Clinical analysis and identification of pediatric patients with colonic ulceration

A wide variety of diseases mimic inflammatory bowel disease (IBD). This study aimed to reduce the misdiagnosis among children with colonic ulcers. Eighty-six pediatric patients with colonic ulcers detected by colonoscopy were enrolled in the retrospective study. Children were divided into different groups according to the final diagnosis. The clinical characteristics, laboratory examinations, endoscopic findings, and histopathological results were compared. IBD (n = 37) was just responsible for 43% of patients with colonic ulceration. Other diagnosis included autoimmune diseases (n = 9), infectious enteritis (n = 13), gastrointestinal allergy (n = 8), and other diseases (n = 19). Comparing IBD and non-IBD groups, children with IBD had a higher frequency of symptoms like weight loss/failure to thrive (P < 0.001), perianal lesions (P = 0.001), and oral ulcers (P = 0.022), and higher expression levels of platelet (P = 0.006), neutrophil-to-lymphocyte ratio (NLR) (P = 0.001), erythrocyte sedimentation rate (P < 0.001), C-reactive protein (P < 0.001), Immunoglobulin G (P = 0.012), Interleukin-1β (P = 0.003), Interleukin-6 (P = 0.024) and TNF-α (P = 0.026), and a wider ulcer distribution in the lower gastrointestinal tract (LGIT) (P < 0.001). Expression levels of hemoglobin (P < 0.001) and albumin (P = 0.001) were lower in IBD patients. Multivariate analysis showed hemoglobin, NLR, Score of ulceration in LGIT, and pseudopolyps contributing to the diagnosis of pediatric IBD with colonic ulcers. We displayed potential indicators to help diagnose pediatric IBD differentiating from other disorders with colonic ulcers more prudently. What is known • Many diseases can mimic IBD and reducing the misdiagnosis of IBD children is essential for the treatment and prognosis. Inflammatory factors like erythrocyte sedimentation rate, and fecal calprotectin have clinical value in diagnosing IBD. What is new • In our study, we investigated that IBD was just responsible for 43% of patients with colonic ulceration. • Some potential indicators (like hemoglobin, neutrophil-to-lymphocyte ratio and ulcer distribution character) may contribute to the diagnosis of pediatric IBD with colonic ulcers.