Upper gastrointestinal mucosal disease in pediatric Crohn disease and ulcerative colitis: A blinded, controlled study

Background: Upper gastrointestinal endoscopic biopsies often show histologi c abnormalities in Crohn disease. Consequently, it has been proposed that r outine endoscopy could help to distinguish Crohn disease from ulcerative co litis. Surprisingly, however, recent case reports and an uncontrolled study suggested that similar abnormalities may occur in ulcerative colitis. Ther efore, a blinded, controlled study was performed. Methods: Esophageal, gast ric antral, and duodenal biopsies from children with Crohn disease (n = 28) and ulcerative colitis (n = 14) were compared with those from controls und ergoing endoscopy for suspected reflux esophagitis (n = 22). Two pathologis ts, unaware of patient identity and diagnosis, agreed on a consensus report . Severity of inflammation was scored semiquantitatively. Helicobacter pylo ri colonization was an exclusion criterion. Results: Inflammation was repor ted as follows: esophagitis: controls 91%; Crohn disease: 72%; ulcerative c olitis: 50%; gastritis: controls: 27%; Crohn disease: 92% (P < 0.001); ulce rative colitis: 69%; duodenitis: controls: 9%; Crohn disease: 33%; ulcerati ve colitis: 23%. In Crohn disease, granulomas were noted in 40% of patients (P = 0.001). Duodenal cryptitis was noted in 26% of patients with Crohn di sease but not ulcerative colitis. In one patient with ulcerative colitis, n eutrophilic infiltration of gastric glands was seen. Abnormalities seen in Crohn disease and ulcerative colitis included gastroduodenal ulceration (Cr ohn disease, 7%; ulcerative colitis, 8%), villus atrophy (Crohn disease, 11 %; ulcerative colitis, 15%), and increased intraepithelial lymphocytes (Cro hn disease, 15%; ulcerative colitis, 31% [P <less than> 0.05]). None of the se abnormalities was noted in the controls. Conclusion: Although the presen ce of granulomas can support a diagnosis of Crohn disease, severe inflammat ion and other abnormalities occur in the proximal gastrointestinal tract in Crohn disease and ulcerative colitis.