Biopsy of Gastric Antrum Helps Diagnose Crohn's Disease

Laurie Barclay, MD

March 24, 2003

March 24, 2003 — Biopsy of the gastric antrum can be helpful in distinguishing Crohn's disease (CD) from other pediatric colitides, according to the results of a small study published in the March issue of the American Journal of Gastroenterology. Based on the antral biopsy, 14% of colonoscopic diagnoses were changed to Crohn's.

"Up to 10% of patients with inflammatory bowel disease confined to the colon have features suggestive of both CD and ulcerative colitis," write P.S. Kundhal, BSc, and colleagues from the University of Toronto in Ontario, Canada. "Distinguishing between ulcerative colitis and CD is important, as responsiveness to some pharmacological agents differs, and surgical options vary."

During workup of suspected inflammatory bowel disease, 39 children and adolescents with colitis and normal small bowel radiography had upper endoscopy and colonoscopy before treatment. Five colonoscopic diagnoses (14%), each made by two reviewers, were changed to CD by antral biopsy revealing granulomatous inflammation. Although rates of nonspecific antral gastritis were similar in Crohn's colitis and ulcerative colitis (92% vs. 75%), focal antral gastritis was more common in Crohn's (52% vs 8%).

"The benefits of baseline upper endoscopy with mucosal biopsy, performed as in this study in the absence of upper gastrointestinal symptoms purely to aid in the differentiation of the type of colitis, must be weighed against the additional morbidity associated with the procedure," the authors write. "In view of the safety of the procedure in the hands of experienced pediatric gastroenterologists and the data presented in this study, we conclude that baseline upper endoscopic examination should continue to be performed in children and adolescents undergoing investigation of suspected chronic colitis. Only the findings of focal antral gastritis or granulomatous inflammation, however, should influence alteration of a colonoscopic diagnosis."

Am J Gastroenterol. 2003;98:557-561

Reviewed by Gary D. Vogin, MD

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