No abstract

Objectives: Current practice during pediatric colonoscopy is to obtain random colonic biopsies, even from normal appearing tissue. The majority of literature published on colonic biopsy practice analyzes adults; however, limited data examines the pediatric population. The lack of standardization regarding tissue sampling during pediatric colonoscopy reinforces the necessity to study this question objectively. The aim of the present study was to assess the value of obtaining mucosal biopsies from grossly normal colonic tissue. Methods: A retrospective study was performed to examine the utility of obtaining colonic biopsies from normal appearing tissue. Subjects included patients who underwent colonoscopy during a 2-year period. Descriptive analyses and logistic regression models were used to determine endoscopic and histologic agreement and to characterize predictors of agreement. Results: The predictive value of agreement between normal appearing colonoscopies (n ¼ 237) and histopathology was 81%. Excluding patients with inflammatory bowel disease (IBD) increased the predictive value to 85%. Two and a half percent of grossly normal colonoscopies had histological findings consistent with newly diagnosed IBD. Predictors of normal histology included abdominal pain (odds ratio [OR] 3.68, 95% CI 1.84-7.37), whereas a known diagnosis of IBD was predictive of abnormal histology (OR 0.22, 95% CI 0.08-0.67). Among the full sample, elevated inflammatory markers (OR 2.02, 95% CI 1.06-3.86) or fatigue (OR 2.60, 95% CI 1.13-5.94) were predictive of abnormal histology. Conclusions: Results suggest that colonic biopsies may not need to be routinely obtained from all pediatric colonoscopies, particularly in those patients with complaints of abdominal pain. Biopsies should continue to be obtained from patients with a known diagnosis of IBD, elevated inflammatory markers, or fatigue. Further studies are needed to standardize protocols for biopsy practice in pediatric colonoscopy.

Dysphagia is an uncommon symptom for celiac disease (CD). Typically, patients with CD present with abdominal pain, diarrhea, steatorrhea, weight loss, growth failure, anemia, or fatigue. We report a case of dysphagia in a pediatric patient with negative celiac serologies and positive histologic findings suspicious for CD. Our patient's dysphagia resolved after being placed on a gluten-free diet. Repeat interval endoscopy on a gluten-free diet to assess for resolution of histological changes confirmed the diagnosis of CD. In patients with dysphagia, CD should be considered in the differential diagnosis despite negative celiac serologies.

RATIONALE: To assess clinical and demographic characteristics of children with eosinophilic esophagitis (EoE) in a new multidisciplinary allergy and gastroenterology clinic serving British Columbia. METHODS: Children referred to the BC Children's Hospital EoE clinic with biopsy-proven EoE were approached to join our longitudinal EoE registry. After parents consented, data on clinical characteristics and management were recorded. Descriptive statistics and Mann-Whitney Utests examined differences between groups given that our data was not normally distributed. RESULTS: Among 63 patients assessed between July/2012 and August/ 2014, the majority (84%) were male, and median age at diagnosis was 5.8 years (IQR56.6). Forty-six percent (29) had allergy testing previously, 41% (26) had immediate food allergy (among those 17% had more than 1 food trigger and 46% (12) had experienced anaphylaxis.) Almost one-third (29%) had atopic dermatitis, 29% had allergic rhinitis, and 24% had asthma. Most were white (71%) or South Asian (25%). Among 19 (30%) patients on dietary intervention for EoE, cow's milk (32%) and egg (21%) were the most commonly restricted foods. Most (62%) were from the Vancouver area where median time from symptom onset to diagnosis was 1.3 years (IQR51.1) versus 2.8 years (IQR54.5) for those outside the Vancouver area (p<0.05). CONCLUSIONS: This is the first EoE registry that we are aware of in Canada. The underlying factors for longer delays outside the Vancouver area need to be further explored in order to evaluate the potential need for improved EoE service access outside of the Vancouver area and better awareness of EoE presenting symptoms across British Columbia.

Given the variety of preparations and lack of standardization of swallowed topical corticosteroids (STC) for treatment of eosinophilic esophagitis (EoE), we sought to better understand STC prescribing practices of pediatric gastroenterologists. A 12-question survey was distributed to members of North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Eosinophilic Gastrointestinal Disease Special Interest Group and responses were analyzed. Forty-two of 68 physicians responded. Oral viscous budesonide (OVB) was overall first choice STC in 31 (74%) survey respondents, with OVB most frequently utilized in patients under 5 years old and fluticasone propionate in patients 13–18 years old. Nineteen types of mixing vehicles were used for OVB preparation, the 3 most frequent being sucralose, honey, and artificial maple syrup. Insurance coverage, cost, and patient compliance were most frequently cited barriers to STC use. Highly variable STC prescribing practices reported by this group highlights the need for standardization of STC treatment in EoE.