Published online Apr 28, 2019. doi: 10.3748/wjg.v25.i16.1928
Peer-review started: March 19, 2019
First decision: March 27, 2019
Revised: April 3, 2019
Accepted: April 10, 2019
Article in press: April 10, 2019
Published online: April 28, 2019
Upper gastrointestinal (UGI) tract involvement of inflammatory bowel disease (IBD) is commonly seen in pediatric patients. Upper endoscopy is included in the routine workup of children with suspected IBD to enhance the diagnosis and management of these patients. Currently, childhood IBD is classified into ulcerative colitis (UC), atypical UC, Crohn’s disease (CD) and IBD unclassified. Histologic confirmation of UGI tract involvement, in particular the presence of epithelioid (non-caseating) granulomas, is helpful in confirming the diagnosis of IBD and its classification. Herein, we reviewed selected IBD-associated UGI tract manifestations in children. Lymphocytic esophagitis, seen predominantly in CD, is histologically characterized by increased intraepithelial lymphocytes (> 20 in one high-power field) in a background of mucosal injury with absence of granulocytes. Focally enhanced gastritis is a form of gastric inflammation in pediatric IBD marked by a focal lymphohistiocytic pit inflammation with or without granulocytes and plasma cells in a relatively normal background gastric mucosa. Duodenal inflammation seen in children with IBD includes cryptitis, villous flattening, increased intraepithelial lymphocytes, and lamina propria eosinophilia. Finally, epithelioid granulomas not associated with ruptured gland/crypt are a diagnostic feature of CD. The clinicopathologic correlation and differential diagnosis of each microscopic finding are discussed. Clinicians and pathologists should be cognizant of the utility and limitations of these histologic features.
Core tip: Upper gastrointestinal tract inflammation is frequently observed in pediatric patients with inflammatory bowel disease. Distinct inflammatory patterns such as lymphocytic esophagitis and focally enhanced gastritis are helpful in rendering the diagnosis of inflammatory bowel disease in an otherwise non-specific case. Epithelioid granulomas are the only specific microscopic finding to distinguish Crohn disease from ulcerative colitis. Meanwhile, duodenal inflammation demonstrates various non-specific histologic findings in the setting of pediatric inflammatory bowel disease. This review highlights the diagnostic criteria and differential diagnosis of each pathologic finding.