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Pediatric Crohn's Disease in the Upper Gastrointestinal Tract: Clinical, Laboratory, Endoscopic, and
Dunja Putniković1, Jovan Jevtić1, Nina Ristić2
1Institute of Pathology "Prof. dr Đorđe Joannović", Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
Insights
Pediatric Crohn's disease (CD) patients showed reduced symptoms and improved lab markers like fecal calprotectin and CRP after treatment. Regular assessments are crucial for monitoring disease progression, especially in the lower GI tract.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Gastroenterology
Background:
- Crohn's disease (CD) is a chronic, immune-mediated gastrointestinal disorder.
- Pediatric CD often presents with more extensive disease, including upper GI tract involvement.
- Histopathological patterns vary in pediatric CD, necessitating detailed analysis.
Purpose of the Study:
- To analyze clinical, laboratory, endoscopic, and histopathological findings in pediatric CD patients.
- To compare initial and follow-up test results in children with Crohn's disease.
- To assess disease progression and treatment effectiveness in pediatric CD.
Main Methods:
- Included 100 pediatric CD patients undergoing endoscopic and histopathological (HP) procedures.
- Compared results from multiple biopsies over an 8-year period.
- Analyzed clinical symptoms, laboratory values (fecal calprotectin, CRP, albumin), and endoscopic findings.
Main Results:
- Significant reduction in symptoms: stool changes (65.52% to 18.18%), weight loss (35.24% to 4%), abdominal pain (41.86% to 6.67%).
- Improved laboratory values: fecal calprotectin (1000 to 60.8 μg/g), CRP (12.2 to 1.9 mg/L), albumin (36 to 41 g/L).
- Upper GI tract involvement found in 32 patients; disease progression noted in the rectum and descending colon, but not the upper GI tract.
Conclusions:
- Follow-up examinations reveal a significant decrease in pediatric CD symptom frequency and improved laboratory markers.
- Regular clinical, laboratory, endoscopic, and histopathological assessments are vital for managing pediatric CD.
- Over a third of patients had specific upper GI endoscopic/HP findings, highlighting the importance of comprehensive evaluation.
Abstract:
Crohn's disease (CD) is a progressive, multifactorial, immune-mediated disease characterized by chronic inflammation of any part of the gastrointestinal (GI) tract. Pediatric patients present with a more extensive form of the disease, especially in the upper GI tract with various histopathological inflammatory patterns. Our study aims to analyze the clinical, laboratory, endoscopic, and histopathological findings in children with diagnosed CD and compare results on the initial and follow-up tests. We have included 100 children and adolescents with CD, with performed endoscopic and histopathological (HP) procedures. The results of multiple biopsies executed in these 8 years were matched and compared. We found a statistically significant frequency reduction in stool changes (65.52% to 18.18%), weight loss (35.24% to 4%), and abdominal pain (41.86% to 6.67%) as presenting symptoms. There was an improvement in all laboratory values: fecal calprotectin (1000 to 60,8 μg/g), C-reactive protein (12.2 to 1.9 mg/L), and albumin (36 to 41 g/L). On esophagogastroduodenoscopy and ileo-colonoscopy 36.59% and 64.86% patients had specific findings, respectively. A total of 32 patients had evidence of Crohn's disease in the upper GI tract. Non-caseating granulomas were found on 9% of oesophageal, 18% of gastric, and 12% of duodenal biopsies. In the lower GI tract, we have observed a disease progression in the rectum (72.29 to 82.22%) and descending colon (73.49 to 80%). There was no registered disease progression in the upper GI tract. Our study demonstrated a significant decline in the frequency of symptoms and an improvement in laboratory values on the follow-up examinations. More than a third of our patients had specific endoscopic and HP findings in the upper GI tract, and an additional 23% had HP findings highly suggestive of CD. We demonstrated the importance of regular clinical, laboratory, endoscopic, and histopathological assessments of pediatric CD patients.
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