Clinical, Endoscopic, and Upper Gastrointestinal Histological Manifestations in Pediatric Inflammatory Bowel Disease: Insights from a Large Cohort

BACKGROUND: Upper GI involvement is common in pediatric IBD, but the relative frequencies of specific endoscopic and histologic abnormalities at diagnosis remain poorly defined. OBJECTIVE: To determine whether specific upper GI endoscopic and histologic features differ among pediatric Crohn disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC) at diagnosis. METHODS: We retrospectively analyzed 243 pediatric patients (<18 years) with newly diagnosed IBD (CD 64.6%, UC 31.2%, IC 4.1%). Clinical parameters, upper GI endoscopic findings, and histologic features were compared using Fisher's exact and non-parametric tests. RESULTS: = .007) were significantly more common in CD. CONCLUSIONS: Upper GI abnormalities are not limited to CD. Specific upper GI features-particularly lymphocytic esophagitis, epithelioid granulomas, and active duodenitis-are more strongly associated with CD at diagnosis and may assist subclassification in challenging pediatric IBD cases.