Ilyssa O Gordon1, Suha Abushamma2, Jacob A Kurowski3, Stefan D Holubar4, Lei Kou5, Ruishen Lyu5, Florian Rieder6. 1. Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. 2. Department of Gastroenterology, Washington University School of Medicine, Barnes Jewish Hospital, St Louis, MO,USA. 3. Department of Paediatric Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA. 4. Department of Colorectal Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. 5. Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. 6. Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, and Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Abstract
BACKGROUND AND AIMS: Intestinal fibrosis has recently been characterised in adult ulcerative colitis and may affect motility, diarrhoea, and the symptom of urgency. We aimed to charactersze the presence of fibrosis in paediatric patients with ulcerative colitis, and its link to severity and chronicity of mucosal inflammation, as well as clinical factors of severity. METHODS: We performed a single-centre cross-sectional study in children ages 1-18 years with ulcerative colitis, undergoing colectomy or proctocolectomy. Tissue cross-sections were derived from proximal, mid, and distal colon and rectum, and inflammation and fibrosis were graded based on previously developed scores. Clinical data were collected prospectively. RESULTS: From 62 patients, 205 intestinal sections were evaluated. Median age at diagnosis was 13 years, 100% had extensive colitis, and all resections were done for refractory disease. The presence, chronicity, and degree of inflammation were linked with the presence of fibrosis. Thickness of the muscularis mucosa was also linked with presence and chronicity of inflammation. The overall submucosal fibrosis burden was associated with prior anti-tumour necrosis factor use. CONCLUSIONS: Paediatric patients with ulcerative colitis exhibit colorectal submucosal fibrosis and muscularis mucosa thickening, which correlate with the presence, chronicity, and degree of mucosal inflammation. Fibrosis should be recognised as a complication of paediatric ulcerative colitis, and ulcerative colitis should be considered a progressive disease.
BACKGROUND AND AIMS: Intestinal fibrosis has recently been characterised in adult ulcerative colitis and may affect motility, diarrhoea, and the symptom of urgency. We aimed to charactersze the presence of fibrosis in paediatric patients with ulcerative colitis, and its link to severity and chronicity of mucosal inflammation, as well as clinical factors of severity. METHODS: We performed a single-centre cross-sectional study in children ages 1-18 years with ulcerative colitis, undergoing colectomy or proctocolectomy. Tissue cross-sections were derived from proximal, mid, and distal colon and rectum, and inflammation and fibrosis were graded based on previously developed scores. Clinical data were collected prospectively. RESULTS: From 62 patients, 205 intestinal sections were evaluated. Median age at diagnosis was 13 years, 100% had extensive colitis, and all resections were done for refractory disease. The presence, chronicity, and degree of inflammation were linked with the presence of fibrosis. Thickness of the muscularis mucosa was also linked with presence and chronicity of inflammation. The overall submucosal fibrosis burden was associated with prior anti-tumour necrosis factor use. CONCLUSIONS: Paediatric patients with ulcerative colitis exhibit colorectal submucosal fibrosis and muscularis mucosa thickening, which correlate with the presence, chronicity, and degree of mucosal inflammation. Fibrosis should be recognised as a complication of paediatric ulcerative colitis, and ulcerative colitis should be considered a progressive disease.
Authors: Eran Zittan; Jennifer Muir; Raquel Milgrom; Marc Berns; Ian M Gralnek; Zane Cohen; Robert Riddell; Mark S Silverberg Journal: Int J Surg Date: 2019-03-26 Impact factor: 6.071
Authors: Athos Bousvaros; Donald A Antonioli; Richard B Colletti; Marla C Dubinsky; Jonathan N Glickman; Benjamin D Gold; Anne M Griffiths; Gareth P Jevon; Leslie M Higuchi; Jeffrey S Hyams; Barbara S Kirschner; Subra Kugathasan; Robert N Baldassano; Pierre A Russo Journal: J Pediatr Gastroenterol Nutr Date: 2007-05 Impact factor: 2.839
Authors: Yael Haberman; Phillip Minar; Rebekah Karns; Phillip J Dexheimer; Sudhir Ghandikota; Samuel Tegge; Daniel Shapiro; Brianne Shuler; Suresh Venkateswaran; Tzipi Braun; Allison Ta; Thomas D Walters; Robert N Baldassano; Joshua D Noe; Joel Rosh; James Markowitz; Jennifer L Dotson; David R Mack; Richard Kellermayer; Anne M Griffiths; Melvin B Heyman; Susan S Baker; Dedrick Moulton; Ashish S Patel; Ajay S Gulati; Steven J Steiner; Neal LeLeiko; Anthony Otley; Maria Oliva-Hemker; David Ziring; Ranjana Gokhale; Sandra Kim; Stephen L Guthery; Stanley A Cohen; Scott Snapper; Bruce J Aronow; Michael Stephens; Greg Gibson; Jonathan R Dillman; Marla Dubinsky; Jeffrey S Hyams; Subra Kugathasan; Anil G Jegga; Lee A Denson Journal: J Crohns Colitis Date: 2020-08-08 Impact factor: 9.071
Authors: Arie Levine; Anne Griffiths; James Markowitz; David C Wilson; Dan Turner; Richard K Russell; John Fell; Frank M Ruemmele; Thomas Walters; Mary Sherlock; Marla Dubinsky; Jeffrey S Hyams Journal: Inflamm Bowel Dis Date: 2010-11-08 Impact factor: 5.325
Authors: Allison D Ta; Nicholas J Ollberding; Rebekah Karns; Yael Haberman; Adina L Alazraki; David Hercules; Robert Baldassano; James Markowitz; Melvin B Heyman; Sandra Kim; Barbara Kirschner; Jason M Shapiro; Joshua Noe; Maria Oliva-Hemker; Anthony Otley; Marian Pfefferkorn; Richard Kellermayer; Scott Snapper; Shervin Rabizadeh; Ramnik Xavier; Marla Dubinsky; Jeffrey Hyams; Subra Kugathasan; Anil G Jegga; Jonathan R Dillman; Lee A Denson Journal: Inflamm Bowel Dis Date: 2021-10-20 Impact factor: 5.325