Distribution of eosinophils in the gastrointestinal tract of children with no organic disease

Koutri, Eleni; Patereli, Amalia; Noni, Maria; Gutiérrez-Junquera, Carolina; González-Lois, Carmen; Oliva, Salvatore; Giordano, Carla; Stefanaki, Katerina; Papadopoulou, Alexandra

doi:10.20524/aog.2020.0518

Cited by 12 publications

(16 citation statements)

References 21 publications

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“…Mucosal eosinophil numbers are thought to increase progressively from the proximal small intestine to the cecum as reported by pediatric studies ( Lowichik and Weinberg, 1996 ; DeBrosse et al, 2006 ; Kiss et al, 2018 ; Koutri et al, 2020 ), although an opposite gradient is found in mice ( Mowat and Agace, 2014 ; Brown and Esterházy, 2021 ). Eosinophils represent around 20% of the leukocyte population in the lamina propria of the proximal small intestine ( Jung and Rothenberg, 2014 ).…”

Section: Intestinal Mucosal Eosinophils In Homeostasis and Inflammationmentioning

confidence: 75%

Immune Activation in Functional Dyspepsia: Bystander Becoming the Suspect

et al. 2022

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Disorders of gut-brain interaction (DGBI), formerly termed functional gastrointestinal disorders (FGID), are highly prevalent although exact pathophysiological mechanisms remain unclear. Intestinal immune activation has been recognized, but increasing evidence supports a pivotal role for an active inflammatory state in these disorders. In functional dyspepsia (FD), marked eosinophil and mast cell infiltration has been repeatedly demonstrated and associations with symptoms emphasize the relevance of an eosinophil-mast cell axis in FD pathophysiology. In this Review, we highlight the importance of immune activation in DGBI with a focus on FD. We summarize eosinophil biology in both homeostasis and inflammatory processes. The evidence for immune activation in FD is outlined with attention to alterations on both cellular and molecular level, and how these may contribute to FD symptomatology. As DGBI are complex and multifactorial conditions, we shed light on factors associated to, and potentially influencing immune activation, including bidirectional gut-brain interaction, allergy and the microbiota. Crucial studies reveal a therapeutic benefit of treatments targeting immune activation, suggesting that specific anti-inflammatory therapies could offer renewed hope for at least a subset of DGBI patients. Lastly, we explore the future directions for DGBI research that could advance the field. Taken together, emerging evidence supports the recognition of FD as an immune-mediated organic-based disorder, challenging the paradigm of a strictly functional nature.

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Section: Intestinal Mucosal Eosinophils In Homeostasis and Inflammationmentioning

confidence: 75%

Immune Activation in Functional Dyspepsia: Bystander Becoming the Suspect

et al. 2022

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“…Some authors have proposed a rigorous definition of eosinophils that can be counted, which includes only cells filled with eosinophilic granules and in which both lobes of the nucleus are visible. 17 Applying this restrictive definition results in an underestimation of tissue eosinophilia. Histologic sections 5-µm thick often cut eosinophils perpendicularly to their bilobate nucleus, thus preventing the visualization of both lobes even though such cells are unequivocally eosinophils.…”

Section: Defining a Countable Eosinophil-what To Countmentioning

confidence: 99%

Quantification of Mucosal Eosinophils for the Histopathologic Diagnosis of Eosinophilic Gastritis and Duodenitis

