Paediatric Crohn's disease: histologic findings at initial presentation

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.