47 research outputs found
Eosinophilic Gastrointestinal Disorders Pathology
Eosinophilic gastrointestinal disorders (EGID) are characterized pathologically by excess eosinophils in mucosal biopsies of one or multiple sites in the gastrointestinal (GI) tract, simultaneously or sequentially. Eosinophilic esophagitis (EoE) is the best characterized EGID, and in most patients it is an abnormal immune-mediated response to food antigens. Current recommendations for diagnosis include signs and symptoms of esophageal dysfunction that do not respond to proton-pump inhibitor therapy, and esophageal biopsies that exhibit at least 15 intraepithelial eosinophils in at least one high power field (HPF). Therapy consists of swallowed glucocorticoids or dietary elimination. Eosinophilic gastritis (EG) is the second most common form of EGID, but like all forms of EGID except EoE consensus recommendations for either clinical or pathological diagnosis do not exist. EG may be associated clinically with peripheral blood eosinophilia, hypoalbuminemia, and anemia, and pathologically with marked expansion of lamina propria by dense eosinophilic infiltrates. Eosinophilic enteritis (EE) may be subdivided into eosinophilic duodenitis, eosinophilic jejunitis, and eosinophilic ileitis. Most investigators believe that EE rarely, if ever, exists as a solitary form of EGID and is encountered only in patients who have at least one other affected portion of the GI tract. Eosinophilic colitis (EC) is perhaps the most enigmatic EGID. Distinction of EC from inflammatory bowel disease may be problematic especially in children. Multiple possible etiologies for EGID include hypereosinophilic syndrome, drug reactions, etc. Currently, the only etiology that can be identified histologically is parasitic infestation, if a portion of an invasive parasite is found in mucosal biopsies. This review will provide guidelines for the pathologic diagnosis of the various forms of EGID
CT imaging features of eosinophilic colitis in children
Background Eosinophilic colitis (EC) is a gastrointestinal
disease of undetermined etiology whose clinical features
overlap with those of the inflammatory bowel diseases. To
the best of our knowledge, the CT imaging features of EC
have not been described in children.
Objective To report and analyze the clinical, imaging and
histological findings in seven children with EC.
Materials and methods Children with EC were identified in
a pediatric pathology database, and those with CT imaging
within 2 months of diagnosis were included, totaling seven
children. Clinical, imaging and pathological features were
reviewed and analyzed. Results The most common presenting symptoms were abdominal pain, bloody diarrhea and rectal bleeding. EC was
characterized as a dense and predominantly eosinophilic
inflammatory infiltrate in the lamina propria or epithelium
without granulomas. CT scans were abnormal in six children
(86%), demonstrating colonic wall thickening, predominantly cecal, in five (71%), mild to moderate terminal ileal
thickening in two (29%), and pneumatosis in one (14%).
Right colonic involvement was greater than terminal ileal
involvement.
Conclusion CT imaging findings in children with EC include right colonic wall thickening of variable extent downstream and absent or mild involvement of the terminal
ileum. EC should be considered in the differential diagnosis
in children presenting with abdominal pain and bloody
diarrhe
Effect of Proton Pump Inhibitor on Esophageal Eosinophilia
Objective: Differentiation between the common etiologies of dense
esophageal eosinophilia such as gastroesophageal reflux disease (GERD)
and eosinophilic esophagitis can be difficult. We hypothesized that histologic features may provide diagnostic clues concerning the etiology of
esophageal eosinophilia.
Methods: We performed a retrospective chart review of 204 children with
the diagnosis of esophagitis characterized by 15 eosinophils (eos) per highpower field (HPF) in at least 1 biopsy. We then restricted our analysis to
subjects who had received at least 8 weeks of only proton pump inhibitors
(PPIs) followed by endoscopy and who had a clinicopathologic response to
this treatment. Symptoms, endoscopic findings, and pathologic descriptions
were reviewed and an eosinophil peroxidase (EPX) index was determined to
assess for degranulation/eosinophil activation.
Results: Of the 204 identified charts, 7 subjects identified met the inclusion
criteria. Five of these 7 patients showed a clinicopathologic response to
PPIs after their follow-up endoscopy, (mean peak eosinophil count: 92 vs
5 eos/HPF, and EPX index: 39.2 vs 14.6, pre- and posttreatment,
respectively). Two patients experienced initial resolution of symptoms and
esophageal eosinophilia with PPI therapy; however, within 17–23 months
they redeveloped symptoms and esophageal eosinophilia while receiving PPI
therapy at the time of a third endoscopy (mean peak eosinophil count: 40 vs
11 vs 36 eos/HPF, and EPX index: 44 vs 21 vs 36.5, pre-, post- and
posttreatment, respectively). No clinicopathologic features or degranulation
patterns differentiated subjects with GERD/PPI responsive esophageal
eosinophilia from those who had transient response to PPI treatment.
Conclusions: No clinicopathologic features differentiated subjects who
responded to PPI treatment. PPI treatment can be helpful to exclude
GERD and PPI responsive esophageal eosinophilia but long-term followup is critical in the management of esophagitis
Ultrastructural features of eosinophilic oesophagitis: impact of treatment on desmosomes
Aims—A growing body of evidence suggests a role for altered epithelial barrier function in the
pathophysiology of eosinophilic oesophagitis (EoE), but few have described the epithelial
structure during inflammation. The purpose of this study was to define ultrastructural features of
active, inactive EoE and control subject’s oesophageal epithelia.
