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Clinical Characteristics and Outcomes of Eosinophilic Colitis in Patients With Cancer. Am J Clin Oncol 2021; 44:395-401. [PMID: 34091476 DOI: 10.1097/coc.0000000000000838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Eosinophilic colitis (EoC) is a rare form of eosinophilic gastrointestinal disease characterized by diffuse eosinophilic infiltration in the deep lamina propria of colonic mucosa. The pathophysiology is unclear, but EoC has been associated with multiple known risk factors. AIM The aim of this study was to characterize the clinical characteristics and disease course of patients with EoC at a major cancer center. MATERIAL AND METHODS We retrospectively reviewed colonic samples obtained between January 2000 and December 2018 from our institutional database and included cases with significant colonic eosinophilia. Baseline clinical data and EoC-related clinical course and outcomes were documented. RESULTS Forty-one patients were included. One fourth had coexisting autoimmune conditions. Seventy-eight percent had a cancer diagnosis. Half the patients received chemotherapy, with a median duration of 180 days between chemotherapy and EoC onset. Symptoms were present in 76% of patients. Diarrhea was more prevalent in patients who received chemotherapy (85% vs. 42%). Median duration of EoC symptoms was 30 days in patients with cancer and 240 days in those without cancer (P=0.03). Most patients (88%) had normal colonoscopy findings. Fifteen percent of patients required hospitalization. All-cause mortality was 37%, mostly related to underlying malignancy and organ failure. CONCLUSIONS EoC in cancer patients appears to have more diarrhea-predominant symptoms, particularly in patients receiving chemotherapy, but a shorter disease duration compared with patients without cancer. Hospitalization can be required for serious cases. Treatment may be reserved for patients requiring symptom management, as most patients with EoC have good clinical outcomes regardless of treatment.
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Sunkara T, Samarghandi A, Dadana S, Gaduputi V. Eosinophilic Colitis Masquerading as Malignancy of Colon. Gastroenterology Res 2017; 10:325-327. [PMID: 29118877 PMCID: PMC5667702 DOI: 10.14740/gr878w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Indexed: 12/14/2022] Open
Abstract
Eosinophilic colitis (EC) is a rare part of spectrum of diseases called eosinophilic gastrointestinal disease (EGID). It was found to have bimodal distribution involving neonates and adults in age groups of 30 - 50 with male preponderance. We present this case of a 78-year-old woman who came to the hospital with abdominal pain, hematochezia and unintentional weight loss, and was found to have EC. This case was very unique given the age at presentation and the radiological findings mimicking malignancy. We reviewed the possible etiologies, clinical features, pathology, and treatment of EC along with the review of the literature.
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Affiliation(s)
- Tagore Sunkara
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Clinical Affiliate of The Mount Sinai Hospital, 121 Dekalb Ave., Brooklyn, NY 11201, USA
| | - Arash Samarghandi
- Division of Gastroenterology and Hepatology, SBH Health System, 4422 Third Ave., Bronx, NY 10457, USA
| | - Sriharsha Dadana
- Division of Gastroenterology and Hepatology, SBH Health System, 4422 Third Ave., Bronx, NY 10457, USA
| | - Vinaya Gaduputi
- Division of Gastroenterology and Hepatology, SBH Health System, 4422 Third Ave., Bronx, NY 10457, USA
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de Bont MP, Malbon AJ, Blundell R, Archer DC. Idiopathic eosinophilic colitis lesions of the equine small (descending) colon. EQUINE VET EDUC 2016. [DOI: 10.1111/eve.12700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - A. J. Malbon
- Institute of Veterinary Pathology; Vetsuisse Faculty; University of Zurich; Switzerland
| | - R. Blundell
- Department of Pathology; University of Liverpool; Neston UK
| | - D. C. Archer
- The Philip Leverhulme Equine Hospital; University of Liverpool; Neston UK
