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Clinical analysis and identification of pediatric patients with colonic ulceration
Yaying You1,2,3, Yijing Tao1,2,3, Yanwen Xu1
1Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
Insights
Inflammatory bowel disease (IBD) accounts for less than half of pediatric colonic ulcers. Key indicators like weight loss, perianal lesions, and specific blood markers help differentiate IBD from other conditions in children.
Area of Science:
- Pediatric Gastroenterology
- Internal Medicine
- Clinical Diagnostics
Background:
- Numerous diseases can mimic Inflammatory Bowel Disease (IBD).
- Accurate diagnosis of colonic ulcers in children is crucial to avoid misdiagnosis.
- This study focuses on differentiating IBD from other causes of colonic ulcers in pediatric patients.
Purpose of the Study:
- To identify clinical, laboratory, and endoscopic indicators that distinguish pediatric Inflammatory Bowel Disease (IBD) from other causes of colonic ulcers.
- To reduce misdiagnosis rates among children presenting with colonic ulcers.
Main Methods:
- Retrospective analysis of 86 pediatric patients with colonoscopically detected colonic ulcers.
- Comparison of clinical characteristics, laboratory findings, endoscopic features, and histopathology between IBD and non-IBD groups.
- Multivariate analysis to identify significant diagnostic predictors for pediatric IBD with colonic ulcers.
Main Results:
- Inflammatory Bowel Disease (IBD) was diagnosed in only 43% of pediatric patients with colonic ulcers.
- Children with IBD showed higher rates of weight loss, perianal lesions, oral ulcers, and elevated inflammatory markers (e.g., NLR, ESR, CRP).
- Lower hemoglobin and albumin levels were observed in pediatric IBD patients. Hemoglobin, NLR, ulceration score, and pseudopolyps were significant predictors for diagnosing pediatric IBD.
Conclusions:
- Several indicators, including clinical symptoms, laboratory markers (hemoglobin, NLR), and endoscopic findings (ulceration score, pseudopolyps), can aid in the prudent diagnosis of pediatric IBD.
- Distinguishing IBD from other disorders causing colonic ulcers in children requires a comprehensive evaluation of these potential indicators.
Background:
A wide variety of diseases mimic inflammatory bowel disease (IBD). This study aimed to reduce the misdiagnosis among children with colonic ulcers.
Methods:
Eighty-six pediatric patients with colonic ulcers detected by colonoscopy were enrolled in the retrospective study. Children were divided into different groups according to the final diagnosis. The clinical characteristics, laboratory examinations, endoscopic findings, and histopathological results were compared.
Results:
IBD (n = 37) was just responsible for 43% of patients with colonic ulceration. Other diagnosis included autoimmune diseases (n = 9), infectious enteritis (n = 13), gastrointestinal allergy (n = 8), and other diseases (n = 19). Comparing IBD and non-IBD groups, children with IBD had a higher frequency of symptoms like weight loss/failure to thrive (P < 0.001), perianal lesions (P = 0.001), and oral ulcers (P = 0.022), and higher expression levels of platelet (P = 0.006), neutrophil-to-lymphocyte ratio (NLR) (P = 0.001), erythrocyte sedimentation rate (P < 0.001), C-reactive protein (P < 0.001), Immunoglobulin G (P = 0.012), Interleukin-1β (P = 0.003), Interleukin-6 (P = 0.024) and TNF-α (P = 0.026), and a wider ulcer distribution in the lower gastrointestinal tract (LGIT) (P < 0.001). Expression levels of hemoglobin (P < 0.001) and albumin (P = 0.001) were lower in IBD patients. Multivariate analysis showed hemoglobin, NLR, Score of ulceration in LGIT, and pseudopolyps contributing to the diagnosis of pediatric IBD with colonic ulcers.
Conclusions:
We displayed potential indicators to help diagnose pediatric IBD differentiating from other disorders with colonic ulcers more prudently.
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