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Mucosal inflammation in pediatric diversion colitis: a quantitative analysis
N J Grant1, H J Van Kruiningen, S Haque
1Department of Pathobiology, University of Connecticut, Storrs 06269-3089, USA.
Insights
Diversion colitis in children shows increased B and T lymphocytes in the colonic mucosa, suggesting a persistent immune response to bypassed segments. This quantitative study confirms earlier qualitative findings.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Colorectal Surgery
Background:
- Diversion colitis affects bypassed colorectal segments, often seen in Hirschsprung's disease patients with colostomies.
- Previous descriptions were qualitative; this study quantitatively assesses inflammatory cells.
Purpose of the Study:
- To quantitatively characterize inflammatory cell population changes in the colonic mucosa of children with diversion colitis.
Main Methods:
- Analyzed colorectal tissues from 15 children with diversion colitis and controls.
- Used immunostaining for B and T lymphocytes, macrophages, IgG, IgM, and IgA.
- Quantified lymphoid follicles and cellular areas via image analysis.
Main Results:
- Diversion colitis featured enlarged, more numerous lymphoid follicles with increased B and T lymphocytes.
- Interfollicular mucosa was thickened with significantly higher B and T cell counts compared to controls.
- No significant increase in macrophages or IgG/IgM plasma cells was observed.
Conclusions:
- Findings support increased lymphoid tissue in bypassed colonic segments.
- Results align with persistent antigenic stimulation of mucosa-associated lymphoid tissue.
Background:
Diversion colitis commonly occurs in bypassed segments of colorectum, and has been described qualitatively in Hirschsprung's disease patients with colostomies. The objective of this study was to characterize quantitatively the changes in the inflammatory cell population in the mucosa of children with diversion colitis.
Methods:
Paraffin blocks of well-oriented, full-thickness colorectal tissues were obtained from 15 children with diversion colitis (all with Hirschsprung's disease), four pediatric controls and four adult controls. Sections were immunostained for B and T lymphocytes, macrophages, IgG, IgM, and IgA. Measurements were made referent to a standard length of muscularis mucosae. Lymphoid follicles were counted and the areas occupied by B and T cells were determined by image analysis. Cells in the interfollicular lamina propria were counted separately, but IgA-containing plasma cells were too abundant to enumerate.
Results:
Pediatric diversion colitis was characterized by enlarged and more numerous lymphoid follicles with approximately four times as many B lymphocytes and twice as many T lymphocytes in the follicular compartment of the mucosa when compared to pediatric controls. The interfollicular mucosa was thickened (499 +/- 27 versus 380 +/- 56 microns) and contained approximately six times as many B cells and eight times as many T cells as controls. Macrophages and plasma cells containing IgG and IgM were not significantly increased.
Conclusions:
These findings extend the qualitative observations of increased follicular and lamina propria lymphoid tissue in bypassed segments of colon, and are consistent with the hypothesis of persistent antigenic stimulation of the mucosa-associated lymphoid tissue.