Lymphocytic esophagitis linked to CD in pediatric patients
MedWire News: Pediatric lymphocytic esophagitis (LE) is a manifestation of pediatric Crohn’s disease (CD) rather than ulcerative colitis or non-inflammatory bowel disease, suggest study results.
“LE is a recently coined term for a histologic phenotype of esophagitis, which is defined by marked esophageal lymphocytosis with no or only rare intraepithelial granulocytes (IEG),” explain Dawn Ebach (University of Iowa, Iowa City, USA) and colleagues.
LE has been linked to CD in some studies, particularly in children, but not in others. Ebach and team therefore analyzed links between LE and different gastrointestinal conditions in children.
Blinded morphologic analysis was carried out on gastrointestinal biopsies from 60 pediatric patients with CD, 30 with ulcerative colitis, and 38 with a spectrum of non-inflammatory bowel disease. The mean age of all the patients was 13.3 years and 72% were male.
The researchers counted the highest density of intraepithelial lymphocytes (IELs), neutrophils (IENs), and eosinophils (IEEs) per high power field (x40). LE was diagnosed as a ratio of IELs to IEGs of 50:1 or higher, or more than 50 IELs per high power field.
Writing in the journal Inflammatory Bowel Diseases, Ebach and co-investigators report that LE was diagnosed in 17 (28%) CD patients, but in only two children with ulcerative colitis and one with non-inflammatory bowel disease.
Of note, six of the CD patients had esophagitis with granulomas, and, of these, three were diagnosed with LE. Upper gastrointestinal symptoms did not differ significantly between CD patients with LE and those who had esophagitis with granulomas.
The authors conclude: “Although not proven by this study, we believe that given the strong association, it is likely that if LE is identified in pediatric patients with known CD, it is likely a manifestation of upper gastrointestinal CD rather than esophagitis due to other etiologies or a variant of normal.”
They add that “given that LE is frequently associated with the diagnosis of CD in pediatric patients, we believe that if LE is seen in the appropriate clinical setting, CD should be seriously considered.”
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By Helen Albert