Ulcerative jejunitis in a child with celiac disease

Area of Science:

• Pediatric Gastroenterology
• Gastrointestinal Endoscopy
• Celiac Disease Pathophysiology

Background:

• Celiac disease presents with diverse manifestations, including ulcerative jejunitis, a rare complication primarily documented in adults with refractory celiac disease.
• This report focuses on the first described pediatric case of ulcerative jejunitis in celiac disease.

Observation:

• A 9-year-old girl with abdominal pain and vomiting, initially inconclusive for celiac disease, underwent capsule endoscopy.
• Video capsule endoscopy revealed delayed villous appearance and jejunal mucosal ulcerations, leading to further diagnostic investigations.
• Immunohistochemical and PCR studies identified specific T cell populations within the jejunal mucosa.

Findings:

• Capsule endoscopy was crucial for diagnosing both celiac disease and ulcerative jejunitis in this pediatric patient.
• The patient was diagnosed with celiac disease and ulcerative jejunitis, confirmed by push enteroscopy and biopsies.
• A strict gluten-free diet resulted in complete endoscopic and histological normalization of the small bowel within one year.

Implications:

• Ulcerative jejunitis in pediatric celiac disease is described for the first time.
• Capsule endoscopy is a valuable tool for diagnosing celiac disease and associated ulcerative jejunitis in children.
• This case suggests that ulcerative jejunitis in pediatric celiac disease may not always indicate refractory disease and can have a positive outcome with dietary management.