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

Endoscopic versus histological disease extent at presentation of paediatric inflammatory bowel disease
Endoscopic versus histological disease extent at presentation of paediatric inflammatory bowel disease
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.
Crohn's disease, endoscopy, histology, paediatric, paediatric inflammatory bowel disease, Paris classification, ulcerative colitis
0277-2116
246-251
Ashton, James J.
03369017-99b5-40ae-9a43-14c98516f37d
Coelho, Tracy
a78b627c-ea78-41e1-9553-0390921e3c93
Ennis, Sarah
7b57f188-9d91-4beb-b217-09856146f1e9
Vadgama, Bhumita
3a9f04f7-2ae2-4c42-aa91-33a4bb3cea12
Batra, Akshay
822f891e-87ca-41d9-b68d-27c395e88809
Afzal, Nadeem A.
62505946-2503-42ba-9b02-85513bb3ec87
Beattie, R. Mark
55d81c7b-08c9-4f42-b6d3-245869badb71
Ashton, James J.
03369017-99b5-40ae-9a43-14c98516f37d
Coelho, Tracy
a78b627c-ea78-41e1-9553-0390921e3c93
Ennis, Sarah
7b57f188-9d91-4beb-b217-09856146f1e9
Vadgama, Bhumita
3a9f04f7-2ae2-4c42-aa91-33a4bb3cea12
Batra, Akshay
822f891e-87ca-41d9-b68d-27c395e88809
Afzal, Nadeem A.
62505946-2503-42ba-9b02-85513bb3ec87
Beattie, R. Mark
55d81c7b-08c9-4f42-b6d3-245869badb71

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).

Record type: Article

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.

Full text not available from this repository.

More information

Published date: February 2016
Keywords: Crohn's disease, endoscopy, histology, paediatric, paediatric inflammatory bowel disease, Paris classification, ulcerative colitis
Organisations: Cancer Sciences, Human Development & Health

Identifiers

Local EPrints ID: 383871
URI: https://eprints.soton.ac.uk/id/eprint/383871
ISSN: 0277-2116
PURE UUID: 7fbdb125-538d-4c64-b44a-86ac252d5727
ORCID for Sarah Ennis: ORCID iD orcid.org/0000-0003-2648-0869

Catalogue record

Date deposited: 25 Nov 2015 11:11
Last modified: 17 Apr 2019 00:36

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Contributors

Author: James J. Ashton
Author: Tracy Coelho
Author: Sarah Ennis ORCID iD
Author: Bhumita Vadgama
Author: Akshay Batra
Author: Nadeem A. Afzal
Author: R. Mark Beattie

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