Prevalence of Upper Gastrointestinal Tract Inflammation in Patients with Ulcerative Colitis
AJ Gersten, D Beneck, D Blanco, RK Yantiss. Weill Cornell Medical College, New York, NY
Background: Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD) that diffusely affects the colonic mucosa in a retrograde fashion from the rectum. Classic teaching emphasizes that UC spares the upper gastrointestinal (UGI) tract and, in fact, its distribution aids distinction from Crohn's disease (CD), particularly among pediatric patients. Some authors have reported rare UC patients to have UGI involvement, although the frequency and severity with which this occurs is not known. The aim of this study was to determine the prevalence of UGI inflammation among UC patients. We chose to evaluate pediatric patients because these children often undergo routine endoscopic examination of the UGI tract during evaluation for colitic symptoms, prior to initiation of therapy.
Design: We identified 81 pediatric patients with newly diagnosed IBD, all of whom underwent endoscopy and biopsy of the UGI tract and colon prior to initiation of therapy. Patients with hard criteria for CD (granulomas, chronic ileitis, strictures, anal disease) were excluded from the study, as were those with confounding inflammatory conditions (e.g. H. pylori infection), yielding a final study group of 24 patients with presumed UC. Endoscopic and mucosal biopsy findings were reviewed, and the presence, distribution, and severity of inflammation were recorded.
Results: There were 10 males and 14 females in the study group (mean: 12.1 years). Colonoscopy revealed colitis in all patients, which, on biopsy analysis, proved to be mild, moderate, or severe in 5, 11, and 8 patients, respectively. Two patients had endoscopic and histologic mild duodenitis. Fifteen (63%) patients had chronic gastritis, which was inactive in 11 (46%) and active in 4 (17%) patients. Giemsa stains were negative for H. pylori in all cases. Seven (29%) patients had esophagitis, including 5 (21%) with distal esophageal inflammation and 2 (8%) with features of eosinophilic esophagitis. At follow-up (mean: 21 months), 20 patients were classified as definite UC and 4 were considered to have probable UC.
Conclusions: Pediatric patients with new-onset UC frequently have UGI tract inflammation, which does not correlate with severity of colonic disease. Most patients with this finding have a clinical course typical of UC, provided they do not have other features to suggest CD. Therefore, the presence of UGI tract inflammation by itself should not be an exclusion criterion for UC in the pediatric population.
Monday, March 22, 2010 1:00 PM
Poster Session II # 73, Monday Afternoon