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Published on: October 29, 2014
Microscopic/"Backwash" Ileitis and Its Association With Colonic Disease in New Onset Pediatric Ulcerative Colitis
Robert M Najarian1, Lori A Ashworth2, Helen H Wang3
1Department of Pathology, MetroWest Medical Center, Framingham.
Insights
Microscopic ileitis occurs in 16% of pediatric ulcerative colitis (UC) patients at diagnosis and is linked to pancolitis. This finding in children with UC does not necessitate reclassification as Crohn disease.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Gastrointestinal Pathology
Background:
- Microscopic ileitis and pancolitis are known associations in adult ulcerative colitis (UC).
- The prevalence and implications of ileitis in pediatric UC remain less understood.
- This study investigated microscopic ileal inflammation in children newly diagnosed with UC.
Purpose of the Study:
- To determine the incidence of microscopic ileitis at diagnosis in pediatric UC patients.
- To explore the association between ileitis and the extent and severity of colitis in this population.
- To clarify diagnostic implications for children with UC and ileitis.
Main Methods:
- Retrospective review of colonoscopy and biopsy data from 105 treatment-naïve pediatric UC patients.
- Histological examination of ileal and colonic biopsies for inflammation.
- Assessment of endoscopic and clinical data to correlate ileitis with colitis characteristics.
Main Results:
- Microscopic ileitis was identified in 16% of pediatric UC patients at diagnosis.
- Ileal inflammation was significantly associated with endoscopic pancolitis (P=0.02).
- No significant association was found between ileitis and the histologic severity or extent of colitis.
Conclusions:
- Pediatric UC patients can present with microscopic ileitis, even with macroscopically normal terminal ileum.
- Endoscopic pancolitis is a predictor of histologic ileitis in pediatric UC.
- Microscopic ileitis in pediatric UC does not warrant reclassification as indeterminate colitis or Crohn disease.
Background:
Microscopic ileitis and its association with pancolitis in adults with ulcerative colitis (UC) have been described. The incidence of ileitis and associations with colonic disease in pediatric UC have, however, not been thoroughly investigated. This study was undertaken to examine the prevalence of microscopic ileal inflammation at the time of initial diagnosis in a cohort of children with UC.
Methods:
We reviewed colonoscopy and biopsy data at time of diagnosis from 105 children and young adults with treatment naïve UC; ileal and colonic mucosal biopsies were available on all patients. Ileal mucosal biopsies were examined for the presence and severity of ileal inflammation, and other histologic features. Concurrently obtained colonic mucosal biopsies were assessed to define the severity, distribution, and extent of disease; endoscopic and clinical follow-up data were reviewed.
Results:
A total of 107 ileal mucosal biopsies and 693 corresponding colonic mucosal biopsies were examined. Seventeen of 105 patients (16%) were found to have ileal inflammation (mean age = 10.4 years, 59% girls), 14 (82%) of whom had histologic pancolitis. The presence of ileal inflammation was significantly associated with endoscopic pancolitis (P = 0.02). The association between histologic pancolitis, severity of active inflammation in the cecum, and ascending colon suggested a possible association with ileal inflammation (P = 0.06, 0.07, and 0.08 respectively), but did not reach statistical significance.
Conclusion:
Patients with new onset UC may have microscopic ileal inflammation at time of diagnosis, even if the terminal ileum appears macroscopically normal. The presence of endoscopic pancolitis is associated with the presence of histologic ileitis. In contrast to existing studies in adults, an association between the presence of ileitis and the histologic severity or the histologic extent of colitis was not observed. Children with microscopic ileitis in the context of UC do not need to be reclassified as "indeterminate colitis" or Crohn disease.
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