Gastral antral biopsy in the differentiation of pediatric colitides

Abstract

Nonspecific antral gastritis is common in all forms of chronic colitis. Nevertheless, upper gastrointestinal endoscopy with biopsy is useful in the differentiation of inflammatory bowel disease confined to the colon, particularly when colonoscopic findings are indeterminate.

Gastroduodenitis associated with ulcerative colitis

“…Since Crohn's disease (CD), another IBD, can affect any portion of the digestive tract, the difference in distribution is one of the most common methods of discriminating between UC and CD; however, several cases of UC with upper gastrointestinal (GI) involvement have been reported recently. [1][2][3][4][5][6][7][8][9][10][11] The majority of such patients have duodenitis resembling UC both macroscopically and microscopically. [1][2][3] Greater spreading infl ammation such as gastroduodenitis or enteritis was also reported.…”

“…However, in pediatric patients, not only case reports 7 but also a few case series have been published. [8][9][10][11] A high prevalence of histological gastritis was found in 50%-94% of pediatric patients with UC. [8][9][10][11] In a controlled study, duodenitis was more common in pediatric patients with UC (23%) than in control patients (9%).…”

“…[8][9][10][11] A high prevalence of histological gastritis was found in 50%-94% of pediatric patients with UC. [8][9][10][11] In a controlled study, duodenitis was more common in pediatric patients with UC (23%) than in control patients (9%). 8 These reports have cast doubt on whether upper GI involvement of UC is an unusual complication, although so-called indeterminate colitis (IC) shows a higher proportion in pediatric IBD than in adults.…”

Challenging Question: Can We Diagnose Crohn's Disease without Histology?

“…As recently reported, gastric erosions or nonserpiginous small ulcers were found in 11/260 (4.2%) patients with UC in the Eurokids registry [12]. Nonspecific histologic gastritis is common in both UC and CD; focal antral gastritis may be more specific for CD [13]; the finding of granulomata on gastric antral biopsy may clarify a diagnosis of CD in the setting of colonic IBD that might otherwise be labeled IBD-U [13]. In a recent review, the detection of granulomata at upper endoscopy (but not elsewhere) in pediatric CD patients ranged from 2 to 21% [14].…”

“…In the setting of predominantly colonic IBD, caution must be exercised in interpreting all gastric or duodenal inflammation as indicative of CD [13]. As recently reported, gastric erosions or nonserpiginous small ulcers were found in 11/260 (4.2%) patients with UC in the Eurokids registry [12].…”