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Microscopic colitis in children
Wael El-Matary1, Safwat Girgis, Hien Huynh
1Division of Pediatric Gastroenterology, Hepatology and Nutrition, Stollery Children's Hospital, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada. WaelElMatary@Capitalhealth.ca
Insights
Microscopic colitis is rare in children, often presenting with watery diarrhea. Most pediatric cases, including lymphocytic and eosinophilic variants, respond well to aminosalicylic acid (5-ASA) treatment.
Area of Science:
- Pediatric Gastroenterology
- Histopathology
- Inflammatory Bowel Disease
Background:
- Microscopic colitis typically affects the elderly, presenting with chronic watery diarrhea and normal endoscopic findings.
- Histopathological examination reveals inflammatory changes, distinguishing it from other diarrheal conditions.
- Data on pediatric microscopic colitis is limited, necessitating further research.
Purpose of the Study:
- To characterize the clinical presentation and outcomes of microscopic colitis in children.
- To identify subtypes and potential contributing factors in pediatric cases.
- To evaluate treatment responses in this pediatric population.
Main Methods:
- Retrospective review of pathology and pediatric inflammatory bowel disease databases (1996-2008).
- Inclusion criteria: children under 17 years with diagnosed microscopic colitis.
- Analysis of patient charts, including diagnostic findings and treatment outcomes.
Main Results:
- Eleven children (mean age 11.2 years) were identified with microscopic colitis.
- Common subtypes included lymphocytic and nonspecific/eosinophilic microscopic colitis.
- The majority of patients responded well to mesalazine (5-ASA); immunodeficiency cases were challenging.
Conclusions:
- Microscopic colitis is a rare but distinct condition in the pediatric population.
- Microscopic eosinophilic colitis is an underrecognized variant.
- Aminosalicylic acid (5-ASA) is effective for most pediatric cases; immunodeficiency-associated cases require specialized management.
- Further multicenter pediatric trials are essential for a comprehensive understanding.
Background:
Microscopic colitis typically presents with chronic watery nonbloody diarrhea with normal endoscopy findings but abnormal inflammatory histopathological findings. As it is mainly a condition of the elderly, pediatric data is scarce.
Aims:
To describe and characterize children with microscopic colitis.
Methods:
The pathology database at the University of Alberta Hospital together with the pediatric inflammatory bowel disease database at the Stollery Children's Hospital were both searched from September 1996 to May 2008. Charts of all children under the age of 17 years who fulfilled the diagnostic criteria of microscopic colitis were examined.
Results:
Eleven children (four girls, mean age at diagnosis 11.2 years, +/- 4.4 years) fulfilled the inclusion criteria. The patients were followed up for a mean of 24.8 months (standard deviation, SD 15.2 months). Two patients were on proton pump inhibitors, two had stool organisms, and two had immunodeficiency. All patients had normal endoscopy and colonoscopy on visualization. Five patients were diagnosed with lymphocytic colitis and the rest had nonspecific/eosinophilic microscopic colitis. The majority of children responded to mesalazine. One patient with immunodeficiency was difficult to manage.
Conclusions:
Microscopic colitis is rare in children. Microscopic eosinophilic colitis is an underdescribed variant of microscopic colitis. The majority of children with microscopic colitis respond well to aminosalicylic acid (5-ASA) medications. Microscopic colitis associated with immunodeficiency can be very challenging to manage. Large multicenter pediatric trials with long-term follow-up are needed to allow investigators to have a better understanding of this rare condition in children.
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