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Histological features of ileitis differentiating pediatric Crohn disease from ulcerative colitis with backwash
Benjamin Sahn1, Vera De Matos2, Ronen Stein3
1Steven & Alexandra Cohen Children's Medical Center of New York, Northwell Health System, Division of Gastroenterology & Nutrition, New York, United States; The Children's Hospital of Philadelphia, Division of Pediatric Gastroenterology, Hepatology, & Nutrition, Philadelphia, PA, United States.
Insights
Distinguishing pediatric Crohn disease (CD) from ulcerative colitis (UC) with backwash ileitis (BWI) is challenging. Histological ileitis features combined with clinical data accurately identify CD in children with ileocolonic inflammation.
Area of Science:
- Pediatric Gastroenterology
- Histopathology
- Inflammatory Bowel Disease
Background:
- Pediatric ileocolonic Crohn disease (CD) can be difficult to differentiate from ulcerative colitis (UC) with backwash ileitis (BWI).
- Accurate diagnosis is crucial for appropriate management of pediatric inflammatory bowel disease (IBD).
Purpose of the Study:
- To determine the probability of diagnosing CD in children presenting with confluent colitis and ileitis.
- To evaluate the diagnostic accuracy of histological and clinical features in differentiating pediatric CD from other IBD.
Main Methods:
- Retrospective observational study of 100 newly diagnosed pediatric IBD patients.
- Two pathologists reviewed ileal biopsy specimens for 8 histological features.
- Clinical variables and histological findings were analyzed for predictive value in diagnosing CD.
Main Results:
- A combination of crypt distortion, lamina propria expansion, and acute inflammation, along with clinical variables, showed adequate discriminative validity for CD diagnosis (mean probability 0.90 vs. 0.59, p<0.001).
- The presence of these histological features, in any combination, demonstrated high specificity (92.9-100%) for CD.
- Sensitivity for CD ranged from 38.4% to 57% based on the combination of histological features.
Conclusions:
- Histological features of ileitis, when combined with clinical variables, can effectively differentiate Crohn disease from other diagnoses in children with ileocolonic inflammation.
- Certain histological findings in ileal biopsies are highly specific for diagnosing pediatric Crohn disease.
Background/Aim:
Pediatric ileocolonic Crohn disease (CD) may be difficult to distinguish from ulcerative colitis (UC) with backwash ileitis (BWI). The primary aim of the study was to determine the probability of CD in children with a confluent colitis and ileitis when newly diagnosed with inflammatory bowel disease (IBD).
Methods:
A retrospective observational study of 100 newly diagnosed patients with IBD was performed. Two pathologists reviewed ileal biopsy specimens for 8 histological features. Biopsy and clinical features were evaluated for predictive ability of a final diagnosis of CD.
Results:
The presence of crypt distortion, lamina propria (LP) expansion, and acute LP inflammation combined with 4 clinical variables in multivariate regression analysis had adequate discriminative validity when comparing the mean probability of a final CD diagnosis between CD and not-CD groups (0.90 vs. 0.59, p value <0.001). When crypt distortion, LP expansion, and acute LP inflammation are present in any combination, the sensitivity and specificity for presence of CD ranges 38.4-57% and 92.9-100%, respectively.
Conclusions:
Combining histological features of ileitis and clinical variables can adequately discriminate between the presence and absence of Crohn disease in children who present with confluent colitis and ileitis. Combined presence of certain histological features has high specificity for CD.
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