Aziz Danish Abdul, Moin Maryum, Majeed Atif, Sadiq Kamran, Biloo Abdul Gaffar
Dr. Danish Abdul Aziz, MBBS, MRCPCH, FCPS. Senior Instructor, Department of Paediatrics, Aga Khan University Hospital, Karachi, Pakistan.
MaryumMoin, Final Year MBBS Medical StudentAga Khan University Hospital, Karachi, Pakistan.
Pak J Med Sci. 2017 Jul-Aug;33(4):793-797. doi: 10.12669/pjms.334.12926.
To determine different clinical presentationsand disease location demarcatedby upper and lower gastrointestinal endoscopyand relevant histopathologyin children diagnosed with inflammatory bowel disease (IBD).
This is 5 years (2010 to 2015) retrospective studyconducted at the Aga Khan University Hospitalenrolling65admitted children between 6 months to 15years from either gender, diagnosed with IBD on clinical presentation, endoscopy and biopsy. Different clinical presentations at the time of diagnosis were noted in different categories of the disease. All patients underwent upper and lower (up to the terminal ileum) endoscopy with multiple punch biopsies and histologic assessment of mucosal specimens. All endoscopies were done by paediatric gastroenterologists at endoscopy suite of the hospital and all specimens were reported by the pathology department. ESPGHAN revised criteria for the diagnosis of inflammatory bowel disease in children and an adolescent was used to standardize our diagnosis. Extent of disease on endoscopy and relevant histopathology of the biopsy samples were noted at the time of diagnosis. Data was summarized using mean, standard deviation, numbers and percentages for different variables.
Total 56 children were enrolled according to inclusion criteria. There were 34children (61.53%) diagnosed with ulcerative colitis (UC), 10 patients (16.92%) had Crohn'sDisease (CD) and 11 (21.53%) patients were labeled as Indeterminate colitis (IC). Mean age at onset of symptoms was10.03±2.44 and mean age at diagnosis was11.10±2.36. Abdominal pain (80%) and chronic diarrhea (70%) were common symptoms in CD whereas bloody diarrhea (79.41%) and rectal bleeding(64.70%)were common presentation in UC. Patients diagnosed with indeterminate colitis(IC) had similar clinical features as in UC patients. Only 7% patients had some extra-intestinal features in the form of joint pain and/or uveitis. Aspartate aminotransferase level (95.18 ±12.89) was relatively high in patients withCD in comparison with other categories of IBD. Endoscopic findings and relevant histopathology of biopsy samples in UC showed 65% patient had pan-colitis and 13 % with disease restricted to rectum only whereas in CD 70% patient had disease in ileo-colon and only 10 % had involvement of ileum at the time diagnosis.
Patients with UC dominated in our cohort. The most common clinical presentation in UC was bloody diarrhea and rectal bleeding and patients with CDhad abdominal pain and chronic diarrhea as predominant clinical features. Extraintestinal features were uncommon in our cohort. In endoscopic findings, pan-colitis was the mostfrequentfinding in UC and ileo-colonwas common location in CD. IC and UC shared common clinical features and disease location on endoscopy.
通过上、下消化道内镜检查及相关组织病理学检查，确定诊断为炎症性肠病（IBD）的儿童的不同临床表现及疾病部位。
这是一项在阿迦汗大学医院进行的为期5年（2010年至2015年）的回顾性研究，纳入65例年龄在6个月至15岁之间、因临床表现、内镜检查和活检确诊为IBD的住院儿童，无论性别。记录不同疾病类型在诊断时的不同临床表现。所有患者均接受上消化道和下消化道（直至回肠末端）内镜检查，并进行多次活检及黏膜标本的组织学评估。所有内镜检查均由医院内镜室的儿科胃肠病学家进行，所有标本均由病理科报告。采用欧洲儿科胃肠病、肝病和营养学会（ESPGHAN）修订的儿童和青少年炎症性肠病诊断标准来规范我们的诊断。记录诊断时内镜检查的疾病范围及活检样本的相关组织病理学结果。使用不同变量的均值、标准差、数量和百分比对数据进行总结。
根据纳入标准共纳入56例儿童。其中34例（61.53%）诊断为溃疡性结肠炎（UC），10例（16.92%）患有克罗恩病（CD），11例（21.53%）被标记为不确定性结肠炎（IC）。症状出现时的平均年龄为10.03±2.44岁，诊断时的平均年龄为11.10±2.36岁。腹痛（80%）和慢性腹泻（70%）是CD的常见症状，而血性腹泻（79.41%）和直肠出血（64.70%）是UC的常见表现。诊断为不确定性结肠炎（IC）的患者具有与UC患者相似的临床特征。只有7%的患者有以关节疼痛和/或葡萄膜炎形式出现的一些肠外表现。与其他IBD类型相比，CD患者的天冬氨酸转氨酶水平（95.18±12.89）相对较高。UC患者活检样本的内镜检查结果及相关组织病理学显示，65%的患者为全结肠炎，13%的患者疾病仅局限于直肠，而在CD患者中，70%的患者在诊断时回结肠受累，仅10%的患者累及回肠。
我们的队列中UC患者占主导。UC最常见的临床表现是血性腹泻和直肠出血，而CD患者以腹痛和慢性腹泻为主要临床特征。我们的队列中肠外表现不常见。在内镜检查结果中，全结肠炎是UC最常见的表现，回结肠是CD的常见部位。IC和UC在内镜检查中具有共同的临床特征和疾病部位。
