Endoscopic versus histological disease extent at presentation of paediatric inflammatory bowel disease

Ashton, James J., Coelho, Tracy, Ennis, Sarah, Vadgama, Bhumita, Batra, Akshay, Afzal, Nadeem A. and Beattie, R. Mark (2016) Endoscopic versus histological disease extent at presentation of paediatric inflammatory bowel disease. Journal of Pediatric Gastroenterology & Nutrition, 62 (2), 246-251. (doi:10.1097/MPG.0000000000001032).

Abstract

Background: The Paris classification (PC) of paediatric inflammatory bowel disease (PIBD) categorises disease extent and therefore impacts on treatment decisions Histological (microscopic) disease extent is not incorporated and endoscopic (macroscopic) findings may underrepresent disease extent when compared to histological findings; this study compares disease extent at presentation.

Methods: Data were obtained of patients below 17 years of age diagnosed with IBD from 2010-13 at University Hospital Southampton. Data are presented as percentage of patients undergoing endoscopy. PC was performed alongside a modified PC by histological disease location.

Results: 172 patients were identified (median age at diagnosis 13.5, 115 male); Crohns disease (CD)- 107, Ulcerative Colitis (UC)- 50, Inflammatory Bowel Disease Unclassified (IBDU)- 15; 159 had undergone upper GI endoscopy, 163 had undergone lower GI endoscopy. Histological disease was more extensive at all points for CD, UC and IBDU.

CD; endoscopic ileal disease in 49% of patients compared to histological disease in 71.3%. Comparing PC; a 10% increase in L3 disease (ileocolonic), a 24% increase in L3+L4a disease (ileocolonic plus upper gastrointestinal (GI)) and a 27% increase in all upper GI involvement if histological disease extent was used.

UC; the most common disease location was the rectum (endoscopic- 91.5% vs histological- 93.6%) and descending colon (endoscopic- 89.4% vs histological-95.7%). Comparing PC; a 19% increase in E4 disease (pancolitis) if histological disease extent was used.

Conclusion: This data confirms that histological disease extent is greater than endoscopic disease extent. This should be considered when the PC is used. Further study is needed to elucidate which classification would better predict disease outcome.

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Contributors

Author: James J. Ashton

Author: Sarah Ennis

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