Characteristics of Upper Gastrointestinal Tract Involvement in Korean Pediatric Crohn's Disease: A Multicenter Study

Abstract

PurposeCrohn's disease (CD) can involve any site of the gastrointestinal tract (GIT). However, the characteristics of upper GIT involvement in CD are unclear, especially in the Eastern pediatric population. This study aimed to estimate the prevalence of upper GIT involvement and identify the clinical features of Korean children with CD.MethodsThis was a retrospective multicenter cohort study that included 52 pediatric patients with CD who underwent esophagogastroduodenoscopy and biopsy. The clinical symptoms and endoscopic and histologic features of the upper GIT were identified according to the presence or absence of upper gastrointestinal symptoms.ResultsAmong the 52 patients, upper GIT involvement was noted in 50.0% (26/52). The mean age at CD diagnosis was 14.1±2.1 years. Gastric ulcer was the most common lesion (19.2%) found on upper GIT endoscopy, followed by duodenal ulcers (15.4%). Chronic inflammation was the most common histopathologic feature (75.0%), followed by gastric erosion (17.3%). Granuloma was found in 9.6% of patients. Helicobacter pylori infection was identified in 5.8% of patients. Endoscopic and histologic findings were not significantly different, but the mean values of erythrocyte sedimentation rate (60.7±27.1 vs. 43.0±27.6 mm/h, p=0.037) and C-reactive protein (16.5±28.2 vs. 6.62±13.4 mg/dL, p=0.014) were significantly different between patients with and without upper gastrointestinal CD symptoms.ConclusionUpper GIT involvement was relatively common in pediatric patients with CD irrespective of upper gastrointestinal symptoms, and H. pylori infection was relatively uncommon. The results of this study should aid the establishment of regional guidelines for upper GIT examination.

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

“…It was subsequently appreciated that similar changes could also be found in ulcerative colitis 26 . Inflammatory changes seen in both major forms of IBD include the following: diffuse superficial chronic gastritis 26,27 (Figure 2A,B); focal active or chronic active gastritis (focal enhanced gastritis), usually in addition to the diffuse superficial gastritis 24–26,28 (Figure 2A–C); a mixed basal inflammatory infiltrate 26 ; and granulomas 26,29,30 …”

“…26 Inflammatory changes seen in both major forms of IBD include the following: diffuse superficial chronic gastritis 26,27 (Figure 2A,B); focal active or chronic active gastritis (focal enhanced gastritis), usually in addition to the diffuse superficial gastritis [24][25][26]28 ( Figure 2A-C); a mixed basal inflammatory infiltrate 26 ; and granulomas. 26,29,30 Superficial chronic gastritis (Figure 2A,B) is frequent in IBD, especially in the paediatric age group. In one large study of patients aged up to 21 years, superficial chronic gastritis was found in 26% of patients with Crohn's disease and in 13% of patients with ulcerative colitis, reaching a peak in the 10-14-year-old age group.…”

“…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.…”

“…9,10 Granulomas, which were once thought to be pathognomonic of Crohn's disease, have also been described, albeit rarely in ulcerative colitis patients. 29 However, as Crohn's disease colitis can occasionally be diffuse, and ulcerative colitis-like, it is difficult not to wonder whether patients with the combination of changes will ultimately prove to have Crohn's disease. However, 'hybrid' patients with features of both diseases clearly exist.…”