Putniković Dunja, Jevtić Jovan, Ristić Nina, Milovanovich Ivan D, Đuknić Miloš, Radusinović Milica, Popovac Nevena, Đorđić Irena, Leković Zoran, Janković Radmila
Institute of Pathology "Prof. dr Đorđe Joannović", Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
Department of Gastroenterology, University's Children's Hospital, 11000 Belgrade, Serbia.
Diagnostics (Basel). 2024 Apr 24;14(9):877. doi: 10.3390/diagnostics14090877.
Crohn's disease (CD) is a progressive, multifactorial, immune-mediated disease characterized by chronic inflammation of any part of the gastrointestinal (GI) tract. Pediatric patients present with a more extensive form of the disease, especially in the upper GI tract with various histopathological inflammatory patterns. Our study aims to analyze the clinical, laboratory, endoscopic, and histopathological findings in children with diagnosed CD and compare results on the initial and follow-up tests. We have included 100 children and adolescents with CD, with performed endoscopic and histopathological (HP) procedures. The results of multiple biopsies executed in these 8 years were matched and compared. We found a statistically significant frequency reduction in stool changes (65.52% to 18.18%), weight loss (35.24% to 4%), and abdominal pain (41.86% to 6.67%) as presenting symptoms. There was an improvement in all laboratory values: fecal calprotectin (1000 to 60,8 μg/g), C-reactive protein (12.2 to 1.9 mg/L), and albumin (36 to 41 g/L). On esophagogastroduodenoscopy and ileo-colonoscopy 36.59% and 64.86% patients had specific findings, respectively. A total of 32 patients had evidence of Crohn's disease in the upper GI tract. Non-caseating granulomas were found on 9% of oesophageal, 18% of gastric, and 12% of duodenal biopsies. In the lower GI tract, we have observed a disease progression in the rectum (72.29 to 82.22%) and descending colon (73.49 to 80%). There was no registered disease progression in the upper GI tract. Our study demonstrated a significant decline in the frequency of symptoms and an improvement in laboratory values on the follow-up examinations. More than a third of our patients had specific endoscopic and HP findings in the upper GI tract, and an additional 23% had HP findings highly suggestive of CD. We demonstrated the importance of regular clinical, laboratory, endoscopic, and histopathological assessments of pediatric CD patients.
克罗恩病（CD）是一种进行性、多因素、免疫介导的疾病，其特征为胃肠道（GI）任何部位的慢性炎症。儿科患者所患疾病形式更为广泛，尤其是在上消化道，存在各种组织病理学炎症模式。我们的研究旨在分析已确诊CD的儿童的临床、实验室、内镜及组织病理学检查结果，并比较初次检查和随访检查的结果。我们纳入了100名患有CD的儿童和青少年，并对其进行了内镜及组织病理学（HP）检查。对这8年中多次活检的结果进行了匹配和比较。我们发现，作为首发症状的大便改变（从65.52%降至18.18%）、体重减轻（从35.24%降至4%）和腹痛（从41.86%降至6.67%）的发生频率在统计学上显著降低。所有实验室指标均有所改善：粪便钙卫蛋白（从1000降至60.8μg/g）、C反应蛋白（从12.2降至1.9mg/L）和白蛋白（从36升至41g/L）。在食管胃十二指肠镜检查和回结肠镜检查中，分别有36.59%和64.86%的患者有特异性发现。共有32例患者上消化道有克罗恩病证据。在食管活检中，9%发现非干酪样肉芽肿，胃活检中为18%，十二指肠活检中为12%。在下消化道，我们观察到直肠（从72.29%升至82.22%）和降结肠（从73.49%升至80%）的疾病进展。上消化道未发现疾病进展。我们的研究表明，随访检查中症状发生频率显著下降，实验室指标有所改善。超过三分之一的患者上消化道有特异性内镜及HP检查发现，另有23%的患者HP检查发现高度提示为CD。我们证明了对儿科CD患者进行定期临床、实验室、内镜及组织病理学评估的重要性。
