Eosinophilic colitis: an infrequent disease with difficult diagnose

2020 ◽  
Vol 13 (9) ◽  
pp. e235804
Author(s):  
Javier Páramo-Zunzunegui ◽  
Ignacio Ortega-Fernandez ◽  
Silvia Benito-Barbero ◽  
Laura Rubio-López
Keyword(s):  
Normal Mucosa ◽  
Eosinophilic Gastroenteritis ◽  
Steroid Treatment ◽  
Inflammatory Disorder ◽  
Rare Entity ◽  
Colon Wall ◽  
Population Impact ◽  
Eosinophilic Colitis ◽  
Eosinophilic Infiltrate ◽  
Bowel Movements

Eosinophilic colitis (EC) is a rare entity. It is part of eosinophilic gastroenteritis, a rare inflammatory disorder characterised by eosinophilic infiltration of tissues that can affect any segment of the digestive tract. The diagnosis is established by the presence of an increased eosinophilic infiltrate in the colon wall in symptomatic patients. There is no characteristic clinical picture of EC. It can be associated with abdominal pain, changes in bowel movements, diarrhoea and rectal bleeding. Biopsies are mandatory if EC is suspected and despite visualising a normal mucosa. Although there are no protocol guidelines in this regard, steroid treatment is the first option in controlling the disease. Increasing the knowledge of clinicians and pathologists of this disorder and the recording its real incidence and population impact, could improve the understanding and treatment of the disease.

scholarly journals Eosinophil Counts in Mucosal Biopsies of the Ileum and Colon: Interobserver Variance Affects Diagnostic Accuracy

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Florian Hentschel ◽  
Anna Franziska Jansen ◽  
Marlis Günther ◽  
Roland Pauli ◽  
Stefan Lüth
Keyword(s):  
Staining Method ◽  
Sampling Site ◽  
Eosinophilic Gastroenteritis ◽  
Rare Entity ◽  
Endoscopic Findings ◽  
Slide Preparation ◽  
Microscopic Field ◽  
Histopathologic Findings ◽  
Very High ◽  
Eosinophil Counts

Primary eosinophilic gastroenteritis and colitis (EGE) is a rare entity with unspecific clinical and endoscopic findings. Validated histopathologic criteria for confirming the diagnosis are lacking, because numeric values for normal or elevated concentrations of eosinophils in mucosal biopsies are varying between observers. To quantify this interobserver variance, we had the same set of 30 slides of eosinophilic-rich mucosal biopsies from the ileum and colon systematically reviewed by a panel of six independent pathologists, each with more than a ten-year experience in the field. Using a highly standardized biopsy and slide preparation protocol, we ruled out any influence by the preparation, the patient, the endoscopist, the endoscopes and calipers used, the sampling site, the fixation and staining method, and the microscopic field sizes. Still, all numeric results differed between pathologists up to a factor greater than 30. Calculated positive or negative diagnosis of EGE differed up to a factor greater than 8. A theoretical incidence for EGE calculated from these numbers differed by a factor greater than 1500. We conclude that eosinophil counts in mucosal biopsies from the lower gastrointestinal tract are subject to a very high interobserver variance. Until further research provides objective and validated methods for standardization, all epidemiologic numbers derived from histopathologic findings may have to be questioned. When diagnosing individual patients with EGE, overall morphologic picture together with clinical and endoscopic findings is more important than numeric eosinophil count.

scholarly journals Endoscopic findings of gastric lesions in patients with eosinophilic gastrointestinal disorders

2020 ◽  
Vol 08 (12) ◽  
pp. E1817-E1825
Author(s):  
Yasuhiro Fujiwara ◽  
Kojiro Tanoue ◽  
Akira Higashimori ◽  
Yu Nishida ◽  
Masatsugu Maruyama ◽  
...  
Keyword(s):  
Eosinophilic Esophagitis ◽  
Submucosal Tumor ◽  
Eosinophilic Gastroenteritis ◽  
Gastrointestinal Disorders ◽  
Gastric Lesions ◽  
Pyloric Ring ◽  
Eosinophilic Colitis ◽  
Endoscopic Findings ◽  
Eosinophilic Gastritis ◽  
Eosinophilic Gastrointestinal Disorders

