Abstract：
OBJECTIVE: Upper gastrointestinal (UGI) tract involvement is frequently reported in pediatric Crohn disease (CD) and ulcerative colitis (UC). Aside from granulomas, most findings are nonspecific. The aims of this study were to review the prevalence of UGI tract findings in pediatric patients with CD or UC at diagnosis and to describe differences in endoscopic and histologic features.
METHODS: Patients with CD and UC aged 2 to 17 years diagnosed between 2000 and 2015 who had upper and lower endoscopy at diagnosis were randomly chosen from the BC Children\'s Hospital inflammatory bowel disease (IBD) registry. Pathology review of the UGI biopsy specimens was blinded to IBD diagnosis.
RESULTS: Of the 198 patients, 102 with CD and 96 with UC were included, with a mean age of 11.7 years (range, 2.3-17 years). Patients with CD were more likely to have aphthous ulcers (20.4% vs 3.5%, P = .002) and erosions (16.3% vs 3.5%, P =.018), most commonly affecting the antrum. Macroscopically normal UGI endoscopy was present in 60% of patients. Microscopic disease was reported in 100% of patients with CD and 87% of patients with UC. In both groups, nonspecific inflammation was the most common finding. Chronic deep, superficial, and diffuse inflammation were more frequent among patients with CD than UC (42% vs 4%, P < .001; 60% vs 17%, P < .001; 50% vs 34%, P = .04, respectively).
CONCLUSIONS: The UGI tract macroscopic changes were common in pediatric IBD, especially in CD. Despite macroscopically normal endoscopy, histologic abnormalities were frequent. Although chronic inflammation was more often reported in patients with CD, aside from granulomas there were no unique histologic abnormalities unique to CD.
METHODS: Patients with CD and UC aged 2 to 17 years diagnosed between 2000 and 2015 who had upper and lower endoscopy at diagnosis were randomly chosen from the BC Children\'s Hospital inflammatory bowel disease (IBD) registry. Pathology review of the UGI biopsy specimens was blinded to IBD diagnosis.
RESULTS: Of the 198 patients, 102 with CD and 96 with UC were included, with a mean age of 11.7 years (range, 2.3-17 years). Patients with CD were more likely to have aphthous ulcers (20.4% vs 3.5%, P = .002) and erosions (16.3% vs 3.5%, P =.018), most commonly affecting the antrum. Macroscopically normal UGI endoscopy was present in 60% of patients. Microscopic disease was reported in 100% of patients with CD and 87% of patients with UC. In both groups, nonspecific inflammation was the most common finding. Chronic deep, superficial, and diffuse inflammation were more frequent among patients with CD than UC (42% vs 4%, P < .001; 60% vs 17%, P < .001; 50% vs 34%, P = .04, respectively).
CONCLUSIONS: The UGI tract macroscopic changes were common in pediatric IBD, especially in CD. Despite macroscopically normal endoscopy, histologic abnormalities were frequent. Although chronic inflammation was more often reported in patients with CD, aside from granulomas there were no unique histologic abnormalities unique to CD.
摘要：
目的：在小儿克罗恩病（CD）和溃疡性结肠炎（UC）中经常报道上消化道（UGI）受累。除了肉芽肿,大多数发现是非特异性的。这项研究的目的是回顾诊断为CD或UC的儿科患者中UGI道发现的患病率，并描述内窥镜和组织学特征的差异。
方法：从BC儿童医院炎症性肠病（IBD）注册表中随机选择2000年至2015年间诊断为2至17岁的CD和UC患者，这些患者在诊断时进行了上下内镜检查。UGI活检标本的病理学检查对IBD诊断是盲的。
结果：在198名患者中，包括CD的102和UC的96，平均年龄为11.7岁(范围，2.3-17年）。患有CD的患者更有可能患有口疮性溃疡（20.4%vs3.5%，P=.002）和侵蚀（16.3%对3.5%，P=.018)，最常影响胃窦。60％的患者存在宏观正常的UGI内窥镜检查。据报道，100％的CD患者和87％的UC患者出现显微镜疾病。在这两组中,非特异性炎症是最常见的发现.慢性深，肤浅的,与UC相比，CD患者的弥漫性炎症发生率更高（42％vs4％，P<.001；60%对17%，P<.001；50%对34%，分别为P=.04)。
结论：UGI道宏观改变在小儿IBD中很常见，尤其是CD。尽管宏观内窥镜检查正常，组织学异常是常见的。尽管慢性炎症更常见于CD患者，除了肉芽肿外，没有CD特有的独特组织学异常。
方法：从BC儿童医院炎症性肠病（IBD）注册表中随机选择2000年至2015年间诊断为2至17岁的CD和UC患者，这些患者在诊断时进行了上下内镜检查。UGI活检标本的病理学检查对IBD诊断是盲的。
结果：在198名患者中，包括CD的102和UC的96，平均年龄为11.7岁(范围，2.3-17年）。患有CD的患者更有可能患有口疮性溃疡（20.4%vs3.5%，P=.002）和侵蚀（16.3%对3.5%，P=.018)，最常影响胃窦。60％的患者存在宏观正常的UGI内窥镜检查。据报道，100％的CD患者和87％的UC患者出现显微镜疾病。在这两组中,非特异性炎症是最常见的发现.慢性深，肤浅的,与UC相比，CD患者的弥漫性炎症发生率更高（42％vs4％，P<.001；60%对17%，P<.001；50%对34%，分别为P=.04)。
结论：UGI道宏观改变在小儿IBD中很常见，尤其是CD。尽管宏观内窥镜检查正常，组织学异常是常见的。尽管慢性炎症更常见于CD患者，除了肉芽肿外，没有CD特有的独特组织学异常。
