High Prevalence of Eosinophilic Gastrointestinal Disease in Children With Intestinal Failure

Abstract

Objectives To describe the prevalence and clinical features of gastrointestinal eosinophilic inflammation among pediatric patients with intestinal failure (IF). Methods Medical records of all patients followed in our institution's intestinal failure program who underwent GI endoscopy over a 15 year period were reviewed and clinical, pathologic, nutrition and laboratory data collected. Results One hundred and five patients underwent 208 GI endoscopic procedures with biopsy. The overall prevalence of eosinophilic inflammation, defined as increased eosinophils in at least one tissue type on at least one endoscopy, was 39/105 (37%). The tissue-specific prevalence of eosinophilic inflammation ranged widely, with the colon/rectosigmoid being the most common (18/68, 26%), followed by the esophagus (17/83, 20%), ileum (9/54, 17%), duodenum (4/83, 5%), and stomach (3/83, 4%). Higher peripheral eosinophil count and hematochezia were associated with eosinophilic inflammation in the colon (p=0.002 and 0.0004, respectively). The use of a strict elemental diet for 3 months prior to endoscopy was not associated with a decreased frequency of eosinophilic inflammation in any tissue. Conclusions Eosinophilic inflammation is a common histopathologic finding in IF patients. Colonic eosinophilic inflammation is associated with clinical symptoms of GI blood loss, and peripheral eosinophilia, and was not abrogated by a strict elemental diet.

A rare case of eosinophilic gastrointestinal disorders with short bowel syndrome after strangulated bowel obstruction

“…Histological features of EC show numerous eosinophil counts, > 50 cells/HPF in the right colon and 30 cells/HPF in the left/transverse colon [5]. Stamm et al reported a high prevalence of gastrointestinal eosinophilic inflammation in a large cohort of children with intestinal failure (IF) [6]. In this current case, eosinophilic inflammation was observed on blood and pathological examinations.…”

“…Prednisolone dose is often started at 0.5-2 mg/kg/day and tapered off after 1-2 weeks. Although most cases show temporary improvement, approximately 60% of patients experience recurrence of symptoms after treatment [6]. Prednisolone administration was effective in combination with other EGIDs treatment approaches.…”

“…In our case, SBS after strangulated bowel obstruction operation caused the development of secondary EGIDs, similar to the mechanism. The management of patients with IF should include awareness of this typical endoscopic finding and careful screening for symptoms such as hematochezia [6].…”

A Rare Case of Primary Midgut Volvulus Necessitating Extensive Bowel Resection in an Adult

“…It has been shown that short-bowel syndrome can lead to many chronic complications including esophagitis [12], diarrhea [13], hepatic steatosis and cholestasis [14], cholelithiasis, electrolyte and micronutrient deficiencies [15], metabolic bone disease [16], nephrolithiasis [17], d-lactic acidosis [18], and catheter-related complications [19].…”

Pediatric Intestinal Failure Review

“…There is a suggestion of increased risk of gastrointestinal allergic disease in infants with intestinal failure. One large single center review of infants with IF found that 40% had gastrointestinal eosinophilic inflammation, postulated due to abnormalities in intestinal permeability [ 20 ].…”