Upper gastrointestinal tract involvement of pediatric inflammatory bowel disease: A pathological review

Table 1 Upper gastrointestinal tract manifestations of childhood inflammatory bowel disease

Entity	Prevalence (%)		Histologic diagnostic criteria	Differential diagnosis
	CD	UC
Lymphocytic esophagitis	12-28[15,20]	7[15,20]	> 20 IELs/HPF; No significant granulocytes; Mucosal injury (edema; dyskeratosis).	Candidiasis, lichen planus esophagitis, lichenoid esophagitis.
Focally enhanced gastritis	54-55[31,32]	21-30[31,32]	Focal pit injury (lymphohistiocytes ± plasma cells or granulocytes); Relatively normal background mucosa.	Lymphoid aggregate, H. pylori-associated gastritis.
Duodenitis	33-48[13,35,36,37]	0-29[13,35,36,37]	Cryptitis; Villous blunting; Increased IELs (> 20 IELs/100 enterocytes); Lamina propria eosinophilia	Celiac disease, H. pylori infection, nonsteroidal anti-inflammatory medications, bacterial overgrowth, autoimmune diseases
Epithelioid granulomas	2.7 (esophagus); 20.1 (stomach); 3.8 (duodenum)[40]	0	Collection of histiocytes; Non-caseating; Surrounded by lymphocytes; Not associated with ruptured gland/crypt	Chronic granulomatous disease, common variable immunodeficiency, and infection

CD: Crohn’s disease; IEL: Intraepithelial lymphocytes; UC: Ulcerative colitis; HPF: High-power field; H. pylori: Helicobacter pylori.