Retrospective study of Crohn disease at a hospital in Andalucía (1978-1988)]

We reviewed 46 cases of Crohn's disease diagnosed during the period between 1978-1988, with the intention to analyse the age, sex, presentation, evolution, complications and diagnosis. The majority of patients were women, with a mean age of 39. In the last years we have seen an increment in our number of cases. The mean time to diagnosis was about 3.5 years. The main symptoms were abdominal pain, diarrhoea and loss of weight. The complications was of 40% in colonic disease and 75% when the affection was in ileum and colon. During the evolution 4 patients died, 2 of them from their Crohn's disease. One patient had a colonic carcinoma. In 15% of the cases there was a previous appendectomy. The most frequent radiological findings were in the small intestine: lack of haustration and cobblestone appearance. In the colon: lack of haustration and ulceration. The most frequent endoscopical findings were ulcers and a cobblestone appearance.     

Plain abdominal radiographic features are not reliable markers of disease extent in active ulcerative colitis

OBJECTIVES: The aims of this study were to assess the reliability of the distribution of fecal residue, mucosal irregularity, and colonic wall thickening on plain abdominal x-ray as markers of disease extent assessed by technetium-99 m hexamethylpropylene amine oxine-labeled leukocyte scans in active ulcerative colitis (UC). METHODS: Plain abdominal radiographs were blindly assessed for the distribution of fecal residue, mucosal irregularity, and colonic wall thickening (>3 mm) in 30 patients with active UC. Most patients were too sick to safely allow total colonoscopy. In 11 patients for whom details of disease extent were available from total colonoscopy or surgery undertaken at the time, there was a close correlation with disease extent defined by technetium-99 m hexamethylpropylene amine oxine-labeled leukocyte scans. Contemporaneous radiolabeled leukocyte scans were therefore used to assess disease extent in comparison with plain abdominal radiographs. RESULTS: Of 30 patients, 15 had pancolitis and 15 had subtotal or distal disease as indicated by radiolabeled leukocyte scans. The distribution of fecal residue on plain abdominal radiographs correctly identified disease extent defined on radiolabeled leukocyte scans in 40% of patients, overestimating it in 13% and underestimating it in 47%. There was no significant correlation between distribution of fecal residue on plain abdominal radiographs and disease extent on radiolabeled leukocyte scans or colonoscopy or surgery. Of patients with pancolitis, 60% had fecal residue present on plain abdominal radiograph with 40% showing stool distal to the hepatic flexure as well as in the right colon. For total UC on radiolabeled leukocyte scanning, the sensitivity and specificity of absence of fecal residue on plain abdominal radiographs were 40% and 80% respectively. Irregularity of mucosal edge and colonic wall thickening were even less accurate than fecal residue in defining disease extent. CONCLUSIONS: The distribution of fecal residue, irregularity of mucosal edge, and colonic wall thickening on plain abdominal radiography do not provide a reliable guide to disease extent in active UC.     

Crohn's-like clinical and pathological manifestations of giant inflammatory polyposis in IBD: A potential diagnostic pitfall

Background & aimsGiant inflammatory polyposis (GIP), characterized by mass-like agglomerations of inflammatory polyps, is a rare complication of inflammatory bowel disease (IBD). We reviewed a series of cases of GIP to determine its diagnostic impact on the clinical and pathologic distinction between ulcerative colitis (UC) and colonic Crohn's disease (CD).MethodsAll colons with GIP resected over a 13-year period were identified prospectively and the corresponding clinical and pathologic records were reviewed.ResultsTwelve cases of GIP were identified, accounting for 0.8% of colectomies for IBD during the same time interval. Preoperatively, 6 (50%) patients were diagnosed with UC, 2 (17%) with CD and 4 (33%) with indeterminate colitis (IC). Postoperatively, 6 of the diagnoses (50%) were revised based on strict histopathologic criteria: all 4 diagnoses of IC to UC, one diagnosis of CD to UC, and one diagnosis of UC to CD, for a total of 10 diagnoses of UC (83%) and two of CD (17%). Significantly, 7 of 10 cases with postoperative diagnoses of UC (70%) had Crohn's-like transmural inflammation exclusively within the polyposis segments attributed to fecal entrapment and stasis and accounting for the Crohn's-like clinical complications in these cases.ConclusionsThis case series of GIP, the largest reported from a single center, highlights the high rate of Crohn's-like clinical and pathological manifestations of GIP and their potential to confound the accurate classification of patients with IBD. A diagnosis of UC should not be amended to CD based on the findings of the polyposis segment alone.     

