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Paneth cell metaplasia in newly diagnosed inflammatory bowel disease in children
Naomi Simmonds, Mark Furman, Evi Karanika
1Child Health Department, Royal Free Hospital, London NW3 2QG, UK. alan.bates@nhs.net.
Insights
Paneth cell metaplasia occurs in the distal colon of children with newly diagnosed idiopathic inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn
Area of Science:
- Gastroenterology
- Pediatric Pathology
- Inflammatory Bowel Disease Research
Background:
- Paneth cell metaplasia (PCM) is documented in adults, but its prevalence in pediatric populations, particularly in the colon, remains understudied.
- Understanding Paneth cell distribution and PCM occurrence in children is crucial for diagnosing and managing pediatric inflammatory bowel disease (IBD).
Purpose of the Study:
- To investigate the distribution of Paneth cells in the pediatric colon.
- To determine the characteristic occurrence of Paneth cell hyperplasia or metaplasia in children with newly diagnosed idiopathic inflammatory bowel disease (IBD).
Main Methods:
- Retrospective review of colonic biopsies from 28 children with newly diagnosed IBD and 14 children with IBD-like symptoms and normal findings.
- Paneth cells were quantified at six colonic sites; inflammation, crypt distortion, and eosinophilia were assessed semi-quantitatively.
Main Results:
- A gradient of decreasing Paneth cell numbers was observed from the cecum to the rectum in control, ulcerative colitis (UC), and Crohn's disease (CD) groups.
- Paneth cells were absent in the distal colon of controls but present in 11/13 UC and 14/15 CD patients.
- Paneth cell hyperplasia was significantly increased in the colons of UC and CD patients compared to controls, irrespective of inflammation or chronicity markers.
Conclusions:
- Paneth cells are normally confined to the proximal colon in children.
- A high proportion of pediatric IBD patients exhibit Paneth cell metaplasia in the distal colon.
- PCM in pediatric IBD is an early finding and does not correlate with histological features of chronicity.
Background:
Paneth cell metaplasia (PCM) is well described in adults but little is known about the distribution of colonic Paneth cells and the occurrence of PCM in a paediatric population. The aim of this study is to determine whether Paneth cell hyperplasia or metaplasia characteristically occurs in the colons of children with newly diagnosed idiopathic inflammatory bowel disease (IBD).
Methods:
We retrospectively reviewed colonic series from 28 new diagnoses of paediatric IBD at a tertiary referral centre, and from a further 14 children with IBD-like symptoms whose colonic biopsies and ancillary investigations were normal. Paneth cells were counted at 6 anatomical sites in the colon, and at each site acute and chronic inflammation were assessed semi-quantitatively and the presence or absence of crypt architectural distortion and eosinophilia was documented.
Results:
In control, ulcerative colitis (UC) and Crohn's disease (CD) groups there was a gradient of decreasing Paneth cell numbers from caecum to rectum. Paneth cells were not seen in the distal colon in the control group, but they were present there in 11 of 13 patients with ulcerative colitis and 14 of 15 with Crohn's disease. Only patients with IBD showed Paneth cell hyperplasia, assessed as more than 10 Paneth cells per 10 well-oriented crypts at any site. There was a statistically significant increase in Paneth cells in the caecum, ascending, transverse and descending colon in UC and in the ascending, transverse, descending and sigmoid colon in CD compared with controls. There was no significant difference between UC and CD. There was no correlation between the site of PCM and acute or chronic inflammation, crypt distortion or eosinophilia.
Conclusion:
Paneth cells are found in the proximal but not the distal colon in otherwise normal paediatric colonic series. A high proportion of UC and CD patients show PCM in the distal colon. This is present early in the disease and does not correlate with histological features of chronicity.
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