Value of upper endoscopic biopsies in predicting medical refractoriness in pediatric patients with ulcerative colitis

Katrina J Sullivan; Mike Wei; Elizabeth Chernetsova; Soufiane Hallani; Joseph de Nanassy; Eric I Benchimol; David R Mack; Ahmed Nasr; Dina El Demellawy

doi:10.1016/j.humpath.2017.06.006

Value of upper endoscopic biopsies in predicting medical refractoriness in pediatric patients with ulcerative colitis

Hum Pathol. 2017 Aug:66:167-176. doi: 10.1016/j.humpath.2017.06.006. Epub 2017 Jun 23.

Authors

Katrina J Sullivan¹, Mike Wei², Elizabeth Chernetsova³, Soufiane Hallani⁴, Joseph de Nanassy⁵, Eric I Benchimol⁶, David R Mack⁷, Ahmed Nasr⁸, Dina El Demellawy⁹

Affiliations

¹ Department of Pathology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada K1H 8L1. Electronic address: ksullivan@cheo.on.ca.
² Faculty of Medicine, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8M5. Electronic address: mwei055@uottawa.ca.
³ Faculty of Medicine, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8M5. Electronic address: evchernetsova@gmail.com.
⁴ Faculty of Medicine, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8M5. Electronic address: selhallani@toh.on.ca.
⁵ Department of Pathology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada K1H 8L1; Faculty of Medicine, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8M5. Electronic address: jdenanassy@cheo.on.ca.
⁶ Faculty of Medicine, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8M5; Department of Pediatrics, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8M5; Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada K1H 8L1; School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8M5; Institute for Clinical Evaluative Sciences, Veterans Hill Trail, Toronto, ON, Canada M4N 3M5. Electronic address: ebenchimol@cheo.on.ca.
⁷ Faculty of Medicine, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8M5; Department of Pediatrics, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8M5; Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada K1H 8L1. Electronic address: dmack@cheo.on.ca.
⁸ Faculty of Medicine, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8M5; Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada K1H 8L1. Electronic address: anasr@cheo.on.ca.
⁹ Department of Pathology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada K1H 8L1; Faculty of Medicine, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8M5. Electronic address: deldemellawy@cheo.on.ca.

PMID: 28652148
DOI: 10.1016/j.humpath.2017.06.006

Abstract

Refractory ulcerative colitis (UC) occurs in patients who experience a severe disease manifestation that is unresponsive to medical therapy. The assessment of upper endoscopic microscopic findings and its correlation with refractory UC has not been fully studied in pediatric patients and is the focus of this study. Medical records of UC patients treated at a tertiary pediatric center between 2000 and 2014 were reviewed. Endoscopic biopsies of the upper gastrointestinal (GI) tract of patients meeting a priori inclusion criteria were compared between refractory UC patients and nonrefractory UC patients for active inflammation. Statistically significant differences were determined between groups, and tissues shown to have significant differences were further evaluated for their diagnostic performance. A total of 52 patients were included, 26 in each group. Significant differences were observed in intraepithelial neutrophil infiltration and percentage involvement of crypts/glands for the antrum, body, and duodenal bulb (P ≤ .001, .005, and .01 [intraepithelial neutrophil infiltration] and P = .001, .009, and .015 [% involvement], respectively). Microabscesses of mucosal glands/crypts were also experienced in a greater number of refractory UC patients in the stomach (ie, antrum and/or body of stomach; P = .005) and duodenum (ie, duodenum and/or duodenal bulb; P = .023). The sensitivity and specificity of upper GI tissues to predict refractory UC were moderate, with sensitivities ranging from 38% to 67% and specificities ranging from 81% to 100%. Our results suggest that children with refractory UC are more likely to have active inflammation in the upper GI tract, and thus, this may represent a predictor of responsiveness to current medical therapy.

Keywords: Histology; Pathology; Refractory colitis; Ulcerative colitis; Upper endoscopy.

MeSH terms

Adolescent
Anti-Inflammatory Agents / therapeutic use
Biopsy
Child
Colectomy
Colitis, Ulcerative / pathology*
Colitis, Ulcerative / therapy
Drug Resistance
Duodenitis / pathology*
Duodenum / pathology*
Endoscopy, Digestive System*
Esophagus / pathology
Female
Gastritis / pathology*
Gastrointestinal Agents / therapeutic use
Humans
Male
Neutrophil Infiltration
Predictive Value of Tests
Reproducibility of Results
Stomach / pathology*
Tertiary Care Centers

Substances

Anti-Inflammatory Agents
Gastrointestinal Agents

Supplementary concepts

Pediatric ulcerative colitis