Pediatric Surgery Unit, Department of Maternal and Child Health, Fondazione IRCCS-Policlinico San Matteo, Pavia, Italy.
Pediatrics Unit, Department of Maternal and Child Health, Fondazione IRCCS-Policlinico San Matteo, Pavia, Italy.
Pediatr Surg Int. 2021 Apr;37(4):485-490. doi: 10.1007/s00383-020-04832-8. Epub 2021 Jan 7.
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.
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).
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.
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.
嗜酸性粒细胞性胃肠道疾病在儿童中较为罕见，其表现为广泛的非特异性症状。迄今为止，尚无经过验证的诊断、治疗和随访指南。本研究的目的是关注嗜酸性结肠炎（EC），以确定相关疾病、宏观表现与治疗/随访之间的可能相关性。
这是一项 2015 年至 2019 年的回顾性研究，纳入了在我院进行的所有结肠镜检查。根据 Collins 确定的阈值，将嗜酸性结肠炎定义为：右半结肠每高倍镜视野（HPF）嗜酸性粒细胞>100 个；横结肠和左半结肠每 HPF>84 个；乙状结肠和直肠每 HPF>64 个。我们排除了 IBD 或其他引起嗜酸性粒细胞增多症（如寄生虫感染、GVHD）的疾病患者的结肠镜检查。
在 355 例患者的 399 次结肠镜检查中，我们做出了 50 例 EC 的诊断，其中男 36 例，女 14 例，中位年龄为 8.5 岁（3-17 岁）。导致内镜检查的症状主要为复发性腹痛（66%）、慢性腹泻（64%）和慢性便秘（8%）。2 例患者出现胃肠道出血，1 例患者出现体重减轻。大体表现多为正常或淋巴滤泡状增生，表现出不同的内镜特征。在 7 名儿童（14%）中，我们发现有过敏和特应性病史。22 名儿童被诊断为自闭症谱系障碍（ASD），患病率高于总体人群（44%比 28.5%，p=0.03）。根据症状，治疗方案各不相同，包括使用类固醇、六种食物剔除饮食、美沙拉嗪。对于有随访资料的患者，我们发现 75%的患者嗜酸性粒细胞仍存在组织学残留，即使症状缓解。
本研究关注 EC 作为一种新的具有挑战性的病理学。需要进行多中心随机临床试验，以了解生理病理机制，验证可能的内镜评分和相关的组织学阈值，并根据临床特征和仪器检查结果规范治疗。ASD 中 EC 的高患病率需要进一步的专门研究。
