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Characteristics of Upper Gastrointestinal Tract Involvement in Korean Pediatric Crohn's Disease: A Multicenter Study
Ji Hyoung Park1, Hye Na Nam1, Ji-Hyuk Lee2
1Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.
Insights
Upper gastrointestinal involvement is common in pediatric Crohn's disease (CD), occurring in half of patients. This highlights the need for upper GIT examinations in diagnosing pediatric CD.
Area of Science:
- Gastroenterology
- Pediatric Medicine
- Inflammatory Bowel Disease
Background:
- Crohn's disease (CD) can affect any part of the gastrointestinal tract.
- Upper gastrointestinal (GIT) involvement characteristics in pediatric CD, particularly in Eastern populations, remain unclear.
Purpose of the Study:
- To determine the prevalence of upper GIT involvement in Korean pediatric CD patients.
- To identify clinical features associated with upper GIT involvement in this population.
Main Methods:
- Retrospective multicenter cohort study of 52 pediatric CD patients.
- Esophagogastroduodenoscopy and biopsy were performed.
- Clinical, endoscopic, and histologic features were analyzed based on upper GI symptoms.
Main Results:
- 50% of pediatric CD patients showed upper GIT involvement.
- Gastric ulcers (19.2%) and duodenal ulcers (15.4%) were most common endoscopic findings.
- Chronic inflammation (75.0%) was the predominant histopathologic feature; Helicobacter pylori infection was uncommon (5.8%).
Conclusions:
- Upper GIT involvement is frequent in pediatric CD, regardless of symptoms.
- Helicobacter pylori infection is rare in this cohort.
- Findings support regional guidelines for upper GIT examination in pediatric CD.
Purpose:
Crohn's disease (CD) can involve any site of the gastrointestinal tract (GIT). However, the characteristics of upper GIT involvement in CD are unclear, especially in the Eastern pediatric population. This study aimed to estimate the prevalence of upper GIT involvement and identify the clinical features of Korean children with CD.
Methods:
This was a retrospective multicenter cohort study that included 52 pediatric patients with CD who underwent esophagogastroduodenoscopy and biopsy. The clinical symptoms and endoscopic and histologic features of the upper GIT were identified according to the presence or absence of upper gastrointestinal symptoms.
Results:
Among the 52 patients, upper GIT involvement was noted in 50.0% (26/52). The mean age at CD diagnosis was 14.1±2.1 years. Gastric ulcer was the most common lesion (19.2%) found on upper GIT endoscopy, followed by duodenal ulcers (15.4%). Chronic inflammation was the most common histopathologic feature (75.0%), followed by gastric erosion (17.3%). Granuloma was found in 9.6% of patients. Helicobacter pylori infection was identified in 5.8% of patients. Endoscopic and histologic findings were not significantly different, but the mean values of erythrocyte sedimentation rate (60.7±27.1 vs. 43.0±27.6 mm/h, p=0.037) and C-reactive protein (16.5±28.2 vs. 6.62±13.4 mg/dL, p=0.014) were significantly different between patients with and without upper gastrointestinal CD symptoms.
Conclusion:
Upper GIT involvement was relatively common in pediatric patients with CD irrespective of upper gastrointestinal symptoms, and H. pylori infection was relatively uncommon. The results of this study should aid the establishment of regional guidelines for upper GIT examination.
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