Benjamin Sahn1, Vera De Matos2, Ronen Stein3, Eduardo Ruchelli4, Samuel Masur3, Andrew J Klink5, Robert N Baldassano3, David A Piccoli3, Pierre Russo4, Petar Mamula3. 1. 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. 2. 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. 3. The Children's Hospital of Philadelphia, Division of Pediatric Gastroenterology, Hepatology, & Nutrition, Philadelphia, PA, United States. 4. The Children's Hospital of Philadelphia, Department of Pathology and Laboratory Medicine, Philadelphia, PA, United States. 5. The Children's Hospital of Philadelphia, Division of Pediatric Gastroenterology, Hepatology, & Nutrition, Philadelphia, PA, United States; Cardinal Health, Dallas, TX, United States.
Abstract
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.
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.