AUTHOR=Kröger Sofia , Repo Marleena , Hiltunen Pauliina , Vornanen Martine , Huhtala Heini , Kivelä Laura , Kurppa Kalle 

TITLE=Differential diagnosis and long-term outcomes of non-atrophic duodenal changes in children

JOURNAL=Frontiers in Pediatrics

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.982623

DOI=10.3389/fped.2022.982623

ISSN=2296-2360

ABSTRACT=Objectives and Study: Gastrointestinal endoscopy is often performed when investigating abdominal complaints in children. While morphological changes of the duodenal mucosa are usually caused by celiac disease, the prevalence and clinical significance of non-atrophic duodenal changes are less clear. We studied these issues in a large pediatric endoscopic cohort.
Methods: Comprehensive data on clinical features, diagnostic findings, and long-term outcomes of 1170 consecutive children who had undergone upper gastrointestinal endoscopy with systematic duodenal sampling were collected. Study variables were compared between children with non-atrophic changes and normal histology, and between those with non-atrophic changes who did and did not receive a diagnosis. 
Results: Fifty-one (4.4%) children had non-atrophic and 315 (26.9%) atrophic duodenal changes and 804 (68.7%) normal histology. The most common non-atrophic findings were non-specific inflammation (n=19) and intraepithelial lymphocytosis (n=14). Patients with non-atrophic changes presented more often with hematochezia (23.5% vs. 11.3%; p=0.009), anemia (43.2% vs. 36.5%; p=0.028) and positive celiac serology (34.3% vs. 12.9%; p<0.001) than those with a normal duodenum. Twenty-four (44%) of those with non-atrophic changes received an initial diagnosis, the most common of which were inflammatory bowel disease (n=8), H.Pylori infection (n=3) and food allergy (n=3). The prevalence of the diagnoses did not differ from those with a normal duodenum. Those who received a diagnosis had more often hematochezia (37.5% vs. 11.1%; p=0.027), anemia (70.6% vs. 20.0%; p=0.002) and negative celiac serology (50.0% vs. 7.7%; p=0.013) than those without diagnosis. During a follow-up of 6.1–13.3 years, five of the 12 initially undiagnosed seropositive patients developed celiac disease, and one patient also developed ulcerative colitis.
Conclusion: Non-atrophic duodenal changes are relatively common and associated with anemia, hematochezia, and positive celiac disease serology. Excluding potential celiac disease, those without an initial diagnosis have a favorable long-term prognosis.