Prevalence and Clinical, Endoscopic, and Pathological Features of Duodenitis in Children

Abstract

Objectives While gastritis and esophagitis are well studied in children, there is very limited literature on duodenitis in children. We aimed to assess the prevalence, etiology, clinical, endoscopic, and pathological features in a large cohort of unselected children with duodenitis. Methods We reviewed the pathology reports of all upper endoscopies performed at our institution over 5 years to identify children with duodenitis. Biopsy sections were reviewed to confirm the diagnosis of duodenitis. Demographic, clinical, endoscopic data and presence of associated gastritis and esophagitis were noted in all children with duodenitis. Etiology of duodenitis was correlated with the patient's clinical diagnosis. Results Out of 2772 children who had endoscopy, 352 had duodenitis with the prevalence rate of 12.7%. Gastritis was seen in 64% of children with duodenitis compared with 46% of children without duodenitis (P < 0.001). Common indications for endoscopy in children with duodenitis were abdominal pain, positive celiac serology and diarrhea. The most common etiology was celiac disease (32%), followed by Crohn's disease (13%), ulcerative colitis (3%), and Helicobacter pylori infection (6%). In 63% of cases, endoscopic appearance of duodenum was normal. Cryptitis, villous changes and cellular infiltration were noted on histology. Conclusions Prevalence of duodenitis is 12.7% in children undergoing endoscopy. Celiac disease and inflammatory bowel disease are common causes of duodenitis. Associated gastritis is common in children with duodenitis and correlation of endoscopic appearance with histology is poor.

Upper gastrointestinal tract involvement of pediatric inflammatory bowel disease: A pathological review

“…Alper et al[34] reported that duodenitis is identified in 12.7% of children undergoing endoscopy with celiac disease and IBD as the most common etiologies. The prevalence of duodenitis in childhood CD and UC ranges from 33%-48% and 0%-29%, respectively[13,35-37].…”

“…The prevalence of duodenitis in childhood CD and UC ranges from 33%-48% and 0%-29%, respectively[13,35-37]. More than half of children with biopsy-proven duodenitis demonstrate unremarkable duodenal mucosa on endoscopy[34]. Macroscopic abnormalities associated with duodenitis include edema, erythema, erosions, scalloping, and ulcers[34].…”

Prediction of esophageal and gastric histology by macroscopic diagnosis during upper endoscopy in pediatric celiac disease

“…Long et al[ 18 ] reported a sensitivity of 54% and specificity of 92% for prediction of duodenal histology by macroscopic findings in pediatric biopsy-proven duodenitis. A recent article investigated duodenitis in children with multiple gastrointestinal diagnoses, including CD, and found a sensitivity of 34% for endoscopic diagnosis in predicting duodenal histology[ 19 ]. Lastly, Sheiko et al[ 20 ] reported the correlation of macroscopic and histologic findings in 1000 pediatric patients with a variety of gastrointestinal concerns, 6.6% of who had histology consistent with celiac disease.…”

Ultrasonographic indices of skin changes in children with Helicobacter pylori-associated gastroduodenitis combined with food allergy

“…The incidence of CGD associated with Helicobacter pylori (H. pylori) infection varies according to the age of the child, being 20% in children aged 4-9 years, 40% in children aged between 10-14 years, and 52-70% in children over 15 years and adults [10][11][12][13] . The prevalence of FA among children ranges from 12.0 to 37.0%, which is significantly higher than in adults [14][15][16][17] . Most researchers emphasize the only mechanism of the occurrence of this pathology -the immunoallergic one 18-20. Morphologically, such patients have allergic reactions in the mucous membranes and skin 21 .…”