The role of esophagogastroduodenoscopy in the initial evaluation of childhood inflammatory bowel disease: a 7-year study.
OBJECTIVE
To assess the role of esophagogastroduodenoscopy in the evaluation of children with suspected inflammatory bowel disease.


METHODS
All children with inflammatory bowel disease who underwent esophagogastroduodenoscopy during their initial evaluation at our institution during a 7-year period (December 1993 to November 2000) were included in the study.


RESULTS
The study included 115 patients: 81 with Crohn disease (mean age, 11.34 years; 42 males) and 34 with ulcerative colitis (mean age, 11.79 years; 20 males). Abnormal findings on esophagogastroduodenoscopy were noted in 64% of patients with Crohn disease and 50% of children with ulcerative colitis; histologic abnormalities were found in 81.6% and 70.6% of the patients, respectively. Granulomas were found in the upper gastrointestinal tracts of 23 of 81 patients (28.4%), with the most common site being the gastric mucosa. Nine of these 23 patients had granulomas solely in the upper gastrointestinal tract. Additional unsuspected pathology noted included: candidiasis, hiatal hernia, Helicobacter pylori infection, and giardiasis.


CONCLUSIONS
Endoscopic and histologic abnormalities were found in the upper gastrointestinal tracts of a significant number of children with inflammatory bowel disease. While the mechanism(s) underlying these abnormalities in patients with ulcerative colitis is unclear, the pathology can contribute to the patient's clinical condition. Pathology in the upper gastrointestinal tract should not exclude a diagnosis of ulcerative colitis. Granulomas, confirming the diagnosis of Crohn disease, were found in the upper gastrointestinal tracts of 28% of our patients with Crohn disease. In some cases, granulomas were found solely in the upper gastrointestinal tracts. Based on our data, esophagogastroduodenoscopy with biopsy should be performed in all pediatric patients with suspected inflammatory bowel disease.
Abdullah
Bisher A
BA
Division of Gastroenterology, James Whitcomb Riley Hospital for Children, Indiana University Medical Center, Indianapolis, USA.
Gupta
Sandeep K
SK
Croffie
Joseph M
JM
Pfefferkorn
Marian D
MD
Molleston
Jean Pappas
JP
Corkins
Mark R
MR
Fitzgerald
Joseph F
JF
D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000473:pathology; D003424:Crohn Disease / Q000175:diagnosis / Q000473:pathology; D003937:Diagnosis, Differential; D004386:Duodenum / Q000473:pathology; D016145:Endoscopy, Digestive System / Q000379:methods*; D004947:Esophagus / Q000473:pathology; D005260:Female; D006099:Granuloma / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis* / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D012189:Retrospective Studies; D013270:Stomach / Q000382:microbiology / Q000473:pathology