Morphological Findings in Upper Gastrointestinal Biopsies of Patients with Ulcerative Colitis: A Controlled Study
J Lin, HD Appelman, BJ McKenna. University of Michigan, Ann Arbor, MI
Background: Gastric inflammation in inflammatory bowel disease, both Crohn's disease and ulcerative colitis (UC), is known to occur, and duodenal involvement by ulcerative colitis has been described. However, the frequency and types of inflammation in upper gastrointestinal biopsies in patients with ulcerative colitis have not been well studied.
Design: Esophageal (24), gastric (59) and duodenal (38) biopsies from 70 UC patients who visited the University of Michigan Health System in 2005 were reviewed. These were compared with biopsies from a control group of 97 consecutive patients of similar age and gender distribution having biopsies of the esophagus (35), stomach (66) and duodenum (46). The pattern and extent of inflammation were noted in each biopsy.
Results: The most common upper gastrointestinal inflammation in UC patients was focal gastritis, present in 17 (28.8%) of 59 patients with gastric biopsies, compared to 9.1% of controls (p<0.01). Thirteen (22.0%) and 12 (20.3%) UC patients had gastric basal mixed inflammation or superficial plasmacytosis respectively, compared with 7.6% and 6.1% of controls (p<0.05 for both features). There were no esophageal inflammations that occurred more commonly in UC than controls. Four UC patients and no controls had diffuse chronic duodenitis (p<0.05). All 4 UC-duodenitis patients were among the 11 with previous colectomies, and all had histories of pouchitis (follow 16-97 mo., avg. 53.7 mo.). Only one of the UC-colectomy patients without duodenitis developed pouchitis (follow up 15-87 mo., avg. 38.6 mo.).
Conclusions: Most UC patients have no upper gastrointestinal inflammation in biopsies, and most of the inflammations they have are not unique. The most common upper gastrointestinal inflammation in patients with UC is focal gastritis (28.8%), followed by gastric basal mixed inflammation (22%) and superficial plasmacytosis (20.3%). The one unique upper gastrointestinal inflammation in UC patients is diffuse chronic duodenitis, present in 9.8% of all patients in the study, and 36.3% of UC patients with colectomy. UC-colectomy patients with diffuse chronic duodenitis are more likely to have pouchitis than those without duodenitis.
Monday, March 22, 2010 1:00 PM
Poster Session II # 80, Monday Afternoon