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Granulomatous Upper Gastrointestinal Inflammation in Pediatric Ulcerative Colitis
Karen Queliza1, Faith D Ihekweazu1, Deborah Schady2
1Department of Pediatric Gastroenterology, Hepatology and Nutrition.
Journal of Pediatric Gastroenterology and Nutrition
|October 10, 2017
Summary
Pediatric ulcerative colitis (UC) can present with granulomatous inflammation in the upper gastrointestinal tract, a finding previously unobserved. This atypical presentation in UC requires careful differentiation from Crohn disease (CD) in children.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pathology
- Inflammatory Bowel Disease
Background:
- Differentiating ulcerative colitis (UC) and Crohn disease (CD) is challenging in pediatric patients.
- Granulomatous inflammation is typically associated with CD, but has been noted in UC colonic biopsies.
- This phenomenon has not been previously described in the upper gastrointestinal (UGI) tract in UC.
Purpose of the Study:
- To report the first cases of pediatric UC with granulomatous inflammation in the UGI tract.
- To describe the clinical characteristics and outcomes of these patients.
- To aid in the differential diagnosis between UC and CD in children.
Main Methods:
- Identified seven pediatric patients with UC exhibiting granulomatous UGI lesions (gUGI).
- Diagnosed UC based on comprehensive clinical, laboratory, imaging, and endoscopic evaluations.
- Compared gUGI patients to a cohort of 149 pediatric UC patients.
Main Results:
- All gUGI cases presented with bloody diarrhea and moderate to severe pancolitis.
- Gastric/duodenal biopsies showed giant cells or granulomas near gland destruction; no small bowel involvement.
- Refractory colitis requiring colectomy was significantly more common in the gUGI group (28.6% vs 1.3%).
Conclusions:
- This study is the first to describe pediatric UC-associated granulomatous inflammation in the UGI tract.
- These gUGI lesions may represent extracolonic manifestations of severe colonic disease.
- These findings broaden diagnostic considerations for differentiating UC and CD in pediatric patients.
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