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Alfadda AA, Shaffer EA, Urbanski SJ, Storr MA. Eosinophilic colitis is a sporadic self-limited disease of middle-aged people: a population-based study. Colorectal Dis 2014; 16:123-9. [PMID: 24138295 DOI: 10.1111/codi.12464] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 08/03/2013] [Indexed: 02/08/2023]
Abstract
AIM Eosinophilic colitis (EC) is a rare manifestation of eosinophilic gastrointestinal disorders. Due to its rarity, little information is available on its natural history. METHOD From the single population-based pathology database of the Calgary Health Region (comprising a population of 1.28 million in 2008), cases of EC during the period 1996-2008 were identified. Medical records of all adults diagnosed with EC were identified and the pathology reviewed. The patients were then contacted for follow-up using a standardized questionnaire. RESULTS Seven cases of EC (four in women) were identified, with a median follow-up of 45 (23-79) months. The median age at diagnosis was 42 (22-70) years. Symptoms at diagnosis were abdominal pain (86%), nonbloody diarrhoea (57%), bloody diarrhoea (29%) and significant (>10%) weight loss (29%). Three patients gave a history of allergic reactions to drugs and four reported allergy to cows' milk. Endoscopic findings were nonspecific, ranging from oedema to small aphthous ulceration. An eosinophilic infiltrate was identified in the lamina propria in the initial colonic biopsy in all patients. Over the longer term, three patients experienced spontaneous resolution without treatment. Two continued to have mild diarrhoea and abdominal cramps but did not require medical therapy. Two patients required medical treatment by 5-aminosalicylic acid, with one requiring prednisone and azathioprine maintenance therapy. CONCLUSION Eosinophilic colitis is a rare mostly self-limiting disease affecting middle-aged adults. It usually has a mild clinical course and drug treatment is not usually necessary. When required, drug treatment follows the standard medication for other inflammatory bowel disease.
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Affiliation(s)
- A A Alfadda
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Calgary, Alberta, Canada
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Brandon JL, Schroeder S, Furuta GT, Capocelli K, Masterson JC, Fenton LZ. CT imaging features of eosinophilic colitis in children. Pediatr Radiol 2013; 43:697-702. [PMID: 23361493 PMCID: PMC3816107 DOI: 10.1007/s00247-012-2615-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 10/31/2012] [Accepted: 11/09/2012] [Indexed: 12/20/2022]
Abstract
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 diarrhea.
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Affiliation(s)
- Jonathan L. Brandon
- Department of Radiology, Children's Hospital Colorado, 13123 E. 16th Ave., Aurora, CO 80045, USA
| | - Shauna Schroeder
- Department of Pediatrics, Gastrointestinal Eosinophilic Diseases Program, University of Colorado Denver School of Medicine, Aurora, CO, USA; Digestive Health Institute, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | - Glenn T. Furuta
- Department of Pediatrics, Gastrointestinal Eosinophilic Diseases Program, University of Colorado Denver School of Medicine, Aurora, CO, USA; Digestive Health Institute, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | - Kelley Capocelli
- Department of Pediatrics, Gastrointestinal Eosinophilic Diseases Program, University of Colorado Denver School of Medicine, Aurora, CO, USA; Department of Pathology, Children's Hospital Colorado, Aurora, CO, USA
| | - Joanne C. Masterson
- Department of Pediatrics, Gastrointestinal Eosinophilic Diseases Program, University of Colorado Denver School of Medicine, Aurora, CO, USA; Digestive Health Institute, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | - Laura Z. Fenton
- Department of Radiology, Children's Hospital Colorado, 13123 E. 16th Ave., Aurora, CO 80045, USA
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Bates AWH. Diagnosing eosinophilic colitis: histopathological pattern or nosological entity? SCIENTIFICA 2013; 2012:682576. [PMID: 24278727 PMCID: PMC3820477 DOI: 10.6064/2012/682576] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 05/06/2012] [Indexed: 06/02/2023]
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.