Clinical Epidemiology and Phenotypic Characteristics of Crohn's Disease in the Central Region of Saudi Arabia

Background/Aims:

Despite the remarkable increase in the incidence of Crohn''s disease among Saudis in recent years, data about Crohn''s disease in Saudi Arabia are scarce. The aim of this study was to determine the clinical epidemiology and phenotypic characteristics of Crohn''s disease in the central region of Saudi Arabia.

Patients and Methods:

A data registry, Inflammatory Bowel Disease Information System (IBDIS), was used to register Crohn''s disease patients who presented to the gastroenterology clinics in four tertiary care centers in Riyadh, Saudi Arabia between September 2009 and February 2013. Patients’ characteristics, disease location, behavior, age at diagnosis according to the Montreal classification, course of the disease, and extraintestinal manifestation were recorded.

Results:

Among 497 patients with Crohn''s disease, 59% were males with a mean age at diagnosis of 25 years [95% Confidence Interval (CI): 24-26, range 5-75 years]. The mean duration from the time of complaint to the day of the diagnosis was 11 months, and the mean duration of the disease from diagnosis to the day of entry to the registry was 40 months. Seventy-seven percent of our patients were aged 17-40 years at diagnosis, 16.8% were ≤16 years of age, and 6.6% were >40 years of age. According to the Montreal classification of disease location, 48.8% of patients had ileocolonic involvement, 43.5% had limited disease to the terminal ileum or cecum, 7.7% had isolated colonic involvement, and 16% had an upper gastrointestinal involvement. Forty-two percent of our patients had a non-stricturing, non-penetrating behavior, while 32.8% had stricturing disease and 25.4% had penetrating disease.

Conclusion:

Crohn''s disease is frequently encountered in Saudi Arabia. The majority of patients are young people with a predilection for males, while its behavior resembled that of western societies in terms of age of onset, location, and behavior.     

昆明市炎症性肠病多中心临床资料分析

目的:回顾性调查昆明市近10年炎症性肠病(IBD)患者的发病状况.方法:调查1998年1月-2007年3月七家综合性医院430例住院IBD患者,其中溃疡性结肠炎(UC)379例,克罗恩病(CD)51例.接受结肠镜、组织病理学和钡剂灌肠检查者在UC和CD患者中分别为98.2%和56.2%、2.6%和72.5%、78.4%和31.4%.对IBD患者的年龄、性别、职业、临床表现、内镜和组织病理学检查结果进行分析.结果:UC患者平均年龄为(46.9±15.8)岁,以30～39岁和50～59岁年龄段患者最多,呈双峰状分布;CD患者平均年龄为(41.6±17.2)岁,以20～29岁年龄段患者最多.UC和CD患者均以男性为主,UC患者中脑力劳动者多见.UC患者以腹泻(302,79.7%)、腹痛(285,75.2%)、血便(290,76.5%)为主.CD患者常见腹痛(44,86.3%)、腹泻(28,54.9%)、体重减轻(28,54.9%).UC患者内镜检查、病理检查、钡剂灌肠诊断符合率分别为88.4%(329/372)、24.4%(52/213)、4/10,CD患者分别为86.5%(32/37)、27.5%(11/40)、75%(12/16).UC患者100%为活动期,其中轻、中、重度分别为38.3%、42.2%和19.5%.CD患者活动期占92.2%,缓解期占7.8%,其中轻、中、重度者分别为15.7%、43.1%41.2%.结论:了解10年来昆明市的IBD发病情况及临床特征将有助于临床诊断和治疗.     

Presenting symptoms and diagnostic lag in children with inflammatory bowel disease.

