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Reduced Lymphoid Hyperplasia of the Terminal Ileum: A New Endoscopic Feature in Crohn's Disease

Cadranel, S; Salame, A; Bontem, P; Scaillon, M

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Journal of Pediatric Gastroenterology and Nutrition: November 2006 - Volume 43 - Issue - p S40
doi: 10.1097/01.mpg.0000256231.78019.6f
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Background: The incidence of IBD, especially Crohn's disease is increasing in childhood. Endoscopy is a useful tool for the diagnosis and the follow up of the lesions and the efficacy of the treatments and its effects on the mucosal. Efforts should be done to explore the terminal ileum after catheterisation of the ileo-caecal valvula in order to assess the lesions that can involve the terminal ileum in Crohn's disease. In the normal terminal ileum lymphoid hyperplasia is physiological and corresponds to Peyer's patches.

Aim: Are Peyer's patches present in children with IBD?

Methods: In 2004-2005 108 ileoscopies were performed in 88 children for several indications including Crohn's disease in 31 and ulcerative colitis in 10. In 11 IBD patients the procedure was repeated. The terminal ileum was systematically catheterised and lymphoid hyperplasia evaluated before taking biopsy samples.

Results: Lymphoid hyperplasia was a constant feature in non-IBD patients. It was prominent and even exaggerated in children with allergy (sometimes involving also the colon) and in patients with infectious ileo-colitis due to Yersinia enterocolitica. On the contrary lymphoid hyperplasia was strikingly either absent or very modest in children with Crohn's disease on steroid treatment but also some cases before starting treatment. A normal lymphoid hyperplasia reappeared in one child with ulcerative colitis in remission, after several years of heavy steroid treatment.

Conclusions: The reduction of lymphoid hyperplasia of the terminal ileum in children with Crohn's disease may indicate a dysfunction at the level of Peyer's patches and deserves confirmation in newly diagnosed children with Crohn's disease and can constitute a helpful hallmark of the disease.

© 2006 Lippincott Williams & Wilkins, Inc.