Su1246 Temporal Trends and Natural History of Eosinophils-Related Gastrointestinal Disease in Asia

Abstract

BACKGROUND: Colitis describes inflammation in the colon and is classified into defined diseases: inflammatory bowel disease (IBD), microscopic colitis, iatrogenic colitis, ischemic colitis, and infectious colitis. Accurate classification helps guide management, but this is often difficult. Nonspecific colitis, or also known as atypical colitis, describes the cases that do not show characteristic features of a specific colitis. The clinical significance of nonspecific colitis is unclear as there are limited studies. Notteghem et al. (1993) showed that out of 104 patients with nonspecific colitis, 52.3% had another episode within 3 years and 54% were diagnosed with ulcerative colitis, 33% with Crohn's, and 13% remained unclassified, suggesting that nonspecific colitis could potentially be undiagnosed IBD. PURPOSE: The objective of this study is to understand their clinical course by examining subsequent colonoscopies and determining if any presenting symptom can predict subsequent diagnosis. METHODS: Patients who had colonoscopies from 1/2004-12/2006 with biopsies showing nonspecific colitis were enrolled in this retrospective observational study. The inclusion criteria are biopsies from colonoscopies showing nonspecific colitis, follow up with a physician for at least one year, and no previous diagnosis of a specific colitis based on history or biopsy. A chart review of the electronic record was done from the time of colonoscopy until current time or the last note. RESULTS: 101 patients were included in the study with a mean follow-up period of 5.09 years. The most common indications for colonoscopy were diarrhea (44.6%), abdominal pain (29.7%), blood in stool (36.6%), and anemia (7.9%). 50.5% of patients had at least one subsequent colonoscopy with 68.6% of them with normal biopsies, 33.3% with nonspecific biopsies, and 15.7% with biopsies consistent with IBD. No presenting symptom was predictive of subsequent biopsies with IBD, such as abdominal pain (OR, 2.4, 95% CI, 0.57-10.5, p = 0.23) or blood in stool (OR, 3.2, 95% CI, 0.7114.2, p = 0.13). 19 out of 101 patients with nonspecific colitis biopsies were treated for IBD given symptoms (18.8%), and 6 out of the 19 patients had subsequent biopsies showing IBD (31.6%). CONCLUSIONS: 50.5% of patients who have biopsies with nonspecific colitis had a subsequent colonoscopy, and 68.6% of subsequent colonoscopies were normal while 15.7% had IBD. Therefore, although most commonly nonspecific colitis is self-limited colitis, there is a portion that are undiagnosed IBD. In fact, 18.8% of patients with nonspecific colitis were empirically treated for IBD given symptoms, and 31.6% of these patients showed IBD on subsequent colonoscopies.