Clinicopathologic Characterization of Lymphocytic Colitis in the Pediatric Population.
Clinicopathologic Characterization of Lymphocytic Colitis in the Pediatric Population.
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DOI：
10.1177/10935266231215117
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发表时间：
2023-12
影响因子：
1.9
通讯作者：
I. González;Maire C Conrad;Sarah Weinbrom;Trusha Patel;J. Kelsen;Pierre Russo
中科院分区：
文献类型：
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作者：
I. González;Maire C Conrad;Sarah Weinbrom;Trusha Patel;J. Kelsen;Pierre Russo
背景：儿科人群的淋巴细胞性结肠炎（LC）与免疫失调有关。方法：儿科 LC 的单中心回顾性研究。结果：确定了 50 名 LC 患者（35 名女性，70%），诊断时中位年龄为 12 岁（四分位距：5.7-15.8）。目前，11 名患者 (22%) 患有营养不良，16 名患者 (32%) 患有已知的潜在免疫失调，4 名患者 (8%) 患有乳糜泻 (CD)，没有一人被诊断为炎症性肠病。诊断前最常见的药物是非甾体类抗炎药、质子泵抑制剂和选择性血清素再摄取抑制剂（各 10%）。结肠活检显示上皮内淋巴细胞 (IEL)/100 个上皮细胞的中位数为 48 个（范围：25-85），只有 10% 的病例患有中性粒细胞性隐窝炎。上消化道检查结果包括淋巴细胞性食管炎（4%），以及不伴有或伴有绒毛钝化的十二指肠 IEL（各 9%）（n：47）。 10 名患者 (23%) 回肠末端 IEL 升高 (n: 43)。包括 5-ASA、布地奈德、泼尼松和无麸质饮食在内的治疗改善了 <50% 的患者 (n: 42) 的症状，并且所有后续结肠镜检查均显示持续性 LC (n: 13)。结论：我们的研究支持 LC 与免疫介导疾病（最常见的是乳糜泻）之间的关联。 <50% 的患者出现症状改善，但重复结肠镜检查的患者均未显示组织学改善。
Background: Lymphocytic colitis (LC) in the pediatric population has been associated with immune dysregulation. Methods: Single-center retrospective study of pediatric LC. Results: 50 patients (35 female, 70%) with a median age of 12 years at diagnosis (interquartile range: 5.7–15.8) of LC were identified. At presentation, 11 patients (22%) had malnutrition, 16 (32%) had a known underlying immune dysregulation, 4 (8%) had celiac disease (CD), and none had a diagnosis of inflammatory bowel disease. The most common medications prior to diagnosis were non-steroidal anti-inflammatory drugs, proton pump inhibitor, and selective serotonin reuptake inhibitors (10% each). Colonic biopsies showed a median number of intraepithelial lymphocytes (IELs)/100 epithelial cells of 48 (range: 25–85), and only 10% of cases had neutrophilic cryptitis. Upper gastrointestinal tract findings included lymphocytic esophagitis (4%), and duodenal IELs without and with villous blunting (9% each) (n: 47). Ten patients (23%) had increased IELs in the terminal ileum (n: 43). Treatments including 5-ASA, budesonide, prednisone, and gluten-free diet improved symptoms in <50% of patients (n: 42), and all follow-up colonoscopies showed persistent LC (n: 13). Conclusion: Our study supports the association of LC with immune-mediated conditions, most commonly celiac disease. Symptomatic improvement was seen in <50% of patients with none of the patients with repeat colonoscopy showing histologic improvement.