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Histologic Correlates of Clinical and Endoscopic Severity in Children Newly Diagnosed With Ulcerative Colitis
Brendan Boyle1, Margaret H Collins, Zhu Wang
1*Nationwide Children's Hospital, Columbus †Cincinnati Children's Hospital Medical Center, Cincinnati, OH ‡Connecticut Children's Medical Center, Hartford, CT §Children's Hospital of Eastern Ontario, Ottawa ∥Hospital for Sick Children, Toronto, ON, Canada ¶Emory Children's Center, Atlanta, GA #Cohen Children's Medical Center, New Hyde Park ‡‡Goryeb Children's Hospital/Atlantic Health, Morristown §§Women & Children's Hospital of Buffalo WCHOB, Buffalo, NY **Hasbro Children's Hospital, Providence, RI ††Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA ∥∥Riley Children's Hospital Indiana University School of Medicine, Indianapolis, IN ¶¶University of California, San Francisco, CA ##UT Southwestern, Dallas, TX ***Children's Hospital of Philadelphia, Philadelphia, PA †††Medical College of Wisconsin, Milwaukee, WI ‡‡‡Boston Children's Hospital, Boston, MA.
Insights
Pediatric ulcerative colitis (UC) in children shows common rectal inflammation and chronic changes. Low eosinophilic inflammation and surface villiform changes may correlate with severe disease activity.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pathology
- Inflammatory Bowel Disease Research
Background:
- Ulcerative colitis (UC) is a chronic inflammatory bowel disease affecting the colon.
- Early histological characterization in pediatric UC is crucial for understanding disease progression.
- The PROTECT Study provides a unique inception cohort for pediatric UC research.
Purpose of the Study:
- To characterize rectal histology in newly diagnosed pediatric ulcerative colitis (UC) patients.
- To investigate the relationship between histological findings and clinical disease severity indices.
- To identify potential histological markers associated with UC activity in children.
Main Methods:
- Analysis of baseline rectal biopsies from 369 children newly diagnosed with UC (age ≤ 17).
- Histological evaluation included acute/chronic inflammation, eosinophilic inflammation, and chronic changes.
- Correlation of histological findings with Mayo endoscopy subscore and Pediatric Ulcerative Colitis Activity Index (PUCAI).
Main Results:
- High prevalence of cryptitis (89%), crypt abscesses (25%), and eosinophilic inflammation (58%).
- Crypt distortion/atrophy was observed in 98% of specimens.
- Severe clinical scores (Mayo, PUCAI) were associated with specific histological features, including basal plasmacytosis, lymphoid aggregates, surface villiform changes, and notably, lower eosinophilic inflammation.
Conclusions:
- Acute, chronic, and eosinophilic inflammation are common in newly diagnosed pediatric UC.
- Histological findings like basal plasmacytosis, lymphoid aggregates, and villiform changes correlate with disease severity.
- The clinical significance of low eosinophilic inflammation and villiform changes in pediatric UC warrants further investigation.
Abstract:
To characterize rectal histology in an inception cohort of children newly diagnosed with ulcerative colitis (UC) and to explore its relationship with clinical indices of disease severity. The PROTECT (Predicting Response to Standardized Pediatric Colitis Therapy) Study enrolled children 17 years of age and younger newly diagnosed with UC. Baseline rectal biopsies were evaluated for acute and chronic inflammation, eosinophilic inflammation (peak eosinophil count > 32 eosinophils/high powered field, eosinophilic cryptitis or abscesses), and architectural/nonarchitectural chronic changes. Correlation with clinical indices including Mayo endoscopy subscore and Pediatric Ulcerative Colitis Activity Index was performed. Rectal biopsies from 369 patients (mean age, 12.9±3.1 y, 50% female) were reviewed. Cryptitis was found in 89%, crypt abscesses in 25%, and eosinophilic inflammation in 58%. Crypt distortion/atrophy was present in 98% of specimens. Higher grades of acute and chronic inflammation were associated with the presence of basal plasmacytosis (P<0.0001), basal lymphoid aggregates (P<0.0001), and surface villiform changes (P<0.0001). A severe Mayo endoscopy subscore was most common among those with severe acute and chronic inflammation, although this relationship was not linear. Severe Pediatric Ulcerative Colitis Activity Index scores were associated with the absence of or only mild eosinophilic inflammation (<32 eosinophils/high powered field) (P<0.03) and the presence of surface villiform changes (P<0.005). Acute and chronic inflammation, eosinophilic inflammation and chronic changes are common in children newly diagnosed with UC. The clinical and biological implication of low to absent eosinophilic inflammation and the presence of surface villiform changes requires further study.
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