Gastral antral biopsy in the differentiation of pediatric colitides.
OBJECTIVE
Differentiation of Crohn's disease (CD) from ulcerative colitis (UC) is problematic, primarily when inflammation is confined to the colon. In a historical cohort study, we evaluated the usefulness of baseline gastric antral biopsies in the differentiation of pediatric chronic colitides.


METHODS
During initial investigation for suspected inflammatory bowel disease, 39 children and adolescents with colitis but normal small bowel radiography underwent pretreatment upper endoscopy concurrently with colonoscopy. Two reviewers assigned a colonoscopic diagnosis (colonic CD, UC, or indeterminate colitis) based on the macroscopic and microscopic appearances of the colonic mucosa. Antral histological findings were compared between groups using Fisher's exact test.


RESULTS
Five (14%) of colonoscopic diagnoses (four indeterminate, one UC) were changed to CD by the finding of granulomatous inflammation in antral biopsies. Nonspecific antral gastritis was found in similar proportions of children and adolescents with Crohn's colitis and UC (92% vs 75%). Focal antral gastritis was more common in patients with Crohn's colitis than UC (52% vs 8%).


CONCLUSIONS
Nonspecific antral gastritis is common in all forms of chronic colitis. Nevertheless, upper gastrointestinal endoscopy with biopsy is useful in the differentiation of inflammatory bowel disease confined to the colon, particularly when colonoscopic findings are indeterminate.
Kundhal
P S
PS
Department of Pediatrics, Division of Gastroenterology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
Stormon
M O
MO
Zachos
M
M
Critch
J N
JN
Cutz
E
E
Griffiths
A M
AM
D000293:Adolescent; D001706:Biopsy; D002648:Child; D003092:Colitis / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006099:Granuloma; D006801:Humans; D007249:Inflammation; D008297:Male; D011706:Pyloric Antrum / Q000473:pathology*