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Precolectomy Therapy Does Not Alter Histologic Findings Distribution in Resected Colon in Pediatric Ulcerative
Ghassan T Wahbeh1, Margaret E Lawless, David L Suskind
1*Inflammatory Bowel Disease Center, Division of Gastroenterology, Seattle Children's Hospital, University of Washington †Laboratory Medicine, Anatomic and Clinical Pathology, Seattle Children's Hospital, University of Washington ‡Seattle Children's Core for Biomedical Statistics, Seattle Children's Research Institute, Seattle Children's Hospital, University of Washington §Department of Laboratories, Seattle Children's Hospital, University of Washington.
Insights
Pre-colectomy medication use in pediatric ulcerative colitis did not alter colon inflammation patterns. This finding suggests that treatments do not affect the accuracy of diagnosing Crohn disease from surgical specimens.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Histopathology
Background:
- Medically intractable pediatric ulcerative colitis often necessitates colectomy, followed by ileoanal pouch creation.
- Post-colectomy complications can be higher in patients with Crohn disease, a diagnosis sometimes made post-surgically.
- Pediatric patients frequently receive medication before colectomy, potentially influencing surgical specimen pathology.
Purpose of the Study:
- To investigate whether pre-colectomy medication exposure affects the distribution of inflammation in the resected colon of pediatric ulcerative colitis patients.
- To assess the impact of medication on diagnostic accuracy when differentiating ulcerative colitis from Crohn disease based on surgical specimens.
Main Methods:
- Retrospective cohort study of 32 pediatric ulcerative colitis cases undergoing colectomy (2007-2014).
- Independent histological review of resected colon by two blinded pathologists using the modified Riley score for proximal, transverse, and distal segments.
- Linear mixed-effects models analyzed associations between inflammation scores, medication use, and clinical factors.
Main Results:
- Inflammation distribution varied: 38% showed decreasing scores distally, 25% increasing, and 37% no change.
- Corticosteroids and anti-tumor necrosis factor antibodies were the most common pre-colectomy treatments.
- No statistically significant association was found between medication exposure (single or combined), sex, age, or disease duration and inflammation distribution.
Conclusions:
- Pre-colectomy therapy does not appear to influence the spatial distribution of acute/active inflammation within the resected colon.
- Findings suggest that medication use is unlikely to confound the histological diagnosis of inflammatory bowel disease in pediatric colectomy specimens.
Objectives:
Medically intractable pediatric ulcerative colitis can lead to colectomy after which patients commonly receive an ileoanal pouch. Postoperative complications are more common in patients with Crohn disease, a diagnosis that may be rendered after the colectomy specimen is examined. Because most children are likely to be exposed to medications before colectomy, we sought to examine whether such exposure influences the distribution of the inflammation within the resected colon and therefore potentially raise questions about the diagnosis accuracy.
Methods:
We conducted a retrospective cohort study of 32 pediatric ulcerative colitis cases undergoing colectomy from 2007 to 2014 for clinical data and precolectomy treatment history. The resected colon histology was reviewed independently by 2 blinded pathologists. The acute/active inflammation was scored using the modified Riley score for 3 colonic segments (proximal, transverse, and distal colon) for each patient. Linear mixed-effects models were used to evaluate possible association between acute/active inflammation scores at various sites and medication use.
Results:
Twelve cases (38%) showed decreasing acute inflammation score distally to proximally, 8 (25%) had increasing scores, and 12 cases showed no change. Patients were most commonly exposed to corticosteroids, followed by anti-tumor necrosis factor antibodies. There was no statistically or clinically significant change in the histologic scores across the colonic segments of the resected colon in association with exposure to any specific medication or combination of medications, sex, age at diagnosis and surgery, or duration of disease.
Conclusions:
Precolectomy therapy does not seem to influence the distribution of inflammation within the resected colon.
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