Presenting symptoms and their duration may affect the time that elapses prior to definitive diagnosis of inflammatory bowel disease (IBD). This study was undertaken to determine the mean duration of presenting symptoms and diagnostic lag in children with IBD. The medical records of all patients less than 19 years of age diagnosed with IBD at the pediatric gastroenterology clinic of Children's Hospital of Wisconsin between 1990-1995 were reviewed. The age at diagnosis, gender, presenting symptoms and duration, disease location, and diagnostic lag were analyzed. There were 91 children (49 male) diagnosed with IBD. Crohn's disease (CD) was diagnosed in 58, ulcerative colitis (UC) in 24, and indeterminate colitis in 9. The mean ages at diagnosis were 11.4 years for CD, 9.7 years for UC, and 7.8 years for indeterminate colitis. The most frequent presenting symptoms were abdominal pain, diarrhea, hematochezia, and weight loss. The average lag in diagnosis of CD was 7.1 months, which varied by disease location: small intestine 10.5 months, ileocolonic 7.5 months, and colonic 6.4 months. The average lag in diagnosis was 6.7 months for UC and 14 months for indeterminate colitis. Children presenting with growth failure had the longest diagnostic lag. (a) The elapsed time between symptom onset and the diagnosis of CD has decreased. (b) The diagnostic lag in CD decreases with distal colonic involvement. (c) Following onset of symptoms UC was diagnosed only slightly more rapidly than CD.     

'Microerosions' in rectal biopsies in Crohn's disease

Small (less than 1 mm), superficial erosions ('microerosions') have been observed stereo-microscopically in surface-stained rectal biopsies in Crohn's disease (CD). Biopsy specimens from 97 patients with CD, 225 with ulcerative colitis (UC), and a control material of 161 patients were investigated to define the occurrence and significance of the microerosions. In CD they were found in 13% of specimens, in UC in 5%, and in the control material not at all. In CD they were observed only in patients with colonic involvement and were most frequent (44%) in patients with this site of affection exclusively. Granulomas were identified in 62% of the biopsies with microerosions and by examination of two consecutive biopsies from each of these patients, in 85% indicating a positive correlation. In patients with microerosions and a primary diagnosis of UC, granulomas were found in 38% and by examination of two biopsies in 54%. Patients with granulomas and a few other patients were reclassified as CD, but there still remained some patients with microerosions, who most probably had UC. In conclusion, microerosions are observed mainly in CD with colonic involvement. There is a high incidence of granulomas in biopsy specimens with microerosions. The demonstration of microerosions in a specimen is suggestive of, but probably not diagnostic of, CD.     

Colonoscopic and histologic features of colonic Crohn's disease in Chinese patients

OBJECTIVE: An attempt was made to provide a better insight into endoscopic and histological features and to enhance the understanding of the diagnostic value of colonoscopy combined with biopsy for colonic Crohn's disease. METHODS: As presented in our 27 cases of colonic Crohn's disease (Crohn's colitis), the endoscopic findings and histological changes of biopsy specimens were analyzed. As collated with correspondent results of biopsy and surgical specimens, the diagnostic accuracy of endoscopy was evaluated. RESULTS: Of these patients, 26 involvements of the colon (often combined with other sites of the bowel) were observed (96.3%). However, involvements limited to the colon alone were seen in only four cases (14.8%). Endoscopically, diverse patterns of multi‐staged‐segmental distributed and multi‐sited inflammatory lesions, both destructive and proliferative/regenerative changes were observed in the bowel of the same patient. The diaganostic accuracy of colonoscopy, as confirmed by the histological examination of biopsy and resected specimens, was 66.7%. The major characteristic features of mucosal biopsy were the focal distribution of inflammatory infiltration and lymphoid aggregate. Otherwise, it may include edematous and widened submucosa, deep fissuring ulcers and hyperplasia, fibrosis and granulomas (detected in 30% of the group), among others. CONCLUSION: The colonic involvement of Crohn's disease was common. Colonoscopy may be valuable in establishing a diagnosis and in assessing the extent and severity of such colonic involvement. Biopsy is helpful to confirm a diagnosis conducted by colonoscopy. Colonoscopy combined with biopsy may replace radiology as the initial test of choice in many clinical situations.     

