Abstract
Purpose
Eosinophilic gastrointestinal disorders are rare in children and present with a broad spectrum of non-specific symptoms. To date, no guidelines for diagnosis, therapy and follow-up are validated. Aim of our study is to focus on eosinophilic colitis (EC), to determine a possible correlation between associated disorders, macroscopic findings and treatment/follow up.
Methods
Retrospective study from 2015 to 2019 including all colonoscopies performed at our Institution. Eosinophilic colitis was defined according to the threshold identified by Collins: > 100 Eo/Hpf: right colon, > 84 Eo/Hpf transverse and left colon, > 64 Eo/Hpf sigma and rectum. We excluded colonoscopy in patients with IBD or other diseases causing hypereosinophilia (i.e., parasite infection, GVHD).
Results
Among 399 colonoscopies performed in 355 patients, we made 50 diagnosis of EC, 36 males, 14 females, median age 8.5 (3–17). Symptoms leading to endoscopy were recurrent abdominal pain (66%), chronic diarrhea (64%), and chronic constipation (8%). Two patients presented with GI bleeding and one with weight loss. Macroscopic findings were mostly normal or lymphoid nodular hypertrophy presenting different endoscopic features. In seven children (14%) we found history of allergy and atopy. 22 children present a diagnosis of autistic spectrum disorder (ASD) with a prevalence higher than in the overall population (44% vs 28.5%, p = 0.03). According to symptoms, treatment consist variably of steroids, six food elimination diet, mesalamine. For patients with available follow-up, we found histological persistence of Eosinophils in 75%, even in patients with symptoms relief.
Conclusion
This study focus attention on EC as a new challenging pathology. Multicentric randomized clinical trials are needed to understand physiopathological mechanisms to validate a possible endoscopic score and related histological threshold, and to standardize therapy according to clinical features and instrumental findings. The high prevalence of EC in ASD need further specific research.
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References
Jensen ET, Martin CF, Kappelman MD, Dellon ES (2016) Prevalence of eosinophilic gastritis, gastroenteritis, and colitis: estimates from a national administrative database. J Pediatr Gastroenterol Nutr 62(1):36–42. https://doi.org/10.1097/MPG.0000000000000865
Licari A, Votto M, Scudeller L, De Silvestri A, Rebuffi C, Cianferoni A, Marseglia GL (2020) Epidemiology of nonesophageal eosinophilic gastrointestinal diseases in symptomatic patients: a systematic review and meta-analysis. J Allergy Clin Immunol Pract 8(6):1994-2003.e2. https://doi.org/10.1016/j.jaip.2020.01.060 (Epub 2020 Feb 28)
Lucendo AJ, Molina-Infante J, Arias Á et al (2017) Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. Unit Eur Gastroenterol J 5(3):335–358. https://doi.org/10.1177/2050640616689525(Epub 2017 Jan 23)
Gonsalves N, Furuta GT, Atkins D (2016) Eosinophilic gastrointestinal disorders affect more than just the esophagus. J Pediatr Gastroenterol Nutr 62(1):1–2. https://doi.org/10.1097/MPG.0000000000000993
Lozinsky AC, Morais MB (2014) Eosinophilic colitis in infants. J Pediatr (Rio J) 90(1):16–21. https://doi.org/10.1016/j.jped.2013.03.024(Epub 2013 Oct 13)
Sheikh RA, Prindiville TP, Pecha RE, Ruebner BH (2009) Unusual presentations of eosinophilic gastroenteritis: case series and review of literature. World J Gastroenterol 15(17):2156–2161. https://doi.org/10.3748/wjg.15.2156
Heifert TA, Susi A, Hisle-Gorman E, Erdie-Lalena CR, Gorman G, Min SB, Nylund CM (2016) Feeding disorders in children with autism spectrum disorders are associated with eosinophilic esophagitis. J Pediatr Gastroenterol Nutr 63(4):e69-73. https://doi.org/10.1097/MPG.0000000000001282
Bjørklund G, Pivina L, Dadar M, Meguid NA, Semenova Y, Anwar M, Chirumbolo S (2020) Gastrointestinal alterations in autism spectrum disorder: what do we know? Neurosci Biobehav Rev 118:111–120. https://doi.org/10.1016/j.neubiorev.2020.06.03(Epub 2013 Oct 13)
Capucilli P, Cianferoni A, Grundmeier RW, Spergel JM (2018) Comparison of comorbid diagnoses in children with and without eosinophilic esophagitis in a large population. Ann Allergy Asthma Immunol 121(6):711–716. https://doi.org/10.1016/j.anai.2018.08.022(Epub 2018 Sep 6)
Chen B, Girgis S, El-Matary W (2010) Childhood autism and eosinophilic colitis. Digestion 81(2):127–129. https://doi.org/10.1159/000252765(Epub 2010 Jan 9)
Pesek RD, Reed CC, Muir AB et al (2019) Increasing rates of diagnosis, substantial co-occurrence, and variable treatment patterns of eosinophilic gastritis, gastroenteritis, and colitis based on 10-year data across a multicenter consortium. Am J Gastroenterol 114(6):984–994. https://doi.org/10.14309/ajg.0000000000000228
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Raffaele, A., Vatta, F., Votto, M. et al. Eosinophilic colitis in children: a new and elusive enemy?. Pediatr Surg Int 37, 485–490 (2021). https://doi.org/10.1007/s00383-020-04832-8
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DOI: https://doi.org/10.1007/s00383-020-04832-8