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Upper and lower gastrointestinal endoscopy in children and adolescents with Crohn's disease: a prospective study
1Department of Gastroenterology, Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
Early endoscopy is crucial for diagnosing pediatric Crohn's disease, revealing high rates of upper gastrointestinal (GI) and colonic involvement. This aids in accurate diagnosis and disease extent assessment in children and adolescents.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Diagnostic Endoscopy
Background:
- Crohn's disease is a chronic inflammatory bowel disease affecting children and adolescents.
- Accurate diagnosis and assessment of disease extent are critical for effective management.
- The role of upper gastrointestinal endoscopy in the initial diagnosis of pediatric Crohn's disease requires further elucidation.
Purpose of the Study:
- To prospectively investigate the incidence and location of gastrointestinal involvement in children and adolescents with Crohn's disease.
- To determine the diagnostic utility of upper and lower gastrointestinal endoscopy with biopsies.
- To assess the overall extent of disease in the upper and lower GI tract.
Main Methods:
- Prospective investigation of 56 children and adolescents diagnosed with Crohn's disease.
- Performance of gastroscopy and colonoscopy regardless of presenting symptoms.
- Systematic biopsies obtained from both normal and abnormal endoscopic areas.
Main Results:
- A high incidence of upper gastrointestinal (GI) involvement was observed in 71% of patients.
- Endoscopic findings were instrumental in diagnosis for 41% of cases.
- Disease prevalence included: upper GI tract (71%), terminal ileum (53%), and colon (86%).
Conclusions:
- Upper and lower gastrointestinal endoscopy with biopsies should be performed early in the diagnostic workup.
- This approach enables accurate diagnosis and comprehensive assessment of disease extent in pediatric Crohn's disease.
- Early endoscopic evaluation is essential for timely and appropriate patient management.
Abstract:
Fifty-six children and adolescents with Crohn's disease were prospectively investigated with gastroscopy and colonoscopy irrespective of localizing symptoms or signs. Routine biopsies were taken from endoscopically normal and abnormal areas. A high incidence (71%) of upper gastrointestinal (GI) involvement was found. In 41%, these findings were instrumental in making the diagnosis. The ileum was viewed in 49 of the 56 cases. Overall, the upper GI tract was involved in 71%, the terminal ileum in 53%, and the colon in 86% (oesophagus 16%, body of stomach 46%, antrum 36%, duodenum 21%, terminal ileum 53%, caecum 69%, transverse colon 71%, sigmoid 60% and rectum 41%). Upper and lower gastrointestinal endoscopy with systematic biopsies should be performed early in the diagnostic assessment of children and adolescents with suspected inflammatory bowel disease to enable accurate diagnosis and assessment of extent of disease.