PROSPECTIVE EVALUATION OF UPPER GASTROINTESTINAL MUCOSAL LESIONS IN CHILDREN WITH ULCERATIVE-COLITIS AND CROHNS-DISEASE

Eighty-eight consecutive children with inflammatory bowel disease were studied, and upper gastrointestinal endoscopy was performed in 80 of them as one of the initial investigations before commencing medical or nutritional treatment. Forty-one children were found to have Crohn's disease and 47, ulcerative colitis. Upper gastrointestinal endoscopy r evealed pathology in 32 (80%) cases of Crohn's disease, esophagitis in 16, and esophageal ulcer in two, nonspecific gastritis in 22, duodeni tis or duodenal ulcer in 18, and Helicobacter pylori infection in two cases. Granulomas were detected in 10 patients in the upper gastrointe stinal tract: one esophageal, eight gastric, and three duodenal. Of th e ulcerative colitis patients, seven had esophagitis, one had esophage al ulcer, 17 had nonspecific gastritis, two had gastric ulcers, two ha d duodenal ulcers, and five had H. pylori infection; altogether 30 (75 %) yielded pathological findings. Radiological studies using barium me al revealed pathology in only eight of all inflammatory bowel disease cases. Symptoms at admission were not conclusive for definite diagnosi s because 63% of patients with Crohn's disease had signs of colitis (s uch as diarrhea, bloody diarrhea) compared to 94% of ulcerative coliti s patients. Upper gastrointestinal endoscopy may be used to achieve a specific diagnosis, thus being helpful when planning treatment. Also a considerable incidence of nonspecific gastritis, duodenitis, and esop hagitis with or without concomitant H. pylori infection may be anticip ated in children suffering from both ulcerative colitis and Crohn's di sease.