Pediatric colonic eosinophilia represents a confounding finding with a wide differential. It is often difficult to determine which children may progress to inflammatory bowel disease (IBD), which have an eosinophilic colitis (EC), and which may have no underlying pathology. There is little guidance for the practitioner on the approach to these patients. To define the clinical presentations of colonic eosinophilia and identify factors which may aid in diagnosis we reviewed patients with colonic eosinophilia and the clinicopathologic factors associated with their diagnoses.
An 8-year retrospective chart review of children whose histopathology identified colonic eosinophilia (N = 72) compared to controls with normal biopsies (N = 35).
Patients with colonic eosinophilia had increased eosinophils/high power field (eos/HPF) compared to controls (p < 0.001) and had three clinical phenotypes. Thirty six percent had an inflammatory phenotype with elevated ESR (p < .0001), chronic inflammation on colonic biopsies (p < 0.001) and were diagnosed with IBD. Thirty seven percent were diagnosed with EC, associated with male gender (p < 0.005) and peripheral eosinophilia (p = 0.041). Twenty one percent had no significant colonic pathology. Forty three percent of patients had more than one colonoscopy and 68% of these had change from initial diagnoses.
There are three main phenotypes of children with colonic eosinophilia. Signs of chronic systemic inflammation raise suspicion for IBD. Peripheral eosinophilia and male gender are associated with EC. A significant percent of children with colonic eosinophilia do not have colonic disease. Eos/HPF is not reliable to differentiate etiologies. Repeat colonoscopies may be required to reach final diagnoses.