Jacob Mark1,2,3, Shahan D Fernando1,2,3, Joanne C Masterson1,3,4,5, Zhaoxing Pan1,3, Kelley E Capocelli3,5,6, Glenn T Furuta1,3,4,5, Edwin F de Zoeten1,2,4,5. 1. Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Digestive Health Institute. 2. Pediatric Inflammatory Bowel Disease Center. 3. Gastrointestinal Eosinophilic Diseases Program, Children's Hospital Colorado. 4. Mucosal Inflammation Program, University of Colorado School of Medicine. 5. University of Colorado School of Medicine. 6. Department of Pathology, University of Colorado School of Medicine, Aurora, CO.
Abstract
OBJECTIVE: Pediatric colonic eosinophilia represents a confounding finding with a wide differential. It is often difficult to determine which children may progress to inflammatory bowel disease (IBD), which have an eosinophilic colitis (EC), and which may have no underlying pathology. There is little guidance for the practitioner on the approach to these patients. To define the clinical presentations of colonic eosinophilia and identify factors which may aid in diagnosis we reviewed patients with colonic eosinophilia and the clinicopathologic factors associated with their diagnoses. METHODS: An 8-year retrospective chart review of children whose histopathology identified colonic eosinophilia (N = 72) compared to controls with normal biopsies (N = 35). RESULTS: Patients with colonic eosinophilia had increased eosinophils/high-power field compared to controls (P < 0.001) and had 3 clinical phenotypes. Thirty-six percent had an inflammatory phenotype with elevated erythrocyte sedimentation rate (P < .0001), chronic inflammation on colonic biopsies (P < 0.001), and were diagnosed as having IBD. Thirty-seven percent were diagnosed as having EC, associated with male sex (P < 0.005) and peripheral eosinophilia (P = 0.041). Twenty-one percent had no significant colonic pathology. Forty-three percent of patients had >1 colonoscopy and 68% of these had change from initial diagnoses. CONCLUSIONS: There are 3 main phenotypes of children with colonic eosinophilia. Signs of chronic systemic inflammation raise suspicion for IBD. Peripheral eosinophilia and male sex are associated with EC. A significant percent of children with colonic eosinophilia do not have colonic disease. Eosinophils/high-power field is not reliable to differentiate etiologies. Repeat colonoscopies may be required to reach final diagnoses.
OBJECTIVE:Pediatric colonic eosinophilia represents a confounding finding with a wide differential. It is often difficult to determine which children may progress to inflammatory bowel disease (IBD), which have an eosinophilic colitis (EC), and which may have no underlying pathology. There is little guidance for the practitioner on the approach to these patients. To define the clinical presentations of colonic eosinophilia and identify factors which may aid in diagnosis we reviewed patients with colonic eosinophilia and the clinicopathologic factors associated with their diagnoses. METHODS: An 8-year retrospective chart review of children whose histopathology identified colonic eosinophilia (N = 72) compared to controls with normal biopsies (N = 35). RESULTS:Patients with colonic eosinophilia had increased eosinophils/high-power field compared to controls (P < 0.001) and had 3 clinical phenotypes. Thirty-six percent had an inflammatory phenotype with elevated erythrocyte sedimentation rate (P < .0001), chronic inflammation on colonic biopsies (P < 0.001), and were diagnosed as having IBD. Thirty-seven percent were diagnosed as having EC, associated with male sex (P < 0.005) and peripheral eosinophilia (P = 0.041). Twenty-one percent had no significant colonic pathology. Forty-three percent of patients had >1 colonoscopy and 68% of these had change from initial diagnoses. CONCLUSIONS: There are 3 main phenotypes of children with colonic eosinophilia. Signs of chronic systemic inflammation raise suspicion for IBD. Peripheral eosinophilia and male sex are associated with EC. A significant percent of children with colonic eosinophilia do not have colonic disease. Eosinophils/high-power field is not reliable to differentiate etiologies. Repeat colonoscopies may be required to reach final diagnoses.
Authors: Samantha A Woodruff; Joanne C Masterson; Sophie Fillon; Zachary D Robinson; Glenn T Furuta Journal: J Pediatr Gastroenterol Nutr Date: 2011-06 Impact factor: 2.839
Authors: Chris A Liacouras; Glenn T Furuta; Ikuo Hirano; Dan Atkins; Stephen E Attwood; Peter A Bonis; A Wesley Burks; Mirna Chehade; Margaret H Collins; Evan S Dellon; Ranjan Dohil; Gary W Falk; Nirmala Gonsalves; Sandeep K Gupta; David A Katzka; Alfredo J Lucendo; Jonathan E Markowitz; Richard J Noel; Robert D Odze; Philip E Putnam; Joel E Richter; Yvonne Romero; Eduardo Ruchelli; Hugh A Sampson; Alain Schoepfer; Nicholas J Shaheen; Scott H Sicherer; Stuart Spechler; Jonathan M Spergel; Alex Straumann; Barry K Wershil; Marc E Rothenberg; Seema S Aceves Journal: J Allergy Clin Immunol Date: 2011-04-07 Impact factor: 10.793
Authors: Elizaveta Chernetsova; Katrina Sullivan; Joseph de Nanassy; Janice Barkey; David Mack; Ahmed Nasr; Dina El Demellawy Journal: Hum Pathol Date: 2016-04-01 Impact factor: 3.466
Authors: Lauren A DiTommaso; Chen E Rosenberg; Michael D Eby; Amy Tasco; Margaret H Collins; John L Lyles; Philip E Putnam; Vincent A Mukkada; Marc E Rothenberg Journal: J Allergy Clin Immunol Date: 2019-01-14 Impact factor: 10.793
Authors: Robert D Pesek; Craig C Reed; Amanda B Muir; Patricia C Fulkerson; Calies Menard-Katcher; Gary W Falk; Jonathan Kuhl; Ellen K Martin; Adam Z Magier; Faria Ahmed; Maureen Demarshall; Ankur Gupta; Jonathan Gross; Tokunbo Ashorobi; Christina L Carpenter; Jeffrey P Krischer; Nirmala Gonsalves; Jonathan M Spergel; Sandeep K Gupta; Glenn T Furuta; Marc E Rothenberg; Evan S Dellon Journal: Am J Gastroenterol Date: 2019-06 Impact factor: 10.864
Authors: Tetsuo Shoda; Margaret H Collins; Mark Rochman; Ting Wen; Julie M Caldwell; Lydia E Mack; Garrett A Osswald; John A Besse; Yael Haberman; Seema S Aceves; Nicoleta C Arva; Kelley E Capocelli; Mirna Chehade; Carla M Davis; Evan S Dellon; Gary W Falk; Nirmala Gonsalves; Sandeep K Gupta; Ikuo Hirano; Paneez Khoury; Amy Klion; Calies Menard-Katcher; John Leung; Vincent A Mukkada; Philip E Putnam; Jonathan M Spergel; Joshua B Wechsler; Guang-Yu Yang; Glenn T Furuta; Lee A Denson; Marc E Rothenberg Journal: Gastroenterology Date: 2022-01-25 Impact factor: 33.883
Authors: Rhiannon T Filippone; Narges Dargahi; Rajaraman Eri; Jose A Uranga; Joel C Bornstein; Vasso Apostolopoulos; Kulmira Nurgali Journal: Int J Mol Sci Date: 2022-07-14 Impact factor: 6.208