Defining eosinophilic colitis in children: insights from a retrospective case series.
OBJECTIVE
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.
Behjati
Sam
S
Department of Histopathology, Royal Free Hampstead NHS Trust, Royal Free and University College Medical School Pond Street, London, UK.
Zilbauer
Matthias
M
Heuschkel
Robert
R
Phillips
Alan
A
Salvestrini
Camilla
C
Torrente
Franco
F
Bates
Alan W
AW
D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D046728:Colitis, Microscopic / Q000175:diagnosis* / Q000276:immunology; D003106:Colon / Q000276:immunology*; D004802:Eosinophilia / Q000097:blood / Q000175:diagnosis*; D004804:Eosinophils; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007223:Infant; D008297:Male; D012189:Retrospective Studies
D007073:Immunoglobulin E