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Tissue and peripheral eosinophilia as predictors for disease outcome in children with ulcerative colitis
Sara Morgenstern1, Elena Brook2, Firas Rinawi3
1Department of Pathology, Rabin Medical Center-Beilinson Campus, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Insights
In pediatric ulcerative colitis, increased tissue and blood eosinophils indicate disease severity at diagnosis. However, eosinophilia does not predict long-term outcomes like colectomy.
Area of Science:
- Gastroenterology
- Pediatric Gastroenterology
- Immunology
Background:
- Eosinophils play a role in the pathogenesis of ulcerative colitis.
- Understanding eosinophil levels can provide insights into disease activity.
Purpose of the Study:
- To quantify mucosal and blood eosinophils in newly diagnosed pediatric ulcerative colitis patients.
- To determine if eosinophil levels predict disease outcomes.
Main Methods:
- Retrospective analysis of colorectal biopsies from 96 pediatric ulcerative colitis patients and 50 controls.
- Assessment of mucosal eosinophils at the most inflamed site.
- Evaluation of peripheral absolute eosinophil counts.
Main Results:
- Tissue eosinophil counts were significantly higher at diagnosis compared to remission (45 vs. 10, p<0.0001).
- Peripheral eosinophil counts correlated with tissue inflammation and severity.
- Eosinophilic infiltration was associated with clinical severity and short-term corticosteroid use.
Conclusions:
- Tissue and peripheral eosinophilia correlate with ulcerative colitis severity at diagnosis.
- Eosinophilia is linked to short-term corticosteroid needs.
- Eosinophil levels do not predict long-term risks such as colectomy.
Background:
Eosinophils are implicated in the pathogenesis of ulcerative colitis.
Aims:
To evaluate the magnitude of mucosal and blood eosinophils in newly diagnosed pediatric ulcerative colitis patients and its significance in predicting disease outcomes.
Methods:
We retrospectively evaluated colorectal biopsies of 96 pediatric patients with ulcerative colitis and 50 age- and sex-matched controls. Samples were taken from diseased areas of the colon and examined by a gastrointestinal pathologist. The most inflamed site was used for assessment of mucosal eosinophils.
Results:
Samples from 96 diagnostic and 70 follow-up colonoscopies were evaluated. Median age was 13.3 years (IQR 10.1-15.3). Median duration of follow-up was 12.8 years (IQR 7.2-17.1). Median number of tissue eosinophils at diagnosis was 45 (IQR 22-73) compared to 10 eosinophils (IQR 8-25) during histologic remission (p<0.0001). Peripheral absolute eosinophil counts correlated with tissue inflammation and eosinophilia (p=0.001). Mucosal eosinophilic infiltration (p=0.02) and peripheral eosinophilia (p=0.04) was associated with clinical severity at diagnosis. Multivariate analysis showed that severe eosinophilic infiltration is associated with corticosteroid therapy following diagnosis (p=0.04) but not with long-term risk for step-up therapy or colectomy.
Conclusion:
Tissue and peripheral eosinophilia correlate with ulcerative colitis severity at diagnosis and with short-term corticosteroid requirement but not with long-term outcomes.
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