Abstract
Reports of “eosinophilic colitis”—raised colonic mucosal eosinophil density in patients with lower gastrointestinal symptoms—have increased markedly over the last fifteen years, though it remains a rarity. There is no consensus over its diagnosis and management, and uncertainty is compounded by the use of the same term to describe an idiopathic increase in colonic eosinophils and an eosinophilic inflammatory reaction to known aetiological agents such as parasites or drugs. In patients with histologically proven colonic eosinophilia, it is important to seek out underlying causes and careful clinicopathological correlation is advised. Because of the variability of eosinophil density in the normal colon, it is recommended that histological reports of colonic eosinophilia include a quantitative morphometric assessment of eosinophil density, preferably across several sites. Few reported cases of “eosinophilic colitis” meet these criteria. As no correlation has been shown between colonic eosinophil density and symptoms in older children or adults, it is suggested that treatment should be directed towards alleviation of symptoms and response to treatment assessed clinically rather than by histological estimates of intramucosal eosinophils.
Highlights
Eosinophils are predominantly tissue-dwelling cells; at any time comparatively few are circulating in the blood
Eosinophil density in the colon is increased in various disorders including food allergy, parasitic infections, and in ammatory bowel disease, but in some patients no underlying gastrointestinal pathology is identi ed and in these cases a diagnosis of primary eosinophilic colitis is sometimes made
In view of the paucity of quantitative data, the large number of conditions and drugs that have been associated with secondary eosinophilia, the variability of symptoms, and the lack of correlation between symptoms and eosinophil density, eosinophilic colitis is best regarded as a nonspeci c reaction pattern rather than a nosological entity
Summary
Eosinophils are predominantly tissue-dwelling cells; at any time comparatively few are circulating in the blood. Eosinophil density in the colon is increased in various disorders including food allergy, parasitic infections, and in ammatory bowel disease, but in some patients no underlying gastrointestinal pathology is identi ed and in these cases a diagnosis of primary eosinophilic colitis is sometimes made. Is rare primary form of eosinophilic colitis has been the subject of fewer than a hundred case reports, including cases from several small series, and its diagnosis and treatment have been discussed in some recent reviews of eosinophilic gastrointestinal disease [1, 2]. Is paper reviews the histopathological ndings in previously reported cases of eosinophilic colitis and considers whether they represent a nonspeci c histological reaction pattern or a distinct pathological entity. On the basis of a literature survey, published data on normal eosinophil density, and the author’s experience of histological examination of material with prominent eosinophilic in ltrates at a tertiary referral centre, some recommendations for diagnosis and management will be made
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