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Related Concept Videos

Inflammatory Bowel Disease II: Crohn's Disease01:30

Inflammatory Bowel Disease II: Crohn's Disease

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Introduction
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by...
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Histology of the Small Intestine01:27

Histology of the Small Intestine

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The small intestine exhibits a unique histological structure that significantly enhances its function in digestion and nutrient absorption. These structures include circular folds, villi, and various specialized cells that collectively facilitate the digestion of food.
The intestinal lining features transverse folds called circular folds, each housing fingerlike projections known as intestinal villi. These villi are covered by a layer of simple columnar epithelium, also referred to as...
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Inflammatory Bowel Disease I: Ulcerative Colitis01:27

Inflammatory Bowel Disease I: Ulcerative Colitis

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Introduction
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
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Chronic Bowel Disorders: Introduction01:17

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Chronic bowel diseases are a group of long-term conditions affecting the digestive tract, characterized by inflammation and damage to the gut lining. These conditions primarily include irritable bowel syndrome and inflammatory bowel disease.
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...
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Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy01:30

Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy

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Various diagnostic tests are employed in the diagnostic process for Inflammatory Bowel Disease (IBD), particularly to differentiate between Crohn's disease and ulcerative colitis.
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
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Renewal of Intestinal Stem Cells01:23

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The intestinal epithelial lining rapidly renews every 4 to 5 days. The renewal is facilitated by intestinal stem cells (ISCs) located at the base of the crypt– a gland located at the bottom of each villus. ISCs divide asymmetrically to form new stem cells and progenitor daughter cells. The daughter cells are called transit-amplifying (TA) cells which move upwards along the crypt and either differentiate into absorptive cells– the enterocytes or secretory cells– including the...
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Diagnosis of Hirschsprung's Disease by Immunostaining Rectal Suction Biopsies for Calretinin, S100 Protein and Protein Gene Product 9.5
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Paediatric Crohn's disease: histologic findings at initial presentation.

Smiljana Spasic1, Amaya Pankaj2, Jess L Kaplan3

  • 1Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA.

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|July 18, 2024
PubMed
Summary

Histological diagnosis of paediatric Crohn's disease (CD) can be challenging. Microgranulomas in GI biopsies are specific to CD and often overlooked, while oesophageal lymphocytosis may predict a need for aggressive treatment.

Keywords:
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Area of Science:

  • Gastroenterology
  • Paediatric Pathology
  • Inflammatory Bowel Disease

Background:

  • Histological diagnosis of paediatric Crohn's disease (CD) presents significant challenges.
  • Evaluating the histological spectrum of treatment-naïve paediatric CD biopsies is crucial for diagnostic accuracy.

Purpose of the Study:

  • To assess the diagnostic and predictive value of histological findings in paediatric CD.
  • To identify under-recognized histological features in paediatric CD.

Main Methods:

  • Retrospective analysis of gastrointestinal (GI) biopsies from three cohorts: paediatric CD (n=137), ulcerative colitis (UC) (n=116), and controls (n=50).
  • Evaluation of active and chronic inflammation, including lymphocyte-pattern oesophagitis, gastritis, terminal ileitis, colitis, granulomas, and microgranulomas.

Main Results:

  • Microgranulomas were observed in 48.9% of CD patients, often missed previously, and were specific to CD compared to UC and controls.
  • Lymphocyte-pattern oesophagitis (15%) and diffuse gastritis (50.4%) were common in paediatric CD.
  • Oesophageal lymphocytosis correlated with increased anti-tumor necrosis factor (TNF) therapy need (p=0.007).

Conclusions:

  • GI microgranulomas are specific to CD and often overlooked in paediatric cases.
  • Oesophageal lymphocytosis may indicate a need for more aggressive treatment in paediatric CD.
  • The study highlights under-recognized histological aspects of paediatric CD, including microgranuloma prevalence and gastritis patterns.