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Clinicopathologic Characterization of Lymphocytic Colitis in the Pediatric Population
Iván A González1, Maire Conrad2, Sarah Weinbrom2
1Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Insights
Pediatric lymphocytic colitis (LC) is linked to immune issues, particularly celiac disease. Treatments offered limited symptom relief, and biopsies showed persistent LC, indicating a need for further research.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Colorectal Diseases
Background:
- Lymphocytic colitis (LC) in children is often associated with immune system dysregulation.
- Understanding pediatric LC is crucial due to its link with immune-mediated conditions.
Purpose of the Study:
- To investigate the clinical characteristics, associated conditions, and treatment outcomes of pediatric lymphocytic colitis.
- To explore the relationship between pediatric LC and immune dysregulation, including celiac disease.
Main Methods:
- A single-center retrospective study identified 50 pediatric patients diagnosed with LC.
- Data collected included patient demographics, comorbidities, medications, and gastrointestinal findings from biopsies and endoscopies.
Main Results:
- The study identified 50 pediatric patients with LC, with 32% having known immune dysregulation and 8% diagnosed with celiac disease.
- Common symptoms and treatments showed limited efficacy (<50% improvement), and repeat colonoscopies revealed persistent LC histologically.
- Associated gastrointestinal findings included increased intraepithelial lymphocytes in the duodenum and terminal ileum.
Conclusions:
- Pediatric LC is associated with immune-mediated conditions, notably celiac disease.
- Current treatments provide suboptimal symptomatic relief, and histologic persistence of LC is common even after treatment.
Background:
Lymphocytic colitis (LC) in the pediatric population has been associated with immune dysregulation.
Methods:
Single-center retrospective study of pediatric LC.
Results:
50 patients (35 female, 70%) with a median age of 12 years at diagnosis (interquartile range: 5.7-15.8) of LC were identified. At presentation, 11 patients (22%) had malnutrition, 16 (32%) had a known underlying immune dysregulation, 4 (8%) had celiac disease (CD), and none had a diagnosis of inflammatory bowel disease. The most common medications prior to diagnosis were non-steroidal anti-inflammatory drugs, proton pump inhibitor, and selective serotonin reuptake inhibitors (10% each). Colonic biopsies showed a median number of intraepithelial lymphocytes (IELs)/100 epithelial cells of 48 (range: 25-85), and only 10% of cases had neutrophilic cryptitis. Upper gastrointestinal tract findings included lymphocytic esophagitis (4%), and duodenal IELs without and with villous blunting (9% each) (n: 47). Ten patients (23%) had increased IELs in the terminal ileum (n: 43). Treatments including 5-ASA, budesonide, prednisone, and gluten-free diet improved symptoms in <50% of patients (n: 42), and all follow-up colonoscopies showed persistent LC (n: 13).
Conclusion:
Our study supports the association of LC with immune-mediated conditions, most commonly celiac disease. Symptomatic improvement was seen in <50% of patients with none of the patients with repeat colonoscopy showing histologic improvement.
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