Upper Gastrointestinal Involvement in Pediatric Inflammatory Bowel Disease: A Decade of Evidence from a Systematic Review (2015-2025)

Abstract

Background:

Upper gastrointestinal (UGI) manifestations of ulcerative colitis (UC) and Crohn’s disease (CD) are common in children but are often clinically silent or overshadowed by lower gastrointestinal manifestations. Accordingly, UGI biopsies should be performed at diagnosis in all patients suspected of CD or UC. The present study investigates the frequency of UGI involvement in pediatric inflammatory bowel disease (IBD).

Materials and Methods:

We conducted a comprehensive search to identify relevant English-language studies published between 01.01.2015 and 01.01.2025. Two independent reviewers screened and selected studies involving pediatric patients (<18 years) with IBD. We searched MEDLINE (via PubMed), EMBASE (via Ovid), the Cochrane Library, and the Trip Database. Keywords and MeSH terms used in the strategy included: Inflammatory bowel disease, Ulcerative colitis, Crohn’s disease, Phenotype, Upper gastrointestinal, Child, and Infants. 

Results:

According to the Paris classification criteria, the most frequent site of involvement in children with CD was the ileum and colon (ileocolonic disease, L3), accounting for 52.8% (1450 patients). Meanwhile, the lowest frequency of involvement was associated with the upper section distally to the ligament of Treitz and proximally to 1/3 of the distal section of ileum (L4b), with a frequency of 7.4%. In this study, the involvement rate of the upper section of the alimentary canal, proximal to the ligament of Treitz (L4a), was 38.5% (1056 patients). Additionally, among patients with UC, 78 patients (5.1%) had evidence of UGI involvement.

Conclusion:

No definitive evidence was reported regarding the relationship between the location of involvement and demographic, genetic, inflammatory, and other factors. However, further studies are required to address this issue.