Upper Gastrointestinal Biopsy Findings in Pediatric Inflammatory Bowel Disease: Histologic and Clinicopathologic Correlations

OBJECTIVES: We aimed to evaluate histologic findings in upper gastrointestinal (UGI) biopsies of pediatric inflammatory bowel disease (IBD) patients, their correlation with endoscopic features, and association with disease activity. METHODS: UGI biopsies from 50 pediatric IBD patients (31 Crohn's disease [CD] and 19 ulcerative colitis [UC]) were retrospectively reviewed. Esophageal, gastric, and duodenal samples were categorized as highly suggestive, suspicious, or unlikely for UGI involvement. Associations with endoscopic abnormalities, colonoscopic disease extent, and simplified Geboes scores were analyzed. RESULTS: -negative active chronic gastritis, distinct from FEG, was identified and classified as suspicious for involvement. Duodenal findings including cryptitis, crypt abscesses, crypt distortion, villous blunting, and foveolar metaplasia may reflect IBD-related changes rather than nonspecific inflammation and were more frequent in UC, but not significantly. Highly suggestive findings in the esophagus and duodenum correlated with endoscopic abnormalities, whereas gastric findings did not. In contrast, highly suggestive antral and corpus findings were associated with higher simplified Geboes scores. CONCLUSIONS: UGI involvement in pediatric IBD is easily overlooked and requires careful assessment. Integrating histologic, clinical, and endoscopic findings is essential, as characteristic UGI features may influence disease evaluation and therapeutic decision making.