Morphologic findings in upper gastrointestinal biopsies of patients with ulcerative colitis

A controlled study

Jingmei Lin, Barbara J. McKenna, Henry D. Appelman

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Introduction: Upper gastrointestinal involvement, both gastric and duodenal, is known to occur in both Crohn disease and ulcerative colitis (UC). However, the frequency and types of inflammation in upper gastrointestinal biopsies in patients with UC has not been well studied, especially in a controlled study. Methods: Twenty-four esophageal, 59 gastric, and 40 duodenal biopsies from 69 UC patients were reviewed. These were compared with 35 esophageal, 66 gastric, and 46 duodenal biopsies from a control group of 97 consecutive patients of similar age and sex distribution. The pattern and extent of inflammation were noted in each biopsy. Results: There were 3 types of gastric inflammation that occurred more in UC patients than in controls, and the differences were statistically significant. The most common was an intense focal gastritis, present in 29% of UC gastric biospies, compared with 9% of controls. Twenty-two percent of UC patients had a basal mixed inflammation compared with 8% of controls, and 20% of the UC patients had superficial plasmacytosis compared with 6% of controls. There were no esophageal inflammations that occurred more commonly in UC than controls. Four UC patients and no controls had diffuse chronic duodenitis, also a statistically significant difference. All 4 UC-duodenitis patients were among the 10 with previous colectomies, and all 4 patients had pouchitis. Only 1 of the 4 UC-colectomy patients without duodenitis developed pouchitis. CONCLUSIONS: Most UC patients have no upper gastrointestinal inflammation in biopsies, and most of the inflammations they have are not unique. The most common upper gastrointestinal inflammatory pattern in patients with UC is focal gastritis, followed by gastric basal mixed inflammation and superficial plasmacytosis. The one unique upper gastrointestinal inflammation in UC patients is diffuse chronic duodenitis, present in 10% of patients who had duodenal biopsies, and in 40% of UC patients who had colectomy and all of these patients had pouchitis. This association strongly suggests that diffuse chronic duodenitis in UC patients who have colectomy is a strong predictor of pouchitis.

Original languageEnglish (US)
Pages (from-to)1672-1677
Number of pages6
JournalAmerican Journal of Surgical Pathology
Volume34
Issue number11
DOIs
StatePublished - Nov 2010
Externally publishedYes

Fingerprint

Ulcerative Colitis
Biopsy
Duodenitis
Inflammation
Pouchitis
Stomach
Colectomy
Gastritis
Sex Distribution
Age Distribution
Crohn Disease

Keywords

  • diffuse chronic duodenitis
  • focal gastritis
  • ulcerative colitis
  • upper gastrointestinal inflammation

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine
  • Surgery

Cite this

Morphologic findings in upper gastrointestinal biopsies of patients with ulcerative colitis : A controlled study. / Lin, Jingmei; McKenna, Barbara J.; Appelman, Henry D.

In: American Journal of Surgical Pathology, Vol. 34, No. 11, 11.2010, p. 1672-1677.

Research output: Contribution to journalArticle

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abstract = "Introduction: Upper gastrointestinal involvement, both gastric and duodenal, is known to occur in both Crohn disease and ulcerative colitis (UC). However, the frequency and types of inflammation in upper gastrointestinal biopsies in patients with UC has not been well studied, especially in a controlled study. Methods: Twenty-four esophageal, 59 gastric, and 40 duodenal biopsies from 69 UC patients were reviewed. These were compared with 35 esophageal, 66 gastric, and 46 duodenal biopsies from a control group of 97 consecutive patients of similar age and sex distribution. The pattern and extent of inflammation were noted in each biopsy. Results: There were 3 types of gastric inflammation that occurred more in UC patients than in controls, and the differences were statistically significant. The most common was an intense focal gastritis, present in 29{\%} of UC gastric biospies, compared with 9{\%} of controls. Twenty-two percent of UC patients had a basal mixed inflammation compared with 8{\%} of controls, and 20{\%} of the UC patients had superficial plasmacytosis compared with 6{\%} of controls. There were no esophageal inflammations that occurred more commonly in UC than controls. Four UC patients and no controls had diffuse chronic duodenitis, also a statistically significant difference. All 4 UC-duodenitis patients were among the 10 with previous colectomies, and all 4 patients had pouchitis. Only 1 of the 4 UC-colectomy patients without duodenitis developed pouchitis. CONCLUSIONS: Most UC patients have no upper gastrointestinal inflammation in biopsies, and most of the inflammations they have are not unique. The most common upper gastrointestinal inflammatory pattern in patients with UC is focal gastritis, followed by gastric basal mixed inflammation and superficial plasmacytosis. The one unique upper gastrointestinal inflammation in UC patients is diffuse chronic duodenitis, present in 10{\%} of patients who had duodenal biopsies, and in 40{\%} of UC patients who had colectomy and all of these patients had pouchitis. This association strongly suggests that diffuse chronic duodenitis in UC patients who have colectomy is a strong predictor of pouchitis.",
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