Value of upper endoscopic biopsies in predicting medical refractoriness in pediatric patients with ulcerative colitis

Publication date: Available online 23 June 2017
Source:Human Pathology
Author(s): Katrina J. Sullivan, Mike Wei, Elizabeth Chernetsova, Soufiane Hallani, Joseph de Nanassy, Eric I. Benchimold, David R. Mack, Ahmed Nasr, Dina El Demellawy
Refractory ulcerative colitis (UC) occurs in patients who experience a severe disease manifestation that is unresponsive to medical therapy. The assessment of upper endoscopic microscopic findings and its correlation with refractory UC has not been fully studied in pediatric patients, and is the focus of this study. Medical records of UC patients treated at a tertiary pediatric center between 2000 and 2014 were reviewed. Endoscopic biopsies of the upper gastrointestinal tract of patients meeting a priori inclusion criteria were compared between refractory UC patients and non-refractory UC patients for active inflammation. Statistically significant differences were determined between groups, and tissues shown to have significant differences were further evaluated for their diagnostic performance. A total of 52 patients were included; 26 in each group. Significant differences were observed in intraepithelial neutrophil infiltration (IEN) and percent involvement of crypts/glands for the antrum, body, and duodenal bulb (p=<0.001, 0.005, 0.01 (IEN) and p=0.001, 0.009, 0.015 (% involvement), respectively). Micro-abscesses of mucosal glands/crypts were also experienced in a greater number of refractory UC patients in the stomach (i.e. antrum and/or body of stomach; p=0.005) and duodenum (i.e. duodenum and/or duodenal bulb; p=0.023). The sensitivity and specificity of upper GI tissues to predict refractory UC was moderate, with sensitivities ranging from 38 to 67%, and specificities ranging from 81 to 100%. Our results suggest that children with refractory UC are more likely to have active inflammation in the upper gastrointestinal tract and thus this may represent a predictor of responsiveness to current medical therapy.



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