Abstract Background and study aims Eosinophilic gastrointestinal disorders are classified into eosinophilic esophagitis, eosinophilic gastritis, eosinophilic gastroenteritis, and eosinophilic colitis according to the site of eosinophilic infiltration. Although well established in eosinophilic esophagitis, endoscopic findings in eosinophilic gastritis and eosinophilic gastroenteritis with regard to gastric lesions have not been clearly described. The aim of this study was to identify endoscopic findings of gastric lesions associated with eosinophilic gastrointestinal disorders. Patients and methods Out of 278 patients with eosinophilic gastrointestinal disorders, 18 had eosinophilic gastritis or eosinophilic gastroenteritis confirmed by biopsy; their endoscopic images were analyzed retrospectively. The association between endoscopic findings and number of eosinophils in the gastric mucosa was investigated. Results Erythema was most frequently observed (72 %), followed by ulcers (39 %), discoloration (33 %), erosions (28 %), nodularity (28 %), and polyps (28 %). There were several unique endoscopic findings such as submucosal tumor-like deep large ulcers in three patients, antral Penthorum-like appearances (small nodules radially lined toward the pyloric ring) in three patients, “muskmelon-like appearances” (discolored mucosa-composed mesh pattern) in three patients, multiple white granular elevations in two patients, cracks (appearance of furrows similar to those in eosinophilic esophagitis) in five patients, and antral rings in one patient. No significant association was observed between endoscopic findings and number of gastric eosinophils. Conclusions Several unique endoscopic findings of gastric lesions were observed in patients with eosinophilic gastritis or eosinophilic gastroenteritis. Submucosal tumor-like ulcers, antral Penthorum-like appearances, muskmelon-like appearances, and cracks might be associated with eosinophilic gastrointestinal disorders.

scholarly journals Carcinoma Colon in a Patient with Eosinophilic Gastroenteritis

2018 ◽  
Vol 09 (04) ◽  
pp. 196-200
Author(s):  
Rachit Agarwal ◽  
Piyush Ranjan ◽  
Sunita Bhalla
Keyword(s):  
Right Hemicolectomy ◽  
Eosinophilic Gastroenteritis ◽  
Fecal Fistula ◽  
Emergency Laparotomy ◽  
Anastomotic Site ◽  
Surgical Specimen ◽  
Eosinophilic Colitis ◽  
Uncommon Disease ◽  
Well Differentiated ◽  
Carcinoma Colon

AbstractEosinophilic gastroenteritis is an uncommon disease which can involve all layers of the gastrointestinal tract anywhere from the esophagus to colon. Clinical features depend upon the site of involvement and layer of GI tract involved. It is an inflammatory disease with remitting and relapsing course. We report a case which presented with discharging fecal fistula in lower abdomen after emergency laparotomy. Initial colonoscopy showed stricture with nodularity of the IC junction and biopsy showed features of eosinophilic gastroenteritis. Due to persistence of fistula he underwent right hemicolectomy with illeo-transverse anastomosis. Biopsy from surgical specimen showed well differentiated adenocarcinoma and eosinophilic infiltrate in muscularis. Surveillance colonoscopy done six months later showed ulcer at anastomotic site and biopsy showed features of eosinophilic colitis. The clinical course of this patient circumstantially indicates a linkage of eosinophilic colitis with carcinoma colon. This is the first reported case of association of eosinophilic colitis with carcinoma colon. We discuss in detail the clinical and pathological features of eosinophilic enteritis and possible mechanisms linking eosinophilc enteritis with carcinoma.

scholarly journals Bilateral Optic Atrophy with Thickened Meninges (Idiopathic Hypertrophic Pachymeningitis) - A Rare Entity

JMS SKIMS ◽  
2011 ◽  
Vol 14 (1) ◽  
pp. 25-27
Author(s):  
Ravouf Asmi ◽  
Feroze Ahmad ◽  
Rangreze Imran ◽  
Zarka Amin Masoodi ◽  
Mushtaq A Wani
Keyword(s):  
Infectious Diseases ◽  
Optic Atrophy ◽  
Visual Loss ◽  
Unknown Etiology ◽  
Inflammatory Disorder ◽  
Rare Entity ◽  
Hypertrophic Pachymeningitis ◽  
Open Biopsy

Idiopathic hypertrophic pachymeningitis (IHP) is a rare, chronic nonspecific and granulomatous inflammatory disorder of the dura with unknown etiology. The diagnosis can be established by an open biopsy and exclusion of all other specific granulomatous and infectious diseases. We report a case of Idiopathic hypertrophic pachymeningitis who manifested primarily by headache and visual loss with optic atrophy. The patient was thoroughly investigated and showed no evidence of underlying cause. The diagnosis was established by an open biopsy. JMS 2011;14(1):25-27

