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Endoscopic and histological assessment of paediatric inflammatory bowel disease over a three year follow-up period

Endoscopic and histological assessment of paediatric inflammatory bowel disease over a three year follow-up period
Endoscopic and histological assessment of paediatric inflammatory bowel disease over a three year follow-up period
Objectives:
Discrepancies between inflammatory bowel disease (IBD) endoscopic/histological extent are documented at diagnosis. It is unclear whether these differences persist through disease course, with potential impact on categorization and management. We aimed to analyze the progression of disease over a 3-year period.

Methods:
Patients younger than 17 years, diagnosed between 2010 and 2013 at Southampton Children's Hospital and followed-up for 3 years were eligible. Primary outcome was disease extent at diagnosis and follow-up. Data are presented as percentage of patients undergoing endoscopy. Paris classification (PC) and PC using histological, rather than endoscopic disease, were determined.

Results:
One hundred and twenty-five patients were included, 66 boys; Crohn's disease (CD) 74, ulcerative colitis (UC) 40, IBD unclassified (IBDU) 11. All had endoscopy at diagnosis. One hundred and two patients underwent ≥1 repeat endoscopies.

Results:
Disease extent reduced from diagnosis to first follow-up endoscopy for both endoscopic and histological disease extent (CD/UC/IBDU, all P < 0.00006). Histological extent remained greater than endoscopic in CD with significant differences in stomach, ileum, and large bowel at all follow-up points (P =  < 0.045). Endoscopic matched histological extent in UC/IBDU. Applying a modified PC resulted in significant changes for CD (L3 27.4%−53.2%, P = 0.006, L3 + L4A 21%−50%, P = 0.001, and upper gastrointestinal disease 50%–80.6%, P = 0.0006) but not UC. CD height (−0.37 to −0.25) and weight (−1.09 to −0.19) standard deviation scores increased from diagnosis to follow-up.

Conclusions:
Histological disease is greater than endoscopic extent at diagnosis and during follow-up in CD, although not in UC/IBDU. Classification of disease extent in CD should be based on both endoscopic and histological criteria.
0277-2116
402–409
Ashton, J.J.
03369017-99b5-40ae-9a43-14c98516f37d
Bonduelle, Q.
c83c5e97-f054-4125-925e-50e033d5a980
Mossotto, E.
96f778af-f51a-464e-8e73-dfa24b4132de
Coelho, T.
a78b627c-ea78-41e1-9553-0390921e3c93
Batra, A.
734758f2-bd9d-4f61-8696-de0715a0bed6
Vadgama, B.
63436bb3-2d90-4907-961b-425088aec350
Ennis, S.
7b57f188-9d91-4beb-b217-09856146f1e9
Beattie, R.M.
f061ad38-5ebf-433c-8f12-141572c68ef3
Ashton, J.J.
03369017-99b5-40ae-9a43-14c98516f37d
Bonduelle, Q.
c83c5e97-f054-4125-925e-50e033d5a980
Mossotto, E.
96f778af-f51a-464e-8e73-dfa24b4132de
Coelho, T.
a78b627c-ea78-41e1-9553-0390921e3c93
Batra, A.
734758f2-bd9d-4f61-8696-de0715a0bed6
Vadgama, B.
63436bb3-2d90-4907-961b-425088aec350
Ennis, S.
7b57f188-9d91-4beb-b217-09856146f1e9
Beattie, R.M.
f061ad38-5ebf-433c-8f12-141572c68ef3

Ashton, J.J., Bonduelle, Q., Mossotto, E., Coelho, T., Batra, A., Vadgama, B., Ennis, S. and Beattie, R.M. (2018) Endoscopic and histological assessment of paediatric inflammatory bowel disease over a three year follow-up period. Journal of Pediatric Gastroenterology and Nutrition, 66 (3), 402–409. (doi:10.1097/MPG.0000000000001729).

Record type: Article

Abstract

Objectives:
Discrepancies between inflammatory bowel disease (IBD) endoscopic/histological extent are documented at diagnosis. It is unclear whether these differences persist through disease course, with potential impact on categorization and management. We aimed to analyze the progression of disease over a 3-year period.

Methods:
Patients younger than 17 years, diagnosed between 2010 and 2013 at Southampton Children's Hospital and followed-up for 3 years were eligible. Primary outcome was disease extent at diagnosis and follow-up. Data are presented as percentage of patients undergoing endoscopy. Paris classification (PC) and PC using histological, rather than endoscopic disease, were determined.

Results:
One hundred and twenty-five patients were included, 66 boys; Crohn's disease (CD) 74, ulcerative colitis (UC) 40, IBD unclassified (IBDU) 11. All had endoscopy at diagnosis. One hundred and two patients underwent ≥1 repeat endoscopies.

Results:
Disease extent reduced from diagnosis to first follow-up endoscopy for both endoscopic and histological disease extent (CD/UC/IBDU, all P < 0.00006). Histological extent remained greater than endoscopic in CD with significant differences in stomach, ileum, and large bowel at all follow-up points (P =  < 0.045). Endoscopic matched histological extent in UC/IBDU. Applying a modified PC resulted in significant changes for CD (L3 27.4%−53.2%, P = 0.006, L3 + L4A 21%−50%, P = 0.001, and upper gastrointestinal disease 50%–80.6%, P = 0.0006) but not UC. CD height (−0.37 to −0.25) and weight (−1.09 to −0.19) standard deviation scores increased from diagnosis to follow-up.

Conclusions:
Histological disease is greater than endoscopic extent at diagnosis and during follow-up in CD, although not in UC/IBDU. Classification of disease extent in CD should be based on both endoscopic and histological criteria.

Text Endoscopic and Histological Assessment of PIBD_untracked - Accepted Manuscript
Restricted to Repository staff only until 13 August 2018.
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More information

Accepted/In Press date: 13 August 2017
e-pub ahead of print date: 16 September 2017
Published date: 1 March 2018

Identifiers

Local EPrints ID: 414125
URI: https://eprints.soton.ac.uk/id/eprint/414125
ISSN: 0277-2116
PURE UUID: af6774b8-e52f-4814-82e7-ad9fc76ba099
ORCID for E. Mossotto: ORCID iD orcid.org/0000-0003-3996-3931

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Date deposited: 15 Sep 2017 16:30
Last modified: 06 Jun 2018 12:15

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Contributors

Author: J.J. Ashton
Author: Q. Bonduelle
Author: E. Mossotto ORCID iD
Author: T. Coelho
Author: A. Batra
Author: B. Vadgama
Author: S. Ennis
Author: R.M. Beattie

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