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Esophageal Crohn disease in children: a clinical spectrum
Kannan Ramaswamy1, Kevan Jacobson, Gareth Jevon
1Division of Gastroenterology, British Columbia's Children's Hospital, 4480 Oak Street, Vancouver V6H 3V4, BC, Canada.
Insights
Esophageal Crohn disease (ECD) affects children, with prevalence up to 17.6% based on histology. Symptoms and endoscopic findings in pediatric ECD are highly variable and often don't align.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Gastrointestinal Endoscopy
Background:
- Esophageal Crohn disease (ECD) incidence varies significantly in children (up to 43%) compared to adults (0.2%-11.2%).
- Understanding the clinical and endoscopic presentation of ECD in pediatric populations is crucial for accurate diagnosis and management.
Purpose of the Study:
- To determine the clinical and endoscopic spectrum of esophageal Crohn disease (ECD) in children.
- To establish the prevalence of ECD within a pediatric patient cohort.
Main Methods:
- Retrospective chart review of pediatric patients diagnosed with Crohn disease (CD).
- Definition of ECD based on established endoscopic and/or histological criteria.
- Analysis of presenting symptoms, endoscopic findings, and concurrent gastrointestinal involvement.
Main Results:
- Out of 210 children with CD, 27 (12.9%) were diagnosed with ECD.
- Upper gastrointestinal symptoms were present in 9 children; endoscopic findings varied widely, including deep ulcers, aphthous ulcers, erosions, and normal mucosa.
- Asymptomatic children also showed varied endoscopic findings, including ulcers and erosions.
- Coexisting gastric and/or duodenal lesions were observed in 26 children; all had ileo-colonic or colonic disease.
- Acid suppressive medications were administered to symptomatic children with endoscopic lesions; no children received steroids at follow-up.
Conclusions:
- The prevalence of endoscopic ECD was 7.6%, while histological evidence was found in 17.6% of the pediatric patient population.
- The clinical presentation and endoscopic findings of ECD in children are highly variable.
- There is a poor correlation between the clinical symptoms and endoscopic findings in pediatric ECD.
Background:
The incidence of esophageal Crohn disease (ECD) in adults ranges from 0.2% to 11.2% and in children is up to 43%. The aim of the study was to determine the clinical and endoscopic spectrum of ECD and its prevalence in our patient population.
Methods:
Chart review of children with Crohn disease (CD). Esophageal Crohn disease was defined by accepted endoscopic and/or histologic findings.
Results:
210 children with CD were identified; 27 of those children had ECD. Nine children presented with specific upper GI symptoms; dysphagia, heartburn, nausea, vomiting, and odynophagia. Esophagoscopy in children with upper gastrointestinal symptoms revealed deep ulcers (n = 2), aphthous ulcers (n = l), erosions (n = l), edematous nodules, (n = l) and normal mucosa (n = 4). In asymptomatic children aphthous ulcers (n = 5), erosions (n = 3), deep ulcers (n = 3), and normal looking mucosa (n = 7) were seen. Twenty children also had gastric lesions, 3 children had duodenal lesions, and 3 children had both duodenal and gastric involvement. All 27 children had evidence of ileo-colonic or colonic disease. Acid suppressive medications were given only to children with upper GI symptoms and endoscopic esophageal lesions. The mean duration of follow-up from diagnosis of CD was 3.02 years (range 2 months-11.7 years). At last follow-up review, 7 children were receiving acid suppression and no children were receiving steroids. There were no complications related to ECD.
Conclusion:
The prevalence of endoscopic ECD is 7.6% but as many as 17.6% of our patient population had histologic evidence of ECD. The clinical and endoscopic spectrum of ECD are highly variable and poorly correlate with each other.