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Chronic Salmonella Infection Induced Intestinal Fibrosis
Published on: September 22, 2019
Paediatric Ulcerative Colitis Is a Fibrotic Disease and Is Linked with Chronicity of Inflammation
Ilyssa O Gordon1, Suha Abushamma2, Jacob A Kurowski3
1Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Insights
Pediatric ulcerative colitis patients show submucosal fibrosis and thickened muscularis mucosa. These changes correlate with inflammation severity and chronicity, indicating ulcerative colitis is a progressive disease in children.
Area of Science:
- Gastroenterology
- Pediatric Pathology
- Inflammatory Bowel Disease Research
Background:
- Intestinal fibrosis is recognized in adult ulcerative colitis, impacting patient symptoms.
- Limited data exists on fibrosis presence and characteristics in pediatric ulcerative colitis.
Purpose of the Study:
- Characterize fibrosis in pediatric ulcerative colitis patients.
- Investigate the link between fibrosis, inflammation severity, and chronicity.
- Explore associations with clinical factors.
Main Methods:
- Single-center cross-sectional study of pediatric ulcerative colitis patients (ages 1-18) undergoing colectomy/proctocolectomy.
- Histopathological grading of inflammation and fibrosis in colon and rectal tissue sections.
- Prospective collection of clinical data.
Main Results:
- Fibrosis was present in pediatric ulcerative colitis patients, with submucosal fibrosis and muscularis mucosa thickening observed.
- The presence, chronicity, and degree of inflammation correlated with fibrosis.
- Submucosal fibrosis burden was associated with prior anti-tumour necrosis factor (anti-TNF) therapy.
Conclusions:
- Pediatric ulcerative colitis is associated with significant colorectal fibrosis.
- Fibrosis correlates with inflammation, suggesting it's a complication of the disease.
- Ulcerative colitis should be viewed as a progressive condition in pediatric patients.
Background And Aims:
Intestinal fibrosis has recently been characterised in adult ulcerative colitis and may affect motility, diarrhoea, and the symptom of urgency. We aimed to charactersze the presence of fibrosis in paediatric patients with ulcerative colitis, and its link to severity and chronicity of mucosal inflammation, as well as clinical factors of severity.
Methods:
We performed a single-centre cross-sectional study in children ages 1-18 years with ulcerative colitis, undergoing colectomy or proctocolectomy. Tissue cross-sections were derived from proximal, mid, and distal colon and rectum, and inflammation and fibrosis were graded based on previously developed scores. Clinical data were collected prospectively.
Results:
From 62 patients, 205 intestinal sections were evaluated. Median age at diagnosis was 13 years, 100% had extensive colitis, and all resections were done for refractory disease. The presence, chronicity, and degree of inflammation were linked with the presence of fibrosis. Thickness of the muscularis mucosa was also linked with presence and chronicity of inflammation. The overall submucosal fibrosis burden was associated with prior anti-tumour necrosis factor use.
Conclusions:
Paediatric patients with ulcerative colitis exhibit colorectal submucosal fibrosis and muscularis mucosa thickening, which correlate with the presence, chronicity, and degree of mucosal inflammation. Fibrosis should be recognised as a complication of paediatric ulcerative colitis, and ulcerative colitis should be considered a progressive disease.
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