Colon capsule endoscopy for inflammatory bowel disease

Colon capsule endoscopy (CCE) is designed for direct visualization of the colonic mucosa through passive propulsion. The role of CCE in the detection of colonic polyps has been extensively evaluated. As mucosal healing has emerged as a pivotal target for treatment of inflammatory bowel disease (IBD), there is increasing data to suggest that CCE can also be used in the monitoring of mucosal inflammation in patients with active IBD, particularly in ulcerative colitis (UC) and Crohn's disease (CD). Despite advantages such as its non‐invasive nature, patient's comfort, safety, and access to anatomical regions not easily reached by conventional endoscopy, CE has limitations including the lack of ability to obtain biopsies or therapeutic capabilities and no control over movement. In this review, the role and diagnostic value of CCE on diagnosis and monitoring of UC and CD patients, its safety and limitations are discussed.     

Anti-neutrophil cytoplasmic antibodies (ANCA) in sera from patients with inflammatory bowel disease (IBD)

Anti-neutrophil cytoplasmic antibodies producing a perinuclear fluorescence pattern on ethanol-fixed granulocytes (p-ANCA) were found in 33 of 67 patients (49%) with ulcerative colitis (UC) but also in 14 of 35 patients (40%) with Crohn's disease (CD). In the latter condition p-ANCA were equally present in subgroups with colonic, ileocolonic, or ileal involvement only. Titers of p-ANCA were higher in patients with UC compared to CD patients, in particular when comparing patients with active disease. In contrast to findings in CD, patients with active UC had higher titers of p-ANCA than patients with inactive UC. Although p-ANCA were incidentally directed to lactoferrin, both in UC and CD, and to proteinase-3 and myeloperoxidase in UC only, the antigenic nature of p-ANCA could not be identified in most of the cases. We conclude that, within the spectrum of inflammatory bowel disease, the presence of p-ANCA is not specific for UC. When titers of p-ANCA are taken into account, the presence of high-titered p-ANCA, however, suggests active UC.     

钙卫蛋白、乳铁蛋白在溃疡性结肠炎患者中表达的临床研究

背景:溃疡性结肠炎(UC)是慢性反复发作的肠道炎性疾病,评估疾病活动度对其疗效判断非常重要,实验室标记物尤其是粪便标记物可很好地反映疾病活动度。目的:探讨钙卫蛋白(Cal)、乳铁蛋白(Lf)在UC患者结肠黏膜和粪便中表达的临床意义。方法:选取1998年1月～2008年1月安徽医科大学第一附属医院收治的具备完整结肠镜或手术病理检查结果的UC患者120例。以临床活动度指数(CAI)评分进行疾病分期,以免疫组化SP法检测结肠黏膜Cal、Lf表达,以ELISA法检测粪便Cal、Lf含量。结果:活动期UC患者结肠黏膜中均表达Cal、Lf,缓解期无或仅弱表达。活动期UC患者粪便Cal、Lf含量显著高于缓解期(P0.01)。UC患者结肠黏膜Cal和Lf表达以及粪便Cal和Lf含量均与CAI评分呈正相关(P=0.000)。粪便Cal和Lf含量与结肠黏膜Cal和Lf表达亦呈正相关(r=0.588,P=0.000;r=0.519,P=0.000),且判断UC活动性的敏感性和特异性均较高。结论:UC患者结肠黏膜Cal、Lf表达可反映临床严重度,粪便Cal、Lf含量与UC活动性显著相关。     

Increasing incidences of inflammatory bowel disease and decreasing surgery rates in Copenhagen City and County, 2003-2005: a population-based study from the Danish Crohn colitis database

