H.A. Kader, M.R. Mascarenhas, R. Verma, B.A. O'Connell, M.N. Collins and R.N. Baldassano
Juvenile retention polyps (JRP) are a common, acquired, non-malignant cause of painless rectal bleeding typically seen in children between the ages of 1-10 yrs.old. JRP are presumed to be a non-inflammatory bowel condition, but the pathogenesis is unknown.
We sought to determine if JRP are associated with histological mucosal inflammation and whether this predisposes the patient to inflammatory bowel disease (IBD).
We retrospectively reviewed the medical records, endoscopy reports and pathology results from 1/87 to 4/98 of patients who had a polypectomy. Patients with JRP were identified and grouped into JRP with normal mucosa or JRP with colitis. Colitis was defined as either acute (PMNs) or chronic (lymphocytes, plasma cells and/or increased eosinophils) inflammatory changes. Patients with JRP and colitis were then analyzed to determine if they had or were subsequently diagnosed with IBD.
Of 113 patients who underwent polypectomy, 96 had JRP: 39 (40.6%) had no concurrent mucosal biopsies, 32 (33.3%) had normal mucosal histology, and 25 (26.1%) had inflammatory histology. 11/25 patients had mucosal inflammation around the polyp (2 with inflammation elsewhere in the colon) while 14 patients had mucosal inflammation elsewhere in the colon. Four patients (16%) had IBD (2 diagnosed prior to and 2 at the time of JRP) but none subsequently. Follow-up was one month to 11 years.
Mucosal biopsies at the time of polypectomy were done in 57/96 (59%) of the patients. Of these 57 patients, a significant number, 25 (43.9%) had mucosal inflammation in addition to their JRP. The normal mucosal biopsies in the remaining patients may have been due to random sampling. In 2 patients, initial IBD presentation was related to their JRP. We postulate that underlying microscopic inflammation may predispose to glandular tubular occlusion and the retention of mucous secretions resulting in cystic dilation and ultimately a JRP. This hypothesis is further supported by JRP occurring in patients with IBD.
Underlying microscopic mucosal inflammation coexists with JRP and this may be a risk factor or possible etiology for the development of JRP. The pathogenesis, natural history and prognosis of this inflammation in relation to JRP remain to be determined. Colitis associated with JRP, however, does not appear to increase one's risk for IBD. NASPGN Abstracts. J. of Pediatric Gastroenterology and Nutrition. October 1998.
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