title: Recurrent blood eosinophilia in ulcerative colitis is associated with severe disease and primary sclerosing cholangitis.
abstract: OBJECTIVE
  Eosinophils are implicated in the pathogenesis of inflammatory bowel disease (IBD). A subset of IBD patients develops blood eosinophilia, and the clinical profile of these patients is undefined. We sought to characterize IBD patients with and without eosinophilia.
  
  
  METHODS
  We studied a prospective registry of 1,176 IBD patients followed in a tertiary referral center. Patients who developed eosinophilia at any time were identified by electronic medical record query. We performed a chart review case-control study comparing patients with recurrent eosinophilia versus randomly selected disease-matched patients with no history of eosinophilia. Histological analysis was performed on selected cases and controls.
  
  
  RESULTS
  Eosinophilia at any time was more prevalent in ulcerative colitis (UC) patients than Crohn's disease patients (22.2 versus 12.7%), as was recurrent eosinophilia (3.4 versus 0.7%). UC patients with recurrent eosinophilia were predominantly male compared with the control UC population (81.3 versus 46.9%) and had higher rates of colectomy for either medically refractory disease or dysplasia/cancer than control UC patients (56.3 versus 15.6%). Primary sclerosing cholangitis (PSC) occurred in 37.5% of UC patients with recurrent eosinophilia compared with only 3.1% in the UC controls. Histological analysis of random diagnostic samples from UC patients with recurrent eosinophilia demonstrated a normal eosinophil pattern as seen in the control UC population.
  
  
  CONCLUSIONS
  Eosinophilia-associated UC is a subgroup of IBD associated with severe colitis and PSC. Further studies are warranted to characterize molecular mechanisms underlying eosinophilia-associated UC and to determine optimal approaches for therapy.
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA. amb145@pitt.edu
authors.forename: Arthur
authors.initials: A
authors.lastname: Barrie
authors.forename: Marwa El
authors.initials: ME
authors.lastname: Mourabet
authors.forename: Katherine
authors.initials: K
authors.lastname: Weyant
authors.forename: Kofi
authors.initials: K
authors.lastname: Clarke
authors.forename: Mahesh
authors.initials: M
authors.lastname: Gajendran
authors.forename: Claudia
authors.initials: C
authors.lastname: Rivers
authors.forename: Seo Young
authors.initials: SY
authors.lastname: Park
authors.forename: Douglas
authors.initials: D
authors.lastname: Hartman
authors.forename: Melissa
authors.initials: M
authors.lastname: Saul
authors.forename: Miguel
authors.initials: M
authors.lastname: Regueiro
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Yadav
authors.forename: David G
authors.initials: DG
authors.lastname: Binion
mesh_terms: D000293:Adolescent; D000328:Adult; D015209:Cholangitis, Sclerosing / Q000150:complications* / Q000473:pathology*; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000150:complications* / Q000473:pathology*; D004802:Eosinophilia / Q000150:complications* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult