الفهرس 
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Abstract
Non neoplastic gastrointestinal lesions in pediatrics are variable and share in clinical presentation, so endoscopic biopsy and histopathological examination are mandatory to differentiate between them.
The aim of this work is to study different types of pediatric non neoplastic gastrointestinal lesions from gastrointestinal endoscopic biopsies received at the Pathology Department in Ain Shams University hospital during a period of 2 years (2017-2018), and to correlate them with the clinicopathological presentations and endoscopic findings.
The current study is a cross sectional study, conducted on five hundred and eighty (n=580) pediatric cases at Pathology Department in Ain Shams University Hospital in a period of two years (2017- 2018). Only cases of pediatrics with age up to16 years old and diagnosed as nonneoplastic GI lesions are included. Collected information from the archival files of the patients included the following: patient age, sex, and any available clinical data regarding symptoms and laboratory findings and endoscopic findings. Inclusion criteria were that cases of pediatrics whose ages were up to 16 years and diagnosed as non-neoplastic gastrointestinal lesions during the period from 2017 to 2018. Histopathological examination was conducted on 5 micrometer thick hematoxylin and eosin stained sections prepared from paraffin blocks to revise and assess the nature of the lesion.
The most common specific non neoplastic GI lesion was Helicobacter pylori associated inflammation represented 43.5%, followed by Eosinophilic GI diseases represented 3.8%, IBD represented 3.7%, Celiac disease represented 1.9%, Abetalipoproteinemia represented 0.3%, Intestinal lymphangiectasia represented 0.3%, and Microvillus inclusion disease represented 0.17%.
The patients’ age ranged from 0.5 - 16 years with a mean of 6.78 ± 4.55 years for Helicobacter pylori associated gastrointestinal inflammation cases, from 0.5-13 years with a mean of 4.82 ± 4.41 years for Eosinophilic gastrointestinal disease cases, from 1 - 16 years with a mean of 9.31 ± 4.78 years for Inflammatory bowel disease (IBD) cases, and from 1- 12 years with a mean of 4.73 ± 3.61 years for Celiac disease cases.
Regarding patients’ gender, In H. pylori associated inflammation; the number of male patients was 132 (52.8%), while the number of female patients was 118 (47.2%). In Eosinophilic GI diseases; the number of male patients was 14 (63.6%), while the number of female patients was 8 (36.4%). In Inflammatory bowel disease; the number of male patients was 12 (57.1%), while the number of female patients was 9 (42.9%). In Celiac disease; the number of male patients was 6 (54.5%), while the number of female patients was 5(45.5%). Abetalipoproteinemia included only one male and only one female. Intestinal lymphangiectasia included 2 female cases. Microvillus inclusion disease included only one male case.
Regarding the clinical presentation; in H. pylori associated inflammation, the most common clinical presentation was hematemesis (34.9%), in Eosinophilic GI disease, the most common clinical presentation was hematemesis (40.9%), in IBD, the common clinical presentation was bleeding per rectum (81%), in Celiac disease, the common clinical presentation was abdominal distension (54.5%). The cases of abetalipoproteinemia, intestinal lymphangiectasia and microvillus inclusion disease were presented with chronic diarrhea.
Regarding the endoscopic findings; in H. pylori associated inflammation, the most common abnormal finding was erythema (65.2%), then mucosal nodularity (35.2%). In Eosinophilic GI disease, the most common abnormal findings were erythema, mucosal nodularity & mucosal ulcers each (31.8%). In IBD, the most common abnormal finding was erythema (66.7%), then mucosal oedema (52.4%). In Celiac disease, the most common abnormal finding was flat mucosa (63.6%), then scalloping of mucosa (45.5%). In abetalipoproteinemia, intestinal lymphangiectasia & microvillus inclusion disease, the abnormal finding was whitish mucosa.
Regarding the histopathological findings of H. pylori associated inflammation, most of cases showed mild chronicity (79.6%), mild activity (80.5%), and +1 infection (77.6%). A statistically significant correlation was detected between intensity of infection and clinical presentation of abdominal pain (P = 0.01). A high statistically significant correlation was detected between stomach as a site of infection and endoscopic finding of erythema and nodularity (P <0.001). A statistically significant correlation was detected between degree of chronicity and endoscopic finding of nodularity (P = 0.004).
Regarding Histopathological findings of Eosinophilic GI diseases; 90.9% of cases were of chronic type of inflammation and also 90.9% of cases were active. A statistically significant correlation was detected between lower GI site of the disease and clinical presentation of bleeding per rectum (P = 0.001). A statistically significant correlation was detected between colorectal site of the disease and endoscopic findings of friability and loss of vascular pattern (P= 0.03 for both).
Regarding IBD, 85.7% of cases were diagnosed as ulcerative colitis, 9.5% of cases were diagnosed as crohn’s disease. 4.8% of cases were diagnosed as IBD unclassified. Regarding Histopathological findings of IBD, the most common findings were activity of the disease (95.2%), and surface ulceration (71.4%). A statistically significant correlation was detected between colon and rectum as sites of IBD and clinical presentation of bleeding per rectum (P= 0.02). A statistically significant correlation was detected between crohn’s disease and clinical presentation of abdominal pain (P= 0.03). A statistically significant correlation was detected between ulcerative colitis and clinical presentation of bleeding per rectum (P= 0.003). A statistically significant correlation was detected between surface ulceration and clinical presentation of abdominal pain and bleeding per rectum (P= 0.05). No statistically significant correlations were detected between type of IBD, any of histopathological findings and endoscopic findings (P> 0.05).
Regarding Celiac disease, 45.5% of cases their Marsh classification was 3a, 27.3% of cases their Marsh classification was 3b, and also 24.3% of cases their Marsh classification was 3c. Regarding Histopathological findings of Celiac disease, all cases showed villus atrophy at different degrees (100%), 45.5% of cases showed crypt hyperplasia, and 63.6% of cases showed inflammation. No statistically significant correlations were detected between histopathological findings and clinical presentation (P> 0.05). No statistically significant correlations were detected between histopathological findings and endoscopic findings (P> 0.05).