Turner

Collins

Walker

et al. 2021

American Journal of Surgical Pathology

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Eosinophilic gastrointestinal diseases, specifically eosinophilic gastritis and duodenitis, are chronic inflammatory conditions characterized by persistent gastrointestinal (GI) symptoms and elevated levels of activated eosinophils in the GI tract. Both clinical and endoscopic findings are nonspecific, no clinical or histopathologic diagnostic guidelines are published, and disease awareness is low, both among clinicians and amongst pathologists, who tend to overlook mild or moderate increases in the density of eosinophils in GI biopsy specimens. Yet, evaluating and, at times, counting eosinophils in GI biopsies may have important clinical implications: the numbers of tissue eosinophils correlate with clinical manifestations, can be used as determinants of effective management, and are used to assess the effects of treatment. A most persuasive argument for providing a count rather than a value judgment is that patients read reports, understand numbers, and use them to help to understand the course of their disease. The objective of this primer is to provide pathologists with the tools to incorporate a quantitative assessment of eosinophilia in the diagnosis of gastric and duodenal biopsy specimens and to develop a systematic approach to their evaluation, counting, and reporting. To achieve this aim, we present our general approach to the biopsy (where to count), followed by details on the characteristics of a countable eosinophil (what to count), and provide with a set of suggestions on the counting methods (how to count). We conclude with suggestions on how to report GI tissue eosinophilia in a manner that alerts clinicians and prompts pertinent management steps.

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“…In a large multicentric paediatric cohort of biopsies 4 , the median peak eosinophil count/mm 2 and their interquartile ranges (in brackets) were: oesophagus 0 (0-0), stomach 10.2 (3.3-15.3), duodenum 56.1 (26.1-86.7), ileum 61.2 (49.0-91.8), cecum 76.5 (40.9-99.7), ascending colon 73.9 (49.5-131.4), transverse colon 66.3 (40.8-91.5), descending colon 66.3 (30.6-81.6), sigmoid colon 39.2 (27.8-51.0), rectum 25.5 (9.8-45.8), respectively. Saad 13 underlined that eosinophils were mainly observed within the lamina propria, and only rarely in the surface and crypt epithelium, such as in the cecum and the rectosigmoid tract, where they may be organised in small clusters.…”

Section: Normal Distribution Of Eosinophils In the Gastrointestinal T...mentioning

confidence: 99%

“…Different studies have tried to assess a range of normal eosinophil distribution in the GI tract in adults 3 while very few studies investigate distribution in the paediatric population 4 , 5 , consequently complicating the pathologist’s ability in identifying an abnormal number of eosinophils. Consensus recommendations for the diagnosis of EoGIDs are limited only to EoE, with some differences depending on the patients’ age 6 .…”

Section: Introductionmentioning

confidence: 99%

Pathologist’s approach to paediatric and neonatal eosinophilic gastrointestinal disorders

et al. 2022

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Summary Children are not simply miniature adults. The evaluation of their gastrointestinal disorders is therefore different from that in full-grown adults and requires a particular clinical/pathologic approach. Different studies have tried to assess the normal eosinophil distribution in the gastrointestinal tract in adults while very few studies have investigated the paediatric population, consequently complicating the pathologist’s ability in identifying an abnormal number of eosinophils in this setting of patients. When evaluating gastrointestinal tract biopsies with eosinophilia, eosinophilic count must be considered along with other histological features like eosinophil distribution in the gastrointestinal wall, their degranulation, cryptitis and crypt abscesses, other accompanying inflammatory cells, apoptotic bodies, foreign material or microorganisms; these findings, although rarely specific, may be a useful aid for diagnosis. Reports should not include a diagnosis of primary eosinophilic gastrointestinal disorders (EoGID) if clinical data and test results do not rule out other forms of gastrointestinal eosinophilia. A more descriptive definition like “with eosinophilic pattern” should be favoured over a specific diagnosis of “eosinophilic disorder” in order to avoid potential confusion between different entities.

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Distribution of eosinophils in the gastrointestinal tract of children with no organic disease

Cited by 12 publications

References 21 publications

Immune Activation in Functional Dyspepsia: Bystander Becoming the Suspect

Immune Activation in Functional Dyspepsia: Bystander Becoming the Suspect

Quantification of Mucosal Eosinophils for the Histopathologic Diagnosis of Eosinophilic Gastritis and Duodenitis

Pathologist’s approach to paediatric and neonatal eosinophilic gastrointestinal disorders

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