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Diagnostic role of upper gastrointestinal endoscopy in pediatric inflammatory bowel disease
S P Castellaneta1, N A Afzal, M Greenberg
1University Department of Paediatric Gastroenterology, Department of Histopathology, Royal Free Hospital, London, UK.
Insights
Upper gastrointestinal endoscopy is crucial for diagnosing inflammatory bowel disease (IBD) in children, even without specific symptoms. This diagnostic tool aids in differentiating Crohn disease (CD) and ulcerative colitis (UC) when ileo-colonoscopy is inconclusive.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Endoscopy
- Inflammatory Bowel Disease Research
Background:
- Distinguishing ulcerative colitis (UC) and Crohn disease (CD) can be challenging with ileo-colonoscopy alone due to non-specific findings.
- Previous studies suggest upper gastrointestinal endoscopy may aid in diagnosis for inflammatory bowel disease (IBD).
Purpose of the Study:
- To prospectively evaluate the diagnostic importance of upper gastrointestinal endoscopy in pediatric IBD cases.
- To identify factors predicting upper gastrointestinal involvement in children with IBD.
Main Methods:
- A prospective study of pediatric patients over two years, utilizing ileo-colonoscopy and barium meal follow-through.
- Patients with confirmed UC procto-sigmoiditis were excluded; remaining patients underwent upper gastrointestinal endoscopy.
- Diagnostic criteria and methodology were pre-established.
Main Results:
- Upper gastrointestinal endoscopy confirmed CD in an additional 20.4% of 54 pediatric IBD patients.
- Upper gastrointestinal inflammation was present in 22% of patients, most commonly in the stomach (67%), esophagus (54%), and duodenum (22%).
- Predictive factors for upper GI involvement included epigastric pain, nausea, vomiting, weight loss, and pan-ileocolitis; however, 31% of affected children were asymptomatic.
Conclusions:
- Upper gastrointestinal endoscopy should be a first-line investigation for suspected pediatric IBD.
- The absence of specific upper gastrointestinal symptoms does not rule out the presence of inflammation in these cases.
Background:
Discrimination between ulcerative colitis (UC) and Crohn disease (CD) may be difficult on ileo-colonoscopy alone because of a lack of definitive lesions. Retrospective studies show upper gastrointestinal endoscopy may be helpful in confirming diagnosis in such cases.
Aims:
To prospectively determine importance of upper gastrointestinal endoscopy in diagnosis of inflammatory bowel disease (IBD) and assess factors predictive of upper gastrointestinal involvement in IBD.
Methods:
All pediatric patients were enrolled prospectively and consecutively over a 2-year period and investigated with an ileo-colonoscopy and barium meal follow-through. Children with procto-sigmoiditis, later confirmed histologically to be typical of UC, were excluded from the study. The remainder underwent upper gastrointestinal endoscopy. The protocol and methodology were determined a priori.
Results:
65 children suspected of IBD underwent colonoscopy. Of the total, 11 had recto-sigmoiditis with typical macroscopic appearances of UC; once this was confirmed on histology these patients were excluded from the study. Of the 54 children (males, 31; median age, 11.1 years) remaining, 23 were initially diagnosed with CD on ileo-colonoscopy and 18 (33%) were diagnosed with UC. The diagnosis remained ambiguous in 13 (six colonic, four ileo-colonic, three normal colon) on clinical, radiologic and histologic grounds. Upper GI endoscopy helped to confirm CD in a further 11 (20.4%). Two patients were diagnosed with indeterminate colitis. Upper gastrointestinal inflammation was seen in 29 of 54 (22 CD; 7 UC ). Epigastric and abdominal pain, nausea and vomiting, weight loss and pan-ileocolitis were predictive of upper gastrointestinal involvement (P < 0.05). However, 9 children with upper gastrointestinal involvement were asymptomatic at presentation (31%). Overall upper gastrointestinal tract inflammation was most common in the stomach (67%), followed by the esophagus (54%) and duodenum (22%).
Conclusions:
Upper gastrointestinal tract endoscopy should be part of the first-line investigation in all new cases suspected of IBD. Absence of specific upper gastrointestinal symptoms do not preclude presence of upper gastrointestinal inflammation.
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