Clinical, Endoscopic, and Upper Gastrointestinal Histological Manifestations in Pediatric Inflammatory Bowel Disease:
Allen Choi1, Eyas Alzayadneh1, Patrick Breheny2
1Department of Pathology, University of Iowa, Iowa City, IA, USA.
Background:
Upper GI involvement is common in pediatric IBD, but the relative frequencies of specific endoscopic and histologic abnormalities at diagnosis remain poorly defined.
Objective:
To determine whether specific upper GI endoscopic and histologic features differ among pediatric Crohn disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC) at diagnosis.
Methods:
We retrospectively analyzed 243 pediatric patients (<18 years) with newly diagnosed IBD (CD 64.6%, UC 31.2%, IC 4.1%). Clinical parameters, upper GI endoscopic findings, and histologic features were compared using Fisher's exact and non-parametric tests.
Results:
Age at diagnosis, gender, BMI, and fecal calprotectin did not differ among CD, UC, and IC. Primary sclerosing cholangitis was more prevalent in UC (5.3%, P = .04), and eosinophilic esophagitis was more frequent in IC (20%, P = .03). CD showed more esophageal erosions/aphthae (12%, P < .01), gastric erosions/ulcers (24% vs UC 17%, P < .01), and duodenal erosions/ulcers (35%, P < .01). Histologically, lymphocytic esophagitis (29%, P < .001), epithelioid granulomas (14%, P < .001), and active duodenitis (28%, P = .007) were significantly more common in CD.
Conclusions:
Upper GI abnormalities are not limited to CD. Specific upper GI features-particularly lymphocytic esophagitis, epithelioid granulomas, and active duodenitis-are more strongly associated with CD at diagnosis and may assist subclassification in challenging pediatric IBD cases.
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