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

Abstract

Upper gastrointestinal (UGI) tract involvement of inflammatory bowel disease (IBD) is commonly seen in pediatric patients. Upper endoscopy is included in the routine workup of children with suspected IBD to enhance the diagnosis and management of these patients. Currently, childhood IBD is classified into ulcerative colitis (UC), atypical UC, Crohn’s disease (CD) and IBD unclassified. Histologic confirmation of UGI tract involvement, in particular the presence of epithelioid (non-caseating) granulomas, is helpful in confirming the diagnosis of IBD and its classification. Herein, we reviewed selected IBD-associated UGI tract manifestations in children. Lymphocytic esophagitis, seen predominantly in CD, is histologically characterized by increased intraepithelial lymphocytes (> 20 in one high-power field) in a background of mucosal injury with absence of granulocytes. Focally enhanced gastritis is a form of gastric inflammation in pediatric IBD marked by a focal lymphohistiocytic pit inflammation with or without granulocytes and plasma cells in a relatively normal background gastric mucosa. Duodenal inflammation seen in children with IBD includes cryptitis, villous flattening, increased intraepithelial lymphocytes, and lamina propria eosinophilia. Finally, epithelioid granulomas not associated with ruptured gland/crypt are a diagnostic feature of CD. The clinicopathologic correlation and differential diagnosis of each microscopic finding are discussed. Clinicians and pathologists should be cognizant of the utility and limitations of these histologic features.

Pediatric Crohn’s disease with severe morbidity manifested by gastric outlet obstruction: two cases report and review of the literature

“…6 Studies in pediatric patients who had simultaneous EGD at the time of diagnosis revealed that the prevalence of gastroduodenal involvement of CD is up to 36%-53%. 7,8 According to this result, the surveillance of UGI involvement is conducted as a significant factor in diagnosis, risk and prognostic evaluation of CD. Patient with UGI manifestations have a higher risk of more aggressive stricturing and more penetrating form of the disease, meaning more recurrences, frequent hospitalization, and more surgical intervention.…”

“…Endoscopic findings of UGI-CD include patchy erythema, mucosal friability, thickened folds, ulcerations, and in severe cases strictures, luminal narrowing, fistula of UGI tract. 7 UGI-CD is relatively rare disease, thus other possible etiologies of gastric outlet obstruction such as peptic ulcer disease, Menetrier disease, collagen vascular disease, various infections like Helicobacter pylori, cytomegalovirus and Mycobacterium tuberculosis, nonsteroidal anti-inflammatory drug use, malignant and infiltrative disease should be ruled out through imaging or upper endoscopy. 10 One-third of patients with isolated UGI-CD do not have small or large intestine disease at the time of diagnosis of CD but develop distal disease over time.…”

Beyond Helicobacter: dealing with other variants of gastritis—an algorithmic approach

“…Focal enhanced gastritis (Figure 2A-C) is focal chronic or chronic active inflammation, usually exquisitely focal, and often seemingly centred on a single pit 29,31,32 (Table 2). It has been described in 24%-48% of Crohn's disease patients, and in up to 76% of paediatric patients, but in as few as 10.5% of Table 2.…”

“…It has been described in 24%-48% of Crohn's disease patients, and in up to 76% of paediatric patients, but in as few as 10.5% of Table 2. Gastric lesions in inflammatory bowel disease (IBD); similar lesions appear in both ulcerative colitis and Crohn's disease, but they appear to be more prevalent in Crohn's disease 29,[31][32][33] Schaumann bodies and birefringent crystalline particles can be seen The stomach, in particular the antrum, is affected in systemic disease. 77,78 However, isolated gastric sarcoidosis has also been described 79 adults.…”

“…77,78 However, isolated gastric sarcoidosis has also been described 79 adults. It has also been described in 29%-36% of ulcerative colitis patients, 26,[31][32][33] but in the majority of patients there is no known association. The marked focal changes are related to IBD in an age-related manner, Crohn's disease in particular being more likely in the paediatric age group; up to 20% have Crohn's disease, so it is a red flag.…”