Methods—We prospectively enrolled patients undergoing diagnostic upper endoscopy for
evaluation of EoE. Mucosal pinch biopsies were obtained from the distal oesophagus and
processed for routine histology and electron microscopic assessment. Clinical features of enrolled
subjects were analysed and subjects were divided into four groups: normal, gastroesophageal
reflux disease (GERD), inactive EoE and active EoE. Representative photomicrographs of the
basal and superficial epithelia were reviewed for abnormalities. Desmosomes were quantified on
the surface of epithelia three to four prickle-cell layers above the basal layer. Results—Twenty-nine paediatric cases (ages 2–18 years) were enrolled in the study. We
observed a significant decrease in the number of desmosomes per cell (DPC) of subjects with
active EoE compared with inactive EoE, GERD and normal epithelia. With respect to DPC, no
significant differences were found between inactive EoE compared with GERD or normal
subjects. Additional ultrastructural features observed included epithelial microplicae and evidence
of eosinophil transmigration, degranulation, and sombrero formation.
Conclusions—Consistent with clinical and molecular findings, our ultrastructural data provide
support for an altered oesophageal barrier in paediatric cases with active EoE, which may improve
following treatmen
Clinical Implications of Pediatric Colonic Eosinophilia
Objective: 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.
Mehtods: An 8-year retrospective chart review of children whose histopathology identified colonic eosinophilia (N = 72) compared to controls with normal biopsies (N = 35).
Results: Patients with colonic eosinophilia had increased eosinophils/high-power field compared to controls (P 1 colonoscopy and 68% of these had change from initial diagnoses.
Conclusions: There are 3 main phenotypes of children with colonic eosinophilia. Signs of chronic systemic inflammation raise suspicion for IBD. Peripheral eosinophilia and male sex are associated with EC. A significant percent of children with colonic eosinophilia do not have colonic disease. Eosinophils/high-power field is not reliable to differentiate etiologies. Repeat colonoscopies may be required to reach final diagnoses
Histologic similarities in children with eosinophilic esophagitis and PPI-responsive esophageal eosinophilia
The EPX histologic scoring system can be used to differentiate children with EoE and PPI-REE relative to GERD, supporting the relationship between these 2 groups and enhancing current diagnostic and treatment approaches
TGF-β1 alters esophageal epithelial barrier function by attenuation of claudin-7 in eosinophilic esophagitis
Barrier dysfunction has been implicated in the pathophysiology of eosinophilic esophagitis (EoE). TGF-β1, a potent pleiotropic molecule, is increased in EoE, however, no study has evaluated its influence on esophageal epithelial barrier. We hypothesized that TGF-β1 regulates barrier dysfunction in EoE. We aimed to determine the role of TGF-β1 in epithelial barrier in models of EoE. To examine the impact of TGF-β1 on esophageal barrier, immortalized human esophageal epithelial (EPC2-hTERT) cells were exposed to TGF-β1 during the 3-dimensional air liquid interface (3D-ALI) model in vitro. TGF-β1 exposure diminished EPC2-hTERT barrier function as measured by transepithelial electrical resistance (TEER) and 3kDa FITC dextran paracellular flux (FITC Flux) and H&E assessment revealed prominent cellular separation. In analysis of epithelial barrier molecules, TGF-β1 led to the specific reduction in expression of the tight-junction molecule, claudin-7 and this was prevented by TGF-β receptor I inhibitor. shRNA mediated claudin-7 knockdown diminished epithelial barrier function, while claudin-7 overexpression resulted in protection from TGF-β1-mediated barrier dysfunction. In analysis of pediatric EoE biopsies claudin-7 expression was decreased, altered localization was observed by immunofluorescence analysis and the TGF-β1 downstream transcription factor phosphorylated SMAD2/3 (pSMAD2/3) was increased. Our data suggest that TGF-β1 participates in esophageal epithelial barrier dysfunction through claudin-7 dysregulation
Local hypersensitivity reaction in transgenic mice with squamous epithelial IL-5 overexpression provides a novel model of eosinophilic oesophagitis
Objective: Eosinophilic oesophagitis (EoE) is a chronic
inflammatory condition of the oesophagus with limited
treatment options. No previous transgenic model has
specifically targeted the oesophageal mucosa to induce
oesophageal eosinophilia.
Design: We developed a mouse model that closely
resembles EoE by utilising oxazolone haptenation in mice
with transgenic overexpression of an eosinophil poietic
and survival factor (interleukin (IL)-5) in resident
squamous oesophageal epithelia.
Results: Overexpression of IL-5 in the healthy
oesophagus was achieved in transgenic mice (L2-IL5)
using the squamous epithelial promoter Epstein–Barr
virus ED-L2. Oxazolone-challenged L2-IL5 mice
developed dose-dependent pan-oesophageal
eosinophilia, including eosinophil microabscess formation
and degranulation as well as basal cell hyperplasia.
Moreover, oesophagi expressed increased IL-13 and the
eosinophil agonist chemokine eotaxin-1. Treatment of
these mice with corticosteroids significantly reduced
eosinophilia and epithelial inflammation.
Conclusions: L2-IL5 mice provide a novel experimental
model that can potentially be used in preclinical testing
of EoE-related therapeutics and mechanistic studies
identifying pathogenetic features associated with
mucosal eosinophilia