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Periappendiceal inflammation in pediatric ulcerative colitis
Caterina Strisciuglio1, Eleonora Giannetti, Francesca Paola Giugliano
1Department of Pediatrics, University of Naples "Federico II", Italy.
Insights
Periappendiceal inflammation (PAI) is a common skip lesion in pediatric ulcerative colitis (UC). It is more prevalent in newly diagnosed patients and linked to more extensive disease and higher inflammation in the ascending colon.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Endoscopic and Histologic Diagnostics
Background:
- Ulcerative colitis (UC) can present with skip lesions.
- The appendiceal orifice has been identified as a skip lesion in adult UC.
- The prevalence of periappendiceal inflammation (PAI) in pediatric UC requires further investigation.
Purpose of the Study:
- To prospectively evaluate the prevalence of PAI in children with UC using endoscopy and histology.
- To determine the association between PAI and disease characteristics in pediatric UC.
Main Methods:
- Prospective study enrolling 50 children with UC diagnosed not beyond the hepatic flexure.
- Total colonoscopy with endoscopic and histologic evaluation for PAI.
- Comparison of disease extent, inflammation grade, and clinical activity between patients with and without PAI.
Main Results:
- PAI was endoscopically detected in 32% (16/50) of pediatric UC patients.
- PAI was more frequent in newly diagnosed patients (P=0.016) and associated with a greater disease extent (P=0.013).
- Patients with PAI showed a significantly higher histologic grade of inflammation in the ascending colon (P=0.014) and higher immunosuppressant use.
Conclusions:
- PAI is a frequent skip lesion in pediatric UC.
- PAI in children with UC is associated with new diagnoses, greater disease extent, and increased histologic inflammation.
- These findings highlight the importance of evaluating the appendiceal region in pediatric UC.
Background:
An involvement of the appendiceal orifice as a distintive skip lesion in adults with left side ulcerative colitis (UC) has been reported. The aim of our prospective study was to evaluate, by endoscopy and histology, the prevalence of periappendiceal inflammation (PAI) in children affected by UC.
Methods:
Fifty of 77 consecutive children undergoing total colonoscopy, who had a diagnosis of UC not extended beyond the hepatic flexure were enrolled.
Results:
PAI was endoscopically present in 16 of 50 patients (32%) with UC. Patients were divided in 2 groups: group A included the 16 patients with PAI, whereas group B included 34 patients without PAI. We found that among the 2 groups, PAI was more frequent in patients with new diagnosis than in those with pre-existing UC (P = 0.016). At index colonoscopy, the patients of group A had a significant major extent of disease (P = 0.013). Moreover, the histologic grade of inflammation at the ascending colon was significantly higher in group A than in group B (P = 0.014). Clinical activity, measured by pediatric ulcerative colitis activity index, and use of medication did not show significant differences among groups (P = 0.464 and P = 0.723, respectively). The use of immunosuppressant was significantly higher in group A than in group B.
Conclusions:
PAI is a frequent skip lesion in children with UC. It seems more frequent in patients with new diagnosis, and it is associated with a major extent of the disease and with a higher grade of histologic inflammation at the ascending colon.
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