biopsies led to a change in diagnosis to CD in 14% of cases (previously indeterminate or UC).
- Nonspecific antral gastritis was prevalent in both CD (92%) and UC (75%) groups.
- Focal antral gastritis was significantly more common in pediatric patients with Crohn's colitis (52%) compared to UC (8%).
Conclusions:
- Nonspecific antral gastritis is frequently observed across various forms of chronic colitis.
- Upper gastrointestinal endoscopy with biopsy is a valuable tool for differentiating CD from UC when inflammation is confined to the colon.
- This approach is particularly useful when colonoscopic findings are indeterminate, aiding in definitive diagnosis.
Objectives:
Differentiation of Crohn's disease (CD) from ulcerative colitis (UC) is problematic, primarily when inflammation is confined to the colon. In a historical cohort study, we evaluated the usefulness of baseline gastric antral biopsies in the differentiation of pediatric chronic colitides.
Methods:
During initial investigation for suspected inflammatory bowel disease, 39 children and adolescents with colitis but normal small bowel radiography underwent pretreatment upper endoscopy concurrently with colonoscopy. Two reviewers assigned a colonoscopic diagnosis (colonic CD, UC, or indeterminate colitis) based on the macroscopic and microscopic appearances of the colonic mucosa. Antral histological findings were compared between groups using Fisher's exact test.
Results:
Five (14%) of colonoscopic diagnoses (four indeterminate, one UC) were changed to CD by the finding of granulomatous inflammation in antral biopsies. Nonspecific antral gastritis was found in similar proportions of children and adolescents with Crohn's colitis and UC (92% vs 75%). Focal antral gastritis was more common in patients with Crohn's colitis than UC (52% vs 8%).
Conclusions:
Nonspecific antral gastritis is common in all forms of chronic colitis. Nevertheless, upper gastrointestinal endoscopy with biopsy is useful in the differentiation of inflammatory bowel disease confined to the colon, particularly when colonoscopic findings are indeterminate.