The Clinical Significance of Incidental Chronic Colitis in Children: Are NSAIDS To Blame?
Kari K Hooper, Jailan M Osman, Ali G Saad. Arkansas Children's Hospital, Little Rock
Background: Chronic colitis is a chronic inflammatory disease of the colon pathologically characterized by the presence of crypt architectural distortion and basal plasmacytosis. In children, a diagnosis of chronic colitis raises a differential diagnosis that includes inflammatory bowel disease (IBD), immunodeficiency states, and longstanding infections. Although previous studies have predominantly focused on the acute effects of NSAIDs, none have linked this drug with histologic changes of chronic colitis.
Design: Patients with chronic colitis with biopsies from the terminal ileum and all five major segments of the colon (cecum, ascending, transverse, descending, and rectosigmoid) on whom follow up lacked definitive etiology are included in this study. Active inflammation is graded as mild (active cryptitis), moderate (crypt abscesses), and severe (erosion/ulceration of surface epithelium).
Results: There were 12 males and 7 females (mean age 10.6 years; range 4-17.2 years). All patients presented with abdominal pain. Follow up (median 21.0 months) resulted in no definitive diagnosis. NSAID intake was documented in 14 patients. Inflammation involved the cecum in 16 patients, ascending in 13 patients, transverse in 5 patients, descending in 4 patients and rectosigmoid in 7 patients. Inflammation involved the right colon (cecum and ascending colon) in 11 patients, left colon (descending and rectosigmoid) in 2 patients, and all 5 segments of the colon in a single patient. Crypt architectural distortion was present in all 19 cases. Basal plasmacytosis was present in 15 cases. In the 4 cases that lacked basal plasmacytosis, significant crypt architectural distortion was present. Biopsies from the ileum were normal in all patients. Eight patients showed mild active inflammation, 7 patients showed moderate active inflammation and 4 patients showed severe active inflammation. In these 4 patients, the histologic features were indistinguishable from active IBD. Three of these 4 patients were taking NSAIDs and there was near total normalization of the colonic mucosa after withdrawal of NSAIDs in 2 patients. In the remaining patients (11 patients), there was normalization of colonic mucosa in 8 patients after withdrawal of NSAIDs.
Conclusions: Our data suggest that the majority of these lesions are likely related to NSAID use. It is important for pathologists and clinicians to be aware of “incidental chronic colitis” to avoid raising other possibilities such as IBD. An important characteristic of these patients is the preferential involvement of the right colon and sparing of the terminal ileum.
Wednesday, March 2, 2011 9:30 AM
Poster Session V # 21, Wednesday Morning