Focal gastric inflammatory infiltrates in inflammatory bowel diseases: prevalence, immunohistochemical characteristics, and diagnostic role

Abstract

Focal gastritis is relatively common in CD patients although it is not exclusive to this condition. Its recognition could be useful in the diagnostic workup of any patient with suspected or indeterminate inflammatory bowel disease, as it makes a diagnosis of CD more likely.

Upper Gastrointestinal Involvement of Crohn’s Disease: A Prospective Study on the Role of Upper Endoscopy in the Diagnostic Work-Up

“…In agreement with a recent, prospective study [8], in our series of CD patients, we identified microscopic inflammation in approximately 60% of cases. Hp is recognized as the most common cause of upper GI lesions, and Hp-related gastritis is characterized by increased numbers of acute and chronic inflammatory cells.…”

“…In our study, FAG was detected in approximately 30% of patients with a definite CD diagnosis, but was not used in any of the cases to establish the diagnosis of upper GI tract CD in the absence of macroscopic findings; indeed, FAG is not exclusive of CD [8][9][10][11]. Although in our series, all patients had an established diagnosis of CD and both macro and microscopical criteria were used to define upper CD involvement, the lack of a definite hallmark for an upper GI tract CD could represent a study limitation.…”

“…Most of the data available in the adult population come from retrospective studies; investigations carried out in CD patients with symptoms suggesting upper GI involvement have reported the uncommon occurrence of a gastro-duodenal localization, ranging from 1 to 5% [2][3][4][5]. On the other hand, despite the low prevalence of symptomatic upper GI tract CD, routine upper endoscopy has revealed mild macroscopic gastro-duodenal lesions in 30-75% of CD patients [6,7], and microscopic inflammation in up to 70% of CD patients [8][9][10][11]. However, there is no recognized clinical correlate for these macroscopic and microscopic lesions, which may simply confirm that CD is an inflammatory pan-gastroenteric disorder.…”

The clinical significance of focal enhanced gastritis in adults with isolated ileitis of the terminal ileum

“…Previous studies have found that FEG had a prevalence of 46%-73% in Crohn's disease, suggesting FEG as a specifi c marker for Crohn's disease. [11][12][13][14] However, another report found that FEG was also commonly diagnosed (20.8%) in ulcerative colitis among children, which suggests that FEG is an indicator for infl ammatory bowel disease but does not differentiate Crohn's disease from ulcerative colitis. 25 Those fi ndings also triggered a study on FEG among a general adult patient population, which showed that FEG had a very low positive predictive value for infl ammatory bowel disease in a general population with a very low prevalence of infl ammatory bowel disease.…”

Clinical Diagnosis

“…Sonderformen einer fokal betonten Gastritis oder Granulome sind zuweilen bei Patienten mit M. Crohn nachweisbar und kön-nen daher hilfreich sein in der Differenzialdiagnose zwischen Morbus Crohn und Colitis ulcerosa, bei Oberbauchbeschwerden oder unklarer Diarrhö [57,58].…”