OBJECTIVES: A continuous increase in the incidence of inflammatory bowel disease (IBD), Crohn's disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC) has been suggested. Since Denmark provides excellent conditions for epidemiological research, we aimed to describe contemporary IBD incidence rates and patient characteristics in Copenhagen County and City. METHODS: All patients diagnosed with IBD during 2003-2005 were followed prospectively. Demographic and clinical characteristics, such as disease extent, extraintestinal manifestations, smoking habits, medical treatment, surgical interventions, cancer, and death, were registered. RESULTS: Five-hundred sixty-two patients were diagnosed with IBD, resulting in mean annual incidences of 8.6/10(5) for CD, 13.4/10(5) for UC, and 1.1/10(5) for IC. Time from onset to diagnosis was 8.3 months in CD and 4.5 months in UC patients. A family history of IBD, smoking, and extraintestinal manifestations was significantly more common in CD than in UC patients. Only 0.6% of UC patients had primary sclerosing cholangitis. In CD, old age at diagnosis was related to pure colonic disease, whereas children significantly more often had proximal and extensive involvement. Twelve percent of CD patients and 6% of UC patients underwent surgery during the year of diagnosis, significantly less than earlier reported. CONCLUSIONS: The incidence of IBD in Copenhagen increased noticeably during the last decades. Time from onset of symptoms until diagnosis decreased markedly, extent of CD was related to age at diagnosis, and the risk of surgery was low in UC.     

High ulcerative colitis and Crohn's disease ratio in a population-based registry from Córdoba,Argentina

BackgroundFew studies have described the epidemiology and clinical behavior of inflammatory bowel disease (IBD) in South America. The aim of this study was to report on the prevalence, phenotype, and treatment of patients with IBD diagnosis in Capital Department of the Province of Córdoba, Argentina.MethodsData from adult patients (≥ 18 years-old) with IBD diagnosis that attended 12 public or private centers between 05/2014 and 05/2019 were included in a common registry.ResultsA total of 655 patients were included (females: 53.4%). The ratio of ulcerative colitis (UC) (n = 561) to Crohn's disease (CD) (n = 88) was 6.38, with age-adjusted IBD prevalence being 70.1 (95% confidence interval 70.08–70.12) cases/100,000 habitants. Extraintestinal manifestations were diagnosed in 22.8% of patients, and left-side colitis (46%) was the most frequent extension in UC patients. In CD patients, colonic involvement (55.7%) and non-stricturing/non-penetrating behavior (74%) were the most frequent presentations. Biologic therapy was used in 36.4% of CD patients and 9.1% of UC patients (P<0.001).ConclusionIn this population registry study, IBD prevalence was similar to that reported in other series in the region. A higher UC/CD ratio was observed due to the lower prevalence of CD compared to similar studies in South America.     

Crohn's disease. Clinical manifestations

Two hundred and fourteen patients with Crohn's disease (CD) consecutively admitted during a 5-year period were observed for a mean of 9 years (range, 0-35 years). Sixty-five per cent had their initial symptoms between 10 and 30 years of age and 9.2% after the age of 50 years. The CD diagnosis was delayed for more than 10 years in 8% (mean, 4.5; range, 0-31 years). Large-bowel involvement was seen in 82.5% and was the only localization of the disease in a fourth of the patients. Recurrent abdominal pain occurred in two-thirds of patients with ileal or ileocolic disease. Acute abdominal pain was the cause of laparotomy in 14% of the patients with ileocolic CD. Diarrhea and rectal bleeding occurred significantly more often in colonic CD, whereas fistula complicated ileocolic disease more often than isolated involvement of small or large bowel. Associated extraintestinal diseases were seen in 117 patients (55%), most frequently related to colonic involvement (joint disease, 21%; eye, 12%, skin, 8%). Of 26 patients (12%) with liver pathology, 10 patients had amyloid deposits. Amyloidosis was diagnosed in altogether 12 patients (6%).     

