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Association Between Endoscopic and Histologic Findings in a Multicenter Retrospective Cohort of Patients with Non-esophageal Eosinophilic Gastrointestinal Disorders

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Abstract

Background

Little is known about the endoscopic and histologic findings of non-esophageal eosinophilic gastrointestinal diseases (EGID).

Aim

To characterize the presenting endoscopic and histologic findings in patients with eosinophilic gastritis (EG), eosinophilic gastroenteritis (EGE), and eosinophilic colitis (EC) at diagnosis and 6 months after initiating the treatment.

Methods

We conducted a retrospective cohort study at 6 US centers associated with the Consortium of Eosinophilic Gastrointestinal Researchers. Data abstracted included demographics, endoscopic findings, tissue eosinophil counts, and associated histologic findings at diagnosis and, when available, after initial treatment.

Results

Of 373 subjects (317 children and 56 adults), 142 had EG, 123 EGE, and 108 EC. Normal endoscopic appearance was the most common finding across all EGIDs (62% of subjects). Baseline tissue eosinophil counts were quantified in 105 (74%) EG, 36 (29%) EGE, and 80 (74%) EC subjects. The mean peak gastric eosinophil count across all sites was 87 eos/hpf for EG and 78 eos/hpf for EGE. The mean peak colonic eosinophil count for EC subjects was 76 eos/hpf (range 10–500). Of the 29% of subjects with post-treatment follow-up, most had an improvement in clinical, endoscopic, and histologic findings regardless of treatment utilized. Reductions in tissue eosinophilia correlated with improvements in clinical symptoms as well as endoscopic and histologic findings.

Conclusions

In this large cohort, normal appearance was the most common endoscopic finding, emphasizing the importance of biopsy, regardless of endoscopic appearance. Decreased tissue eosinophilia was associated with improvement in symptoms, endoscopic, and histologic findings, showing that disease activity is reversible.

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Author information

Authors and Affiliations

  1. Division of Allergy/Immunology, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, 13 Children’s Way, Slot 512-13, Little Rock, AR, 72202, USA

    Robert D. Pesek

  2. Center for Esophageal Diseases and Swallowing and Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, CB #7080, Chapel Hill, NC, 27599, USA

    Craig C. Reed & Evan S. Dellon

  3. Division of Pathology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA

    Margaret H. Collins

  4. Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA

    Amanda B. Muir, Ankur Gupta, Jonathan Gross & Tokunbo Ashorobi

  5. Division of Allergy/Immunology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7028, Cincinnati, OH, 45229, USA

    Patricia C. Fulkerson, Jonathan Kuhl, Adam Z. Magier & Marc E. Rothenberg

  6. Division of Gastroenterology, Department of Pediatrics, Children’s Hospital Colorado, 13123 E 16th Avenue #B361, Aurora, CO, 80045, USA

    Calies Menard-Katcher, Faria N. Ahmed & Glenn T. Furuta

  7. Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PCAM South Pavilion, 7th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Gary W. Falk & Maureen Demarshall

  8. Rare Disease Clinical Research Network Data Coordinating Center, Health Informatics Institute, University of South Florida, 3650 Spectrum Blvd, Suite 100, Tampa, FL, 33612, USA

    Christina L. Carpenter & Jeffrey P. Krischer

  9. Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Lavin Family Pavilion, 259 E Erie St, 16th Floor, Chicago, IL, 60611, USA

    Nirmala Gonsalves & Ikuo Hirano

  10. Division of Allergy and Immunology, The Children’s Hospital of Philadelphia, 3550 Market St., Philadelphia, PA, 19104, USA

    Jonathan M. Spergel

  11. Department of Pediatrics, Perelman School of Medicine of University of Pennsylvania, 3550 Market St., Philadelphia, PA, 19104, USA

    Jonathan M. Spergel

  12. Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Illinois and the University of Illinois College of Medicine, 800 NE Glen Oak Ave, Peoria, IL, 61603, USA

