Granulomatous Upper Gastrointestinal Inflammation in Pediatric Ulcerative Colitis
| Autor: | Richard Kellermayer, Karen Queliza, Faith D. Ihekweazu, Craig L. Jensen, Deborah Schady |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
Pancolitis medicine.medical_specialty Adolescent medicine.medical_treatment Gastroenterology Article 03 medical and health sciences symbols.namesake Upper Gastrointestinal Tract 0302 clinical medicine Internal medicine medicine Humans Colitis Child Fisher's exact test Colectomy Retrospective Studies Granuloma medicine.diagnostic_test business.industry Retrospective cohort study medicine.disease Ulcerative colitis Endoscopy Giant cell 030220 oncology & carcinogenesis Child Preschool Pediatrics Perinatology and Child Health symbols 030211 gastroenterology & hepatology Colitis Ulcerative Female medicine.symptom business |
| Zdroj: | Journal of pediatric gastroenterology and nutrition. 66(4) |
| ISSN: | 1536-4801 |
| Popis: | Objectives Differentiating ulcerative colitis (UC) and Crohn disease (CD) can be clinically challenging, especially in children. Granulomatous inflammation has traditionally been attributed to CD. Crypt-associated giant cells and granulomas, however, have been observed in colonic biopsies of patients with UC. This phenomenon has not been described in the upper gastrointestinal (UGI) tract with UC. Methods Seven pediatric patients with UC with granulomatous UGI (gUGI) lesions were identified. Diagnosis of UC was based on symptoms, clinical course, laboratory results, imaging, and endoscopy. We compared the gUGI patients to a large cohort of pediatric patients with UC (n = 149). Results All fully evaluated cases were associated with bloody diarrhea and moderate to severe pancolitis. Gastric and/or duodenal biopsies demonstrated giant cells or granulomas near gland destruction. Small bowel imaging did not reveal any involvement. The majority of cases responded to standard medical therapies, except for 2 patients (28.6%) who required total colectomy. Acute severe, refractory colitis (ie, colectomy within 1 month of presentation) was significantly more common in the gUGI group than the large pediatric UC group (28.6% vs 1.3%, Fisher exact P = 0.01). Conclusions This is the first report of pediatric UC-associated granulomatous inflammation in the UGI tract. We speculate that these lesions represent extracolonic manifestations of intense colonic disease. These atypical findings expand the diagnostic considerations that should be incorporated during the differentiation between UC and CD in the pediatric age group. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text