Pneumatosis Coli Secondary to Eosinophilic Colitis: A Rare Entity

2017 ◽  
Vol 112 ◽  
pp. S814-S815
Author(s):  
Harika Balagoni ◽  
Vikas Koppurapu ◽  
Kalpit Devani ◽  
Parag Brahmbhatt ◽  
Manoj Srinath ◽  
...  
Keyword(s):  
Rare Entity ◽  
Pneumatosis Coli ◽  
Eosinophilic Colitis

scholarly journals Importance of biopsies and histological evaluation in patients with chronic diarrhea and normal colonoscopies

2014 ◽  
Vol 27 (3) ◽  
pp. 184-187 ◽  
Author(s):  
Franciane Mayra Nicoli KAGUEYAMA ◽  
Fernanda Michely NICOLI ◽  
Mauro Willemann BONATTO ◽  
Ivan Roberto Bonotto ORSO
Keyword(s):  
Differential Diagnosis ◽  
Terminal Ileum ◽  
Chronic Diarrhea ◽  
Collagenous Colitis ◽  
Normal Mucosa ◽  
Cross Sectional Study ◽  
Lymphoid Hyperplasia ◽  
Histological Evaluation ◽  
Cross Sectional ◽  
Eosinophilic Colitis

BACKGROUND: In patients with chronic diarrhea, colonoscopy may identify inflammatory causes or some occult disease, and also can show a normal mucosa. Serial biopsies of intestinal mucosa can be useful for a differential diagnosis, and to modify the treatment. AIM: To evaluate whether the biopsies performed in patients with chronic diarrhea and a normal colonoscopy contribute to the differential diagnosis and alter the therapeutic approach. METHODS: A descriptive, retrospective and cross-sectional study using a computerized database was done. Patients with chronic diarrhea and a normal colonoscopy underwent serial biopsies of the terminal ileum, ascending colon and rectum. RESULTS: From 398 records, 214 were excluded. Of the 184 patients enrolled, 91 showed histological changes: 40% nonspecific inflammation; 5.18% lymphocytic inflammation, 10.37% eosinophilic inflammation; 39.26% lymphoid hyperplasia; 2.22% collagenous colitis; 2.22% melanosis; and 0.74% pseudomelanose. The sites with the largest number of changes were the terminal ileum and right colon. CONCLUSIONS: Serial biopsies in patients with chronic diarrhea and normal colonoscopy identified changes in almost 50% of cases and 22% of these cases may had modified the treatment after identification of collagenous, lymphocytic and eosinophilic colitis.

scholarly journals Idiopathic Hypertrophic Pachymeningitis: Does Earlier Treatment Improve Outcome?

Children ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 11
Author(s):  
Emilia Rizzo ◽  
Ailsa Elizabeth Ritchie ◽  
Vinay Shivamurthy ◽  
Ata Siddiqui ◽  
Ming Lim
Keyword(s):  
Dura Mater ◽  
Visual Outcome ◽  
Severe Headache ◽  
Steroid Treatment ◽  
Inflammatory Disorder ◽  
Hypertrophic Pachymeningitis ◽  
Improve Outcome ◽  
Chronic Inflammatory Disorder ◽  
Poor Visual Outcome ◽  
Delayed Initiation

Background/goal: Hypertrophic pachymeningitis is a rare chronic inflammatory disorder characterized by marked fibrous thickening of the cerebral and/or spinal dura mater. This condition has largely been reported in adults, but there are very few reports in children. Methods: We describe a 14-year-old boy with idiopathic hypertrophic pachymeningitis, who presented with deteriorating vision on a background of severe headache. We evaluated pediatric cases of hypertrophic pachymeningitis and compared treatments and their relation to outcomes. Results: There are only eleven pediatric cases of hypertrophic pachymeningitis reported in the literature. In the patients treated with steroids either at presentation or subsequent relapses, a good response was reported. In the cases with delayed initiation of steroid treatment, this was often related to an incomplete recovery. In our patient, this delay may have contributed to his poor visual outcome. Conclusions: Early initiation of steroid treatment in children with idiopathic hypertrophic pachymeningitis may improve outcomes.

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