Upper Gastrointestinal Mucosal Disease in Pediatric Crohn Disease and Ulcerative Colitis: A Blinded, Controlled Study

Tobin, Jacinta; Sinha, Bidisa; Ramani, Pramila; Saleh, Abdulkarim; Murphy, Michael S.

doi:10.1097/00005176-200104000-00010

Cited by 191 publications

(137 citation statements)

References 20 publications

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“…Crohn's disease patients with histologic evidence of upper intestinal involvement have significantly more active small bowel disease than do those with negative findings (103). Focal gastritis and duodenitis have also been described in pediatric patients with Crohn's disease (104).…”

Section: Gastritis and Duodenitis In Patients With Inflammatory Bowelmentioning

confidence: 99%

Gastritis and Carditis

Owen

2003

Modern Pathology

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Dyspepsia is a common clinical problem. Its causes include peptic ulcer disease, gastroesophageal reflux, and functional (nonulcer) dyspepsia. A detailed clinical description of pain does not reliably differentiate the cause. Approximately 80% of gastroscopies are performed for the investigation of dyspepsia. "Gastritis" is diagnosed endoscopically in 59% of all stomachs, although in only 3% are the changes severe. Pathologic examination of unselected gastric biopsy specimens reveals that abnormalities are present in 62-73%, but there is only a weak correlation between endoscopic and histologic findings. For these reasons, it is recommended that endoscopic examination should always be accompanied by biopsy. Ideally, biopsies should be taken in a systematic fashion to include sampling of antrum and corpus. Recent evidence suggests that gastric infection by Helicobacter pylori initially presents as a superficial gastritis. Later it may become atrophic with development of intestinal metaplasia. The onset of atrophic changes may be related to the duration of infection, the strain of the infecting organism, associated dietary factors, or as-yet undefined host factors related to immunity. Persistent superficial gastritis predisposes to duodenal ulcer and gastric mucosa-associated lymphoid tissue lymphoma. Atrophic gastritis predisposes to gastric ulcer and adenocarcinoma. Evidence is accumulating that in some patients, pernicious anemia may be an end result of H. pylori-induced atrophic gastritis. Reactive gastropathy is a relatively common finding in gastric biopsies; in most instances it is associated with either reflux of duodenal contents or therapy with nonsteroidal anti-inflammatory drugs. Lymphocytic gastritis, eosinophilic gastritis, and the gastritis associated with Crohn's disease are distinct morphologic entities. Most gastroscopies are performed for the investigation of dyspepsia (1-7). This is a common clinical problem but is rarely life-threatening. The causes of dyspepsia include peptic ulcer disease (30%), gastroesophageal reflux (29%), and nonulcer (functional) dyspepsia (40%). The cause of functional dyspepsia is unclear at the present time, although in many instances it may be related to abnormalities of gut motility. In Ͻ1% of cases is gastric cancer a cause of dyspepsia. A detailed description of the symptoms of dyspepsia does not reliably differentiate the cause, although the presence of heartburn strongly suggests a component of gastroesophageal reflux. Correlations among patient symptoms, endoscopic appearances, and biopsy findings of gastritis are imperfect (4 -6). Agreement is best in cases where peptic ulcer or another focal lesion is identified. A study by Khakoo et al. (7) from the United Kingdom illustrates the problems encountered. Endoscopic and histologic findings were reviewed in 167 patients who underwent gastroscopy for dyspeptic symptoms. Of these, 98 patients (57%) had endoscopic evidence of gastritis. In 42% of patients, gastritis involved the antrum alone, in 7% it involved the...

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Section: Gastritis and Duodenitis In Patients With Inflammatory Bowelmentioning

confidence: 99%

Gastritis and Carditis

Owen

2003

Modern Pathology

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“…1,27 Upper GI involvement (esophagus, stomach and or duodenum) is much more often related to CD than UC, particularly if the inflammatory changes are patchy, or associated with deep fissuring ulceration, or granulomas. [29][30][31][32] Unfortunately, recognition of these major features may be difficult, particularly when the findings are limited, or masked, by extensive ulceration. Nevertheless, failure to recognize or accept any one or combination of these features as definitive evidence of CD, even in a patient who otherwise appears to have pathologic changes of UC, may lead to a potential erroneous diagnosis of either UC or IC.…”

Section: Failure To Utilize Major Diagnostic Criteria As Evidence In mentioning

confidence: 99%

“…Gastric and/or duodenal involvement has, rarely, been reported in association with UC. 29,30,[62][63][64][65][66] For instance, in a recent study by Lin et al, 65 esophageal, gastric and duodenal biopsies in 69 UC patients were compared with 97 non-UC controls. In that study, UC patients showed a higher prevalence rate of focal gastritis, basal mucosal mixed inflammation, superficial plasmacytosis and diffuse chronic, or chronic active, duodenitis (Figure 4).…”

Section: Uc With Crohn's-like Featuresmentioning

confidence: 99%

A contemporary and critical appraisal of ‘indeterminate colitis‘

Odze

2015

Modern Pathology

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Distinguishing ulcerative colitis (UC) from Crohn's disease (CD) is normally based on evaluation of a variety of clinical, radiologic, serologic and pathologic findings, the latter in biopsy and/or resection specimens. Unfortunately, some patients with IBD show overlapping pathologic features of UC and CD, which makes definite distinction between these two disorders difficult or even impossible. In most instances of uncertainty, the patient shows clinical and pathologic features of UC, but in addition, the patient's colon resection specimen reveals one or more CD-like features. In this setting, a diagnosis of indeterminate colitis (IC) is often rendered. IC is not a distinct disease entity, and, thus, it has no diagnostic criteria. The most common causes of uncertainty in IBD pathology that may lead to a diagnosis of IC in a colon resection specimen includes the presence of fulminant (severe and toxic) colitis, insufficient radiologic, endoscopic, or pathologic information (including analysis of prior biopsies) on the patient, failure to utilize major diagnostic criteria as hard evidence in favor of CD, failure to recognize unusual variants of UC and CD that may mimic each other, failure to recognize non-IBD mimics and other superimposed diseases that cause unusual pathologic features in a resection specimen, an attempt to distinguish UC from CD in mucosal biopsies of the colon and ileum, or an attempt to change the patients diagnosis (of UC or CD) based on pouch or diversion-related complications. Details of each of these causes of uncertainty are discussed, in detail, in this review article. A diagnosis of IC should never be made clinically or by pathologists based on evaluation of pre-resection colonic mucosal biopsies. Ultimately, the majority of indeterminate cases represent UC, and, thus, most of these patient can be treated safely with a colectomy combined with an ileal pouch anal anastomosis procedure.

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“…46 Chronic idiopathic inflammatory bowel disease can be associated with duodenal intraepithelial lymphocytosis. 12,13,47 Duodenal intraepithelial lymphocytosis also has been noted in association with both lymphocytic and collagenous colitis. Notably, in many cases, the association appears to be exclusive of gluten sensitivity, despite the recognized association of both variants of microscopic colitis with celiac disease.…”

Section: Autoimmune Conditionsmentioning

confidence: 99%