Abstract
Background:
Upper GI involvement is common in pediatric IBD, but the relative frequencies of specific endoscopic and histologic abnormalities at diagnosis remain poorly defined.
Objective:
To determine whether specific upper GI endoscopic and histologic features differ among pediatric Crohn disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC) at diagnosis.
Methods:
We retrospectively analyzed 243 pediatric patients (<18 years) with newly diagnosed IBD (CD 64.6%, UC 31.2%, IC 4.1%). Clinical parameters, upper GI endoscopic findings, and histologic features were compared using Fisher’s exact and non-parametric tests.
Results:
Age at diagnosis, gender, BMI, and fecal calprotectin did not differ among CD, UC, and IC. Primary sclerosing cholangitis was more prevalent in UC (5.3%, P = .04), and eosinophilic esophagitis was more frequent in IC (20%, P = .03). CD showed more esophageal erosions/aphthae (12%, P < .01), gastric erosions/ulcers (24% vs UC 17%, P < .01), and duodenal erosions/ulcers (35%, P < .01). Histologically, lymphocytic esophagitis (29%, P < .001), epithelioid granulomas (14%, P < .001), and active duodenitis (28%, P = .007) were significantly more common in CD.
Conclusions:
Upper GI abnormalities are not limited to CD. Specific upper GI features—particularly lymphocytic esophagitis, epithelioid granulomas, and active duodenitis—are more strongly associated with CD at diagnosis and may assist subclassification in challenging pediatric IBD cases.
Keywords
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