Un estudio descriptivo de la enfermedad inflamatoria intestinal en un centro de atención terciario egipcio

Introduction and aimsInflammatory bowel disease (IBD) is a group of chronic intestinal disorders that trigger prolonged inflammation of the digestive tract. Its incidence and prevalence appear to be increasing in the African population and in Egypt. The present study aims to highlight the pattern and management of IBD in Egyptian patients.Materials and methodsTwo hundred patients with IBD were assessed for ulcerative colitis (UC), through the Mayo score, and for Crohn's disease (CD), with the Crohn's disease activity index (CDAI).ResultsMedian patient age was 35 years, with a predominance of females. UC was more common than CD (88% and 12%, respectively) and severity was moderate, in the majority of cases. Most UC patients had left-sided lesions, whereas ileitis was the most common finding (37.5%) in the CD patients. Proctitis was the least common finding in both diseases and Crohn's fistulizing disease was detected in 4.1% of the patients. Interestingly, peripheral arthropathy was the most common extraintestinal manifestation in the IBD patients (70%) and axial arthropathy was the least common (6%). Severe ocular or mucocutaneous involvement was very rare. Finally, biologic treatment was prescribed to 15.4% of the UC patients and 20.8% of the CD patients.ConclusionsAlthough the clinical presentation of IBD in Egypt is comparable to that reported worldwide, diagnoses were found to be delayed. There were fewer cases of CD than UC, but more mild-to-moderate disease severity. The surveillance of patients with IBD must continue and awareness of the disease in the Egyptian medical community needs to increase. A national registry must be established, multicenter studies need to be conducted, and molecular diagnostics is recommended.     

Riesgo de fenómenos tromboembólicos en pacientes con enfermedad inflamatoria intestinal

Introduction

Inflammatory bowel disease (IBD) is an independent risk factor for thromboembolic phenomena (TEP). We evaluated the prevalence and the possible risk factors associated with developing TEP in patients with IBD in our center.

Material and methods

Data were retrospectively collected from January 1995 to December 2011 from 23 patients. A total of 61% were diagnosed with Crohn's disease (CD) and 39% with ulcerative colitis (UC) according to routine criteria.

Results

When the Montreal classification was used, 58% of the patients with CD had an inflammatory pattern (B1), 25% a stenosing pattern (B2) and 17% a fistulizing pattern (B3). Half the patients had ileocolic involvement (L3), one-third had colonic involvement (L2) and the remainder had ileal involvement (L1). Among patients with UC according to the Montreal classification, 78% had extensive colitis (E3), 11% had left colonic involvement (E2) and 11% had proctocolitis (E1). During the event, almost half the patients with UC had severe inflammatory activity (S3; 44%), 33% had mild-moderate activity (S1: 22%, S2: 11%) and only 22% were in remission (S0). Overall, at the time of the TEP, 48% of the patients had mild-moderate activity and 22% had severe activity. Likewise, 44% were hospitalized at the time of the event. In UC, an increase in the prevalence of TEP was found in admitted patients (66%). None of the patients had a family history of TEP, two patients (9%) had associated thrombophilia and 26% were active smokers. There were no TEP during pregnancy. Only one patient was taking contraceptive pills when the event occurred. The most frequent forms of TEP were deep vein thrombosis of the legs (55%) followed by pulmonary thromboembolism (25%).

Conclusions

TEP are relatively frequent in patients with IBD, with a strong impact on morbidity and mortality. In our series, risk factors for these events were more extensive involvement (any of the groups) and severe inflammatory activity. No significant association between classical risk factors such as the use of contraceptives, pregnancy, coagulation disorders or smoking and the risk of TEP were found.     

European Cooperative Crohn's Disease Study (ECCDS): clinical features and natural history

In the European Cooperative Crohn's Disease Study patients from 14 centers were included in whom diagnosis was made within 2 years before study entry on the basis of generally accepted radiological, endoscopical and/or histological criteria or a combination of all. Reasons for exclusion were: diagnosis older than 2 years in patients who did not require active treatment, age less than 18 years, duration of symptoms less than 3 months, presence of complications which potentially required emergency surgery. Data on clinical features were obtained in 633 patients, of whom 452 were eligible to participate in the study. In 110 patients randomized to placebo the natural course of Crohn's disease was studied. Patients with ileocolonic involvement were younger than patients with either colonic or small intestinal involvement only. Classic ileitis terminalis was present in 14% of the patients. 49% of the patients had combined involvement of both the small and large intestine. 30% of patients had only small intestinal involvement, and in 21% colonic disease was present. Small intestinal involvement was associated with a significantly lower Crohn's Disease Activity Index (CDAI) than other anatomical locations of the disease. Perianal disease was more often associated with colonic than with small intestinal involvement. 60% of placebo patients with active disease at entry achieved at least a transient remission within the initial 5 months of study. After 2 years, 23% of patients with active disease at entry and 68% of patients with quiescent disease had reached or maintained a remission, respectively. By stepwise multiple linear regression analysis long duration of disease between diagnosis and randomization, normal serum albumin and combined involvement of small intestine and colon were identified as predictors of a more favorable outcome of patients treated with placebo. In contrast, extensive small bowel disease, treatment with steroids and bowel resection prior to study entry correlated with a less favorable outcome. However, by life table analysis outcome of previously untreated and treated patients in the placebo group was similar.     

