[Clinical and colonoscopic characteristics of pediatric inflammatory bowel disease]

Abstract

Objective: To analyze clinical manifestations, endoscopic and histological features for establishing a diagnosis of pediatric inflammatory bowel disease (IBD).

Method: Thirty-four inpatients with inflammatory bowel disease (ulcerative colitis/UC/: 24; Crohn's disease/CD/:10) were enrolled into this study. Data of clinical manifestations, laboratory values, endoscopic findings and histopathological features of biopsy material were analyzed.

Result: Four children had mild/moderate active Crohn's disease. Six had severe active disease. The most common presenting symptom in CD was abdominal pain (80%, 8/10). One child had intestinal perforation; 2 had obstruction. Anal fistula was found in 2 patients. There were 5 mild, 14 moderate and 5 severe diseases in UC group. Diarrhea (23/24, 96%) was the most common symptom. Three children with UC suffered from perianal diseases. One had chronic intussusception. ESR and C reactive protein values were significantly higher in patients with CD compared with patients with UC (chi(2) = 15.938, P < 0.01; chi(2) = 11.184, P < 0.01). The pattern of anatomic involvement in CD was: ileocolic 60%, colon 10% and small bowel 30%. Endoscopically, discontinuous lesions, diverse ulcers, proliferative/regenerative patterns and narrowed bowel lumen were observed. Histologically, lymphocytes aggregation in the lamina propria and submucosa were observed. Non-caseating granulomas were found in 22% cases. Twenty-five percent of patients with UC had pancolitis. Colonoscopy showed diffusely distributed multiple erosions and ulcers in UC cases. Twenty-nine percent of children had pseudopolyps. No mucosal bridge was found. Mucosal biopsies showed chronic inflammatory cells, neutrophils and eosinophils diffusely infiltrated in the lamina propria. Crypt abscess was found in 4 cases.

Conclusion: The clinical manifestations in pediatric inflammatory bowel disease are nonspecific. Colonoscopic examination and biopsy are valuable in establishing the diagnosis of pediatric ulcerative colitis. It is important for colon involved CD children to have a colonoscopic examination. But the mucosal biopsies were short of specificity. Multi-place and deep biopsy are needed to improve the diagnosis.