Journal article
Histological features of ileitis differentiating pediatric Crohn disease from ulcerative colitis with backwash ileitis.
- Sahn B Steven & Alexandra Cohen Children's Medical Center of New York, Northwell Health System, Division of Gastroenterology & Nutrition, New York, United States; The Children's Hospital of Philadelphia, Division of Pediatric Gastroenterology, Hepatology, & Nutrition, Philadelphia, PA, United States. Electronic address: bsahn@northwell.edu.
- De Matos V The Children's Hospital of Philadelphia, Division of Pediatric Gastroenterology, Hepatology, & Nutrition, Philadelphia, PA, United States; The Pediatric Gastroenterology and Hepatology Unit, Department of Pediatrics, University Hospitals of Geneva, Switzerland.
- Stein R The Children's Hospital of Philadelphia, Division of Pediatric Gastroenterology, Hepatology, & Nutrition, Philadelphia, PA, United States.
- Ruchelli E The Children's Hospital of Philadelphia, Department of Pathology and Laboratory Medicine, Philadelphia, PA, United States.
- Masur S The Children's Hospital of Philadelphia, Division of Pediatric Gastroenterology, Hepatology, & Nutrition, Philadelphia, PA, United States.
- Klink AJ The Children's Hospital of Philadelphia, Division of Pediatric Gastroenterology, Hepatology, & Nutrition, Philadelphia, PA, United States; Cardinal Health, Dallas, TX, United States.
- Baldassano RN The Children's Hospital of Philadelphia, Division of Pediatric Gastroenterology, Hepatology, & Nutrition, Philadelphia, PA, United States.
- Piccoli DA The Children's Hospital of Philadelphia, Division of Pediatric Gastroenterology, Hepatology, & Nutrition, Philadelphia, PA, United States.
- Russo P The Children's Hospital of Philadelphia, Department of Pathology and Laboratory Medicine, Philadelphia, PA, United States.
- Mamula P The Children's Hospital of Philadelphia, Division of Pediatric Gastroenterology, Hepatology, & Nutrition, Philadelphia, PA, United States.
- 2017-11-02
Published in:
- Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. - 2018
Crohn disease
Ileitis
Pediatrics
Ulcerative colitis
Adolescent
Child
Colitis, Ulcerative
Colon
Crohn Disease
Diagnosis, Differential
Female
Humans
Ileitis
Ileum
Logistic Models
Male
Multivariate Analysis
ROC Curve
Retrospective Studies
English
BACKGROUND/AIM
Pediatric ileocolonic Crohn disease (CD) may be difficult to distinguish from ulcerative colitis (UC) with backwash ileitis (BWI). The primary aim of the study was to determine the probability of CD in children with a confluent colitis and ileitis when newly diagnosed with inflammatory bowel disease (IBD).
METHODS
A retrospective observational study of 100 newly diagnosed patients with IBD was performed. Two pathologists reviewed ileal biopsy specimens for 8 histological features. Biopsy and clinical features were evaluated for predictive ability of a final diagnosis of CD.
RESULTS
The presence of crypt distortion, lamina propria (LP) expansion, and acute LP inflammation combined with 4 clinical variables in multivariate regression analysis had adequate discriminative validity when comparing the mean probability of a final CD diagnosis between CD and not-CD groups (0.90 vs. 0.59, p value <0.001). When crypt distortion, LP expansion, and acute LP inflammation are present in any combination, the sensitivity and specificity for presence of CD ranges 38.4-57% and 92.9-100%, respectively.
CONCLUSIONS
Combining histological features of ileitis and clinical variables can adequately discriminate between the presence and absence of Crohn disease in children who present with confluent colitis and ileitis. Combined presence of certain histological features has high specificity for CD.
Pediatric ileocolonic Crohn disease (CD) may be difficult to distinguish from ulcerative colitis (UC) with backwash ileitis (BWI). The primary aim of the study was to determine the probability of CD in children with a confluent colitis and ileitis when newly diagnosed with inflammatory bowel disease (IBD).
METHODS
A retrospective observational study of 100 newly diagnosed patients with IBD was performed. Two pathologists reviewed ileal biopsy specimens for 8 histological features. Biopsy and clinical features were evaluated for predictive ability of a final diagnosis of CD.
RESULTS
The presence of crypt distortion, lamina propria (LP) expansion, and acute LP inflammation combined with 4 clinical variables in multivariate regression analysis had adequate discriminative validity when comparing the mean probability of a final CD diagnosis between CD and not-CD groups (0.90 vs. 0.59, p value <0.001). When crypt distortion, LP expansion, and acute LP inflammation are present in any combination, the sensitivity and specificity for presence of CD ranges 38.4-57% and 92.9-100%, respectively.
CONCLUSIONS
Combining histological features of ileitis and clinical variables can adequately discriminate between the presence and absence of Crohn disease in children who present with confluent colitis and ileitis. Combined presence of certain histological features has high specificity for CD.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.dld.2017.10.006
- PMID 29089273
- Persistent URL
- https://sonar.ch/global/documents/137862
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