Diagnostic yield of upper endoscopy in paediatric patients with Crohn's disease and ulcerative colitis. Subanalysis of the HUPIR registry

Background, aimsAccording to Porto Criteria upper gastrointestinal (UGI) endoscopy is recommended in patients with suspected inflammatory bowel disease (IBD). Nevertheless, previous studies revealed frequent involvement of UGI tract even in patients with ulcerative colitis (UC). The aim of the present study was to determine the diagnostic role of esophagogastroduodenoscopy (EGD) and assess the prevalence and different aspects of UGI involvement in children registered in the Hungarian Pediatric IBD Registry (HUPIR) from 1st of January 2007 to 31th of December 2009.MethodsTwenty seven institutes provided prospective follow-up data about newly diagnosed IBD patients to HUPIR. The registry was based on detailed questionnaire (76 parameters) involving anamnestic data, laboratory findings, activity indexes, diagnostic procedures, endoscopic examinations (EGD and ileocolonoscopy), and histological data. Localization and phenotype of disease were based on the Montreal classification criteria.ResultsDuring the 3-year period 420 children were diagnosed with IBD, 265 (63%) of them had Crohn's disease (CD), 130 (31%) UC, and 25 (6%) IBD-unclassified (IBD-U). The mean age at diagnosis was 13.2 years (range: 1.2–18 years). EGD was performed in 237 patients (56%), in most cases in patients suffering from CD. Macroscopic lesions on EGD were noted in 64% of patients with CD and 40% of children with UC. Characteristic lesions for CD (ulcer, erosion, aphthous lesion, and granuloma) were noted in 31% of CD patients, however, EGD helped to establish the final diagnosis in 9% of CD patients (diagnostic yield, 9%).ConclusionsThere was a high frequency of UGI involvement in children with CD and UC. One third of CD patients showed significant lesions at upper endoscopy and one patient out of ten had real diagnostic help from EGD.     

Clinical characteristics and prognosis of patients with ulcerative colitis that shows rectal sparing at initial diagnosis

BACKGROUND Ulcerative colitis(UC) is characterised by mucosal inflammation from the rectum to its proximal area in a symmetric and continuous fashion. However, although uncommon, we encounter cases of UC with rectal sparing in the initial stage.AIM To evaluate the clinical characteristics and clinical course for rectal sparing UC compared with typical UC.METHODS We looked at records from 2004 to 2015, and selected patients who were newly diagnosed with UC, and who could be followed up for at least 5 years in our hospital. We then retrospectively analysed the medical records and endoscopic findings of those patients. To compare the clinical course and prognosis, we matched each patient with rectal sparing UC 1:3 with controls by age, sex, and disease extent.RESULTS Of 619 UC patients, 24(3.9%) showed rectal sparing at diagnosis. During the follow-up period(median 8 years), in two(8.3%) of the 24 patients, rectal sparing remained through follow-up inspections; but for the other 22(91.7%) patients,obvious rectal inflammation was found at follow-up endoscopy. Of the 24 patients, 8(33.3%) were initially misdiagnosed with infectious colitis. No diagnosis was changed to Crohn's disease. The uses of corticosteroid or biologic agents, hospitalisation rate, and colectomy rates were not different between the rectal sparing UC group and typical UC group.CONCLUSION Some patients with UC can reveal atypical patterns of disease distribution, such as rectal sparing in its initial stage; but despite this, the clinical course and prognosis may not differ from those of typical UC patients.