The Significance and Clinical Outcome of Lymphocytic Duodenosis in Children. Mayo Clinic Experience and Systematic Review.

BACKGROUND Lymphocytic duodenosis (LD) defined as increased intraepithelial lymphocytes >25 IEL per 100 epithelial cells with normal villous architecture is associated with many gastrointestinal (GI) disorders. We aim to assess the rate and outcome of LD in children and perform a systematic review. METHOD We reviewed all children (<18 years) who underwent esophagogastroduodenoscopy (EGD) with duodenal biopsy between 01/2000- 06/2019 to identify LD cases and control group. Demographics, clinical, and pathologic information were reviewed and recorded. A systematic review including our findings was performed. RESULTS During the study period 12,744 children underwent an EGD with biopsies. Of those we identified 426 children with LD (3%) and 474 controls. The median age in years was 10.7 and 12.6 and there were 254 (60%) and 278 (59%) females in the LD and control group, respectively. The most common presenting symptoms in both groups were abdominal pain (52%), gastroesophageal acid reflux disease (18%), diarrhea (16%), and vomiting (12%). Diarrhea (21% vs. 12%, p < 0.001) and constipation (2% vs. 0.4%, p = 0.021) were statistically different between the LD and control group, respectively. Median follow up (range) is 3.6 (0.0, 190.9) and 3.1 (0.0, 194.2) in the LD and control group respectively. CD (5% vs 0%, p < 0.001), Crohn's disease (9% vs 3%, p = 0.003) and H. Pylori gastritis (3% vs 1%, p = 0.021) were more common in the LD group. CONCLUSION The Rate of LD in children is similar to reported rate in adults. In the absence of Crohn's disease, CD or H. Pylori, LD seems to be a benign and transient histologic finding in children.