Morphologic Findings in Upper Gastrointestinal Biopsies of Patients With Ulcerative Colitis A Controlled Study

Department of Pathology, University of Michigan, Ann Arbor, MI 48109-0054, USA.
The American journal of surgical pathology (Impact Factor: 5.15). 10/2010; 34(11):1672-7. DOI: 10.1097/PAS.0b013e3181f3de93
Source: PubMed


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.
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.
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.
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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    • "While UC is traditionally considered to be a disease of the colon, inflammation of the upper gastro-intestinal (GI) tract has been described in a small proportion of UC patients. Gastric findings in UC patients include superficial plasmacytosis, focal gastritis, and basal mixed inflammation [31]. Duodenal pathology in UC includes diffuse chronic active duodenitis [31, 32] and intra-epithelial lymphocytosis, with or without partial villous atrophy. "
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