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Comparison of Duodenal Strictures Between Crohn's and Non-Crohn's Diseases in Children
Ji Won Youn1, Jong Woo Hahn1,2, Hye Ran Yang1,2
1Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
Purpose:
This study aimed to compare the clinical features and laboratory findings of duodenal strictures caused by Crohn's disease (CD) with those of other etiologies in children.
Methods:
We recruited children diagnosed with duodenal strictures through a full investigation. Clinical, laboratory, endoscopic, and radiological data at diagnosis were collected retrospectively.
Results:
Of the 11 included patients, four were diagnosed with CD, four with eosinophilic gastrointestinal disorder (EGID), and the other three were grouped together (Helicobacter-associated in one and idiopathic disease in two). Serum anti-Saccharomyces cerevisiae antibody (ASCA) was positive in four of four (100%) CD cases, four of four (100%) EGID cases, and none (0%) of the other cases (p=0.011). The median fecal calprotectin concentration was 994 mg/kg in the CD group (range: 626-2,118 mg/kg), 548 mg/kg in the EGID group (range: 458-1,056 mg/kg), and 124 mg/kg in one patient in the other group (p=0.313). Surgery for duodenal obstruction was performed in four patients (one with CD and three with idiopathic and Helicobacter-associated conditions) (p=0.021), and balloon dilation was performed in one patient with CD and one other patient.
Conclusion:
Although acquired duodenal strictures are rare in children, they can develop in pediatric patients with CD or EGID. The measurement of serum ASCA and fecal calprotectin levels before endoscopic and histopathological investigations may identify the presence of organic causes of duodenal strictures in children.
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