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Defining Eosinophilic Colitis in Children: Insights From a Retrospective Case Series

Behjati, Sam*; Zilbauer, Matthias; Heuschkel, Robert; Phillips, Alan; Salvestrini, Camilla; Torrente, Franco; Bates, Alan W*

Journal of Pediatric Gastroenterology & Nutrition: August 2009 - Volume 49 - Issue 2 - p 208–215
doi: 10.1097/MPG.0b013e31818de373
Original Articles: Gastroenterology

Objectives: Although it is a well-described syndrome in infants, eosinophilic colitis is a loosely defined and poorly understood diagnosis in older children. The aims of this case series were to characterise colonic eosinophilia in children and to determine whether it represents a distinct clinicopathological condition.

Methods: We retrospectively reviewed symptomatic children older than 12 months with the principal diagnosis of colonic eosinophilia who presented between January 2000 and February 2007 (n = 38) and a further 10 children whose colonic biopsies were reported as histologically normal. The eosinophil density in all available gastrointestinal biopsies (n = 620) of these children was determined using a validated quantitative morphometric method. Patients were subdivided according to mean colonic eosinophil levels into 3 groups (marked, moderate, or minimal colonic eosinophilia). The following patient information was obtained and compared among patient groups: symptoms prompting endoscopy, atopic history, outcome, serum C-reactive protein and total immunoglobulin E (IgE) levels, erythrocyte sedimentation rate, blood eosinophil count, and endoscopic findings.

Results: In all 3 patient groups, there was a colonic gradient of decreasing eosinophil density from caecum to rectum. Upper gastrointestinal tract biopsies did not exhibit eosinophilia. Although a significant association (P = 0.03) between abnormal total IgE levels and moderate or severe colonic eosinophilia was found, there was no significant difference (P > 0.05) in other patient characteristics. Furthermore, follow-up data did not show a consistent relation between eosinophil density and progression of symptoms.

Conclusions: We find no association between “eosinophilic colitis,” defined as a histologically demonstrated marked colonic eosinophilia, and symptoms, history of atopy, inflammatory markers, or clinical outcome.

*Department of Histopathology, UK

Centre for Paediatric Gastroenterology, Royal Free Hampstead NHS Trust, Royal Free and University College Medical School Pond Street, London, UK

Received 18 February, 2008

Accepted 9 September, 2008

Address correspondence and reprint requests to Alan W. Bates, MD, Consultant Pathologist, Department of Histopathology, Royal Free Hospital Pond Street, London, NW3 2QG, UK (e-mail: alan.bates@royalfree.nhs.uk).

The authors report no conflicts of interest.

© 2009 Lippincott Williams & Wilkins, Inc.