Lin J, McKenna BJ, Appelman HD. Am J Surg Pathol 2010;34:1672–7.
Lin and colleagues evaluated the frequency and types of inflammation present in the upper gastrointestinal (GI) tract in ulcerative colitis (UC) patients, and compared the findings with those of upper GI biopsies from control subjects. Three types of gastric inflammation occurred more frequently in UC than in controls: focal gastritis, basal mixed inflammation, and superficial plasmacytosis.
In this study, 69 patients with ulcerative colitis (UC) had some combination of esophageal, gastric, and/or duodenal biopsies and their findings were compared with those of 97 controls of similar age and sex distribution with upper gastrointestinal biopsies. Sixteen of the UC patients were aged <18 years. There were three types of gastric inflammation that occurred more frequently in UC than in controls. The first was an intense focal gastritis in 29% of UC patients versus 9% of controls. This focal pattern was identified anywhere in the mucosa, from the superficial area to the muscularis mucosae. Overall, 22% of UC patients’ biopsies had basal mixed inflammation compared with 8% of controls. Superficial plasmacytosis was evident in 20% of UC patients versus 6% of controls. Only 23% of UC patients who underwent gastric biopsies had normal findings. Children were significantly more likely (50%) to have intense focal gastritis than adults (22%; p=0.01). The presence of Helicobacter pylori and reactive gastropathy (as seen with nonsteroidal anti-inflammatory drug [NSAID] use) were significantly less common in UC patients than in controls but were uncommon in both. While four patients with UC had a unique chronic diffuse duodenitis (10% of those who had duodenal biopsies), this amounted to 40% of those who had colectomies. Furthermore, all four UC patients with duodenitis had pouchitis. None of the controls had duodenitis. This unique pattern of inflammation included crypt architecture distortion and both plasmacytosis and neutrophilic infiltrates. As high as 83% of UC patients had normal duodenal biopsies. There was no esophageal inflammatory pattern that was more common in UC than in the controls, and 54% of UC patients’ esophageal biopsies were normal.