Gastroduodenal Pathology in Inflammatory Bowel Disease
Amber Cockburn, Robert Genta. Miraca Life Sciences Research Institute, Irving, TX
Background: Focal active gastritis has been reported in various percentages of patients with Crohn's disease (CD) (Oberhuber et al., Gastroenterology 1997;Sonnenberg et al, Inflamm Bowel Dis. 2011) whereas chronic gastritis has been associated with ulcerative colitis (UC) (Lin et al., Am J Surg Pathol, 2010). It remains unclear how these findings could help establish a specific diagnosis in patients with suspected inflammatory bowel disease (IBD). This study was designed to assess the prevalence and types of gastritis and duodenitis in patients with a synchronous diagnosis of IBD.
Design: Using a nationwide pathology database, we extracted all patients who had a bidirectional endoscopy between Jan 2008 and Dec 2012 and both gastric and ileocolonic biopsies. Study patients were those with a clinicopathologic diagnosis of IBD (UC, CD, or indeterminate, IND); controls were patients with a normal colon and ileum. All subjects with history or diagnosis of malignancy, upper GI surgery, autoimmune, or infectious diseases were excluded. Gastritis was classified according to the Updated Sydney System.
Results: There were 699 patients with CD (57.4% female; median age 46 years, range 5-86), 988 with UC (51.6% female; median age 51 years, range 9-93); 246 with IND (47.2% female; median age 50 years, range 3-92); and 26,409 controls (67.3% female; median age 49 years, range 1 mo – 98 years). Table 1 summarizes the results of the gastric pathology. Gastric granulomas were found in 4 patients with CD (0.6%), and in one each of UC, IND, and control subjects. Active duodenitis was significantly more common in all IBD patients (14.4%) than in controls (7.5%), with the highest prevalence (17.6%) in those with CD (OR 2.68, 95% CI 2.07-3.37).
Conclusions: One in 5 patients with CD and one in 10 with UC have H. pylori-negative gastritis (focal or diffuse). While these associations may be pathogenetically important, as they reflect a wide involvement of the gastrointestinal tract in IBD, neither the prevalence nor the type of gastritis and duodenitis are sufficiently distinctive to help pathologists focus on a diagnosis of CD versus UC.
Wednesday, March 6, 2013 1:00 PM
Poster Session VI # 103, Wednesday Afternoon