    Sandeep K. Gupta

Authors
  1. Robert D. Pesek
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  2. Craig C. Reed
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  3. Margaret H. Collins
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  4. Amanda B. Muir
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  5. Patricia C. Fulkerson
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  6. Calies Menard-Katcher
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  7. Gary W. Falk
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  8. Jonathan Kuhl
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  9. Adam Z. Magier
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  10. Faria N. Ahmed
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  11. Maureen Demarshall
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  12. Ankur Gupta
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  13. Jonathan Gross
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  14. Tokunbo Ashorobi
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  15. Christina L. Carpenter
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  16. Jeffrey P. Krischer
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  17. Nirmala Gonsalves
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  18. Ikuo Hirano
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  19. Jonathan M. Spergel
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  20. Sandeep K. Gupta
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  21. Glenn T. Furuta
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  22. Marc E. Rothenberg
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  23. Evan S. Dellon
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Consortia

the Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR)

Contributions

RDP was a consultant for Allakos. MHC was a consultant for Allakos, AstraZeneca, Esocap, Celgene Corporation, Regeneron, and Shire and received research support from Regeneron and Shire. PF was a consultant for Genentech, Inc, and received grant funding from the NIH and research support from Knopp Biosciences, LLC. GF was a consultant for Takeda/Shire and Adare and obtained research support from Takeda/Shire, Celgene, Adare, Regeneron, and Allakos. JMS was a consultant for Regeneron, DBV Technology, and Kaleo and received grant funding from DBV Technology, Aimmune Therapeutics, and Food Allergy Research Education and royalties from UpToDate. NG was in the advisory board for Allakos and obtained royalties from UpToDate. SKG was a consultant for Adare, Alkalos, Abbott, GossamerQOL, and Receptos and obtained research support from Shire and royalties from UpToDate. GF was the founder of EnteroTrack and a consultant for Shire. MER was a consultant for Pulm One, Spoon Guru, Clostrabio, Celgene, Shire, Astra Zeneca, GlaxoSmithKline, Allakos, Adare, Regeneron, and Novartis, has an equity interest in the first three listed and Immune Pharmaceuticals, and received royalties from reslizumab (Teva Pharmaceuticals), PEESSv2 (Mapi Research Trust), and UpToDate. MER is an inventor of patents owned by Cincinnati Children’s. ED was a consultant for Adare, Aimmune, Allakos, Alivio, AstraZeneca, Banner, Biorasi, Calypso, Celgene/Receptos, Enumeral, EsoCap, Gossamer Bio, GSK, Regeneron, Salix, and Shire and received research funding from Adare, Allakos, Celegene/Receptos, GSK, Miraca, Meritage, Nutricia, Regeneron, and Shire and educational grant from Allakos, Banner, and Holoclara.

Corresponding author

Correspondence to Robert D. Pesek.

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Conflict of interest

As a corresponding author, I declare the disclosures and potential conflicts of interest listed below on behalf of all authors. This has been verified to be accurate and up to date at the time of submission of the manuscript. In addition to the disclosures below, this study was funded in part through a research training grant as a part of the Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR) (U54 AI117804). CEGIR is part of the Rare Disease Clinical Research Network (RDCRN), an initiative of the Office of Rare Diseases Research (ORDR), NCATS, and is funded through collaboration between NIAID, NIDDK, and NCATS. CEGIR is also supported by patient advocacy groups including APFED CURED and EFC. This project also received support from NIH T32 DK007634 (CCR).

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Pesek, R.D., Reed, C.C., Collins, M.H. et al. Association Between Endoscopic and Histologic Findings in a Multicenter Retrospective Cohort of Patients with Non-esophageal Eosinophilic Gastrointestinal Disorders. Dig Dis Sci 65, 2024–2035 (2020). https://doi.org/10.1007/s10620-019-05961-4

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