Abstract
BackgroundEarly manifestations of pediatric inflammatory bowel disease (IBD) can be relatively nonspecific. Initial mucosal biopsies may not be conclusive, delaying the diagnosis until subsequent biopsies demonstrate typical histologic features of IBD. We hypothesized that certain inflammatory cell types may be utilized as early histologic indicators of IBD in children.MethodsA retrospective analysis compared histologic findings from initially inconclusive or negative endoscopic studies in 22 patients who were subsequently diagnosed with IBD (after diagnostic endoscopy) to those of 20 comparison patients with functional abdominal pain matched for age, gender, and study type. A pediatric pathologist, blinded to study group, reviewed biopsies for histologic abnormalities. Eosinophil densities were obtained from the stomach, duodenum, and rectosigmoid areas. Immunohistochemistry (IHC) staining for tumor necrosis factor-α (TNF-α) and matrix metalloproteinase-9 (MMP-9) was performed on the stomach and rectosigmoid areas.ResultsGastritis and colonic crypt distortion were present in the IBD group at a greater rate (61 % vs. 22 %, p = 0.020; 34 % vs. 4 %, p = 0.008, respectively). Peak and mean eosinophil densities in the rectosigmoid area were greater in the IBD group (17.0/hpf vs. 5.0/hpf, p = 0.0063; 12.3/hpf vs. 4.2/hpf, p = 0.0106, respectively). TNF-α and MMP-9 staining did not reveal any significant differences.ConclusionsOur data suggests that significantly greater inflammation in the stomach, crypt distortion in the colon, and eosinophilia in the rectosigmoid distinguished the IBD group from the comparison group at the time of the initial endoscopic evaluation.
Highlights
Manifestations of pediatric inflammatory bowel disease (IBD) can be relatively nonspecific
Patients Twenty-two IBD patients (11 Crohn’s disease (CD), 10 Ulcerative colitis (UC), and 1 indeterminate colitis) were identified through a gastroenterology departmental IBD database as subjects who had an initial inconclusive endoscopy performed from January 2002 to December 2008 prior to a later confirmatory diagnosis of IBD
Our results demonstrated that initial biopsies in children with an eventual diagnosis of IBD in comparison to biopsies of children with functional abdominal pain have significantly greater frequency of inflammation in the stomach, crypt distortion in the colon, and eosinophilia in the rectosigmoid area
Summary
Manifestations of pediatric inflammatory bowel disease (IBD) can be relatively nonspecific. We hypothesized that certain inflammatory cell types may be utilized as early histologic indicators of IBD in children. Diagnosing pediatric inflammatory bowel disease (IBD) may be challenging at times as a broad spectrum of gastrointestinal and extra-intestinal symptoms may complicate the clinical presentation. Histologic confirmation cannot always be obtained early in the course of the disease, delaying the diagnosis and treatment, and the optimal growth potential and quality of life for these patients. The typical histologic features of IBD are those of a chronic active colitis, encompassing chronicity features of crypt architectural distortion and basal plasmacytosis. Disease activity is determined by cryptitis, crypt abscesses, and ulcerations. Ulcerative colitis (UC) demonstrates a gradation of activity indices depending on the acuity of disease [2, 3]. Mucus depletion from goblet cells, cryptitis with crypt abscesses, and
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