Clinical, Endoscopic, and Upper Gastrointestinal Histological Manifestations in Pediatric Inflammatory Bowel Disease: Insights from a Large Cohort

Allen Choi; Eyas Alzayadneh; Patrick Breheny; Yiqin Xiong

doi:10.1177/10935266251404114

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Clinical, Endoscopic, and Upper Gastrointestinal Histological Manifestations in Pediatric Inflammatory Bowel Disease: Insights from a Large Cohort

Journal article

Peer reviewed

Clinical, Endoscopic, and Upper Gastrointestinal Histological Manifestations in Pediatric Inflammatory Bowel Disease: Insights from a Large Cohort

Allen Choi, Eyas Alzayadneh, Patrick Breheny and Yiqin Xiong

Pediatric and developmental pathology, Vol.29(2), pp.112-119

03/01/2026

DOI: 10.1177/10935266251404114

PMID: 41473946

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Abstract

Upper GI involvement is common in pediatric IBD, but the relative frequencies of specific endoscopic and histologic abnormalities at diagnosis remain poorly defined. To determine whether specific upper GI endoscopic and histologic features differ among pediatric Crohn disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC) at diagnosis. We retrospectively analyzed 243 pediatric patients (<18 years) with newly diagnosed IBD (CD 64.6%, UC 31.2%, IC 4.1%). Clinical parameters, upper GI endoscopic findings, and histologic features were compared using Fisher's exact and non-parametric tests. Age at diagnosis, gender, BMI, and fecal calprotectin did not differ among CD, UC, and IC. Primary sclerosing cholangitis was more prevalent in UC (5.3%, = .04), and eosinophilic esophagitis was more frequent in IC (20%, = .03). CD showed more esophageal erosions/aphthae (12%, < .01), gastric erosions/ulcers (24% vs UC 17%, < .01), and duodenal erosions/ulcers (35%, < .01). Histologically, lymphocytic esophagitis (29%, < .001), epithelioid granulomas (14%, < .001), and active duodenitis (28%, = .007) were significantly more common in CD. Upper GI abnormalities are not limited to CD. Specific upper GI features-particularly lymphocytic esophagitis, epithelioid granulomas, and active duodenitis-are more strongly associated with CD at diagnosis and may assist subclassification in challenging pediatric IBD cases.

Adolescent

Child

Child, Preschool

Colitis, Ulcerative - diagnosis

Colitis, Ulcerative - pathology

Crohn Disease - diagnosis

Crohn Disease - pathology

Endoscopy, Gastrointestinal

Female

Humans

Inflammatory Bowel Diseases - diagnosis

Inflammatory Bowel Diseases - pathology

Male

Retrospective Studies

Upper Gastrointestinal Tract - pathology

Details

Title: Subtitle: Clinical, Endoscopic, and Upper Gastrointestinal Histological Manifestations in Pediatric Inflammatory Bowel Disease: Insights from a Large Cohort
Creators: Allen Choi - University of Iowa
Eyas Alzayadneh - University of Iowa
Patrick Breheny - University of Iowa
Yiqin Xiong - University of Iowa
Resource Type: Journal article
Publication Details: Pediatric and developmental pathology, Vol.29(2), pp.112-119
DOI: 10.1177/10935266251404114
PMID: 41473946
ISSN: 1093-5266
eISSN: 1615-5742
Language: English
Date published: 03/01/2026
Academic Unit: Pathology; Surgery
Record Identifier: 9985240893602771

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