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Affiliation(s)
- Alan W. H. Bates
- Research Department of Pathology, University College London, London WC1E 6BT, UK
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Gaertner WB, MacDonald JE, Kwaan MR, Shepela C, Madoff R, Jessurun J, Melton GB. Eosinophilic colitis: university of Minnesota experience and literature review. Gastroenterol Res Pract 2011; 2011:857508. [PMID: 21837236 PMCID: PMC3152953 DOI: 10.1155/2011/857508] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 06/17/2011] [Indexed: 12/11/2022] Open
Abstract
Eosinophilic colitis is a rare form of primary eosinophilic gastrointestinal disease that is poorly understood. Neonates and young adults are more frequently affected. Clinical presentation is highly variable depending on the depth of inflammatory response (mucosal, transmural, or serosal). The pathophysiology of eosinophilic colitis is unclear but is suspected to be related to a hypersensitivity reaction given its correlation with other atopic disorders and clinical response to corticosteroid therapy. Diagnosis is that of exclusion and differential diagnoses are many because colonic tissue eosinophilia may occur with other colitides (parasitic, drug-induced, inflammatory bowel disease, and various connective tissue disorders). Similar to other eosinophilic gastrointestinal disorders, steroid-based therapy and diet modification achieve very good and durable responses. In this paper, we present our experience with this rare pathology. Five patients (3 pediatric and 2 adults) presented with diarrhea and hematochezia. Mean age at presentation was 26 years. Mean duration of symptoms before pathologic diagnosis was 8 months. Mean eosinophil count per patient was 31 per high-power field. The pediatric patients responded very well to dietary modifications, with no recurrences. The adult patients were treated with steroids and did not respond. Overall mean followup was 22 (range, 2-48) months.
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Affiliation(s)
- Wolfgang B. Gaertner
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 450, Minneapolis, MN 55455, USA
| | - Jennifer E. MacDonald
- Medical School, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 450, Minneapolis, MN 55455, USA
| | - Mary R. Kwaan
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 450, Minneapolis, MN 55455, USA
| | - Christopher Shepela
- Division of Gastroenterology, Department of Medicine, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 450, Minneapolis, MN 55455, USA
| | - Robert Madoff
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 450, Minneapolis, MN 55455, USA
| | - Jose Jessurun
- Department of Laboratory Medicine and Pathology, Department of Medicine, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 450, Minneapolis, MN 55455, USA
| | - Genevieve B. Melton
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 450, Minneapolis, MN 55455, USA
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Lankveld DPK. Tracheal obstruction by an eosinophilic granuloma in a horse: surgical and Nd:YAG laser treatment. EQUINE VET EDUC 2010. [DOI: 10.1111/j.2042-3292.2001.tb00119.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Eosinophilic colitis (EC) is a rare form of primary eosinophilic gastrointestinal disease with a bimodal peak of prevalence in neonates and young adults. EC remains a little understood condition in contrast to the increasingly recognized eosinophilic esophagitis. Clinical presentation of EC is highly variable according to mucosal, transmural, or serosal predominance of inflammation. EC has a broad differential diagnosis because colon tissue eosinophilia often occurs in parasitic infection, drug-induced allergic reactions, inflammatory bowel disease, and various connective tissue disorders, which require thorough searching for secondary causes that may be specifically treated with antibiotics or dietary and drug elimination. Like eosinophilic gastrointestinal disease involving other segments of the gastrointestinal tract, EC responds very well to steroids that may be spared by using antihistamines, leukotriene inhibitors and biologics.
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von Wattenwyl F, Zimmermann A, Netzer P. Synchronous first manifestation of an idiopathic eosinophilic gastroenteritis and bronchial asthma. Eur J Gastroenterol Hepatol 2001; 13:721-5. [PMID: 11434601 DOI: 10.1097/00042737-200106000-00018] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Eosinophilic gastroenteritis is a rare disease of the gastrointestinal tract in which the eosinophils seem to play an important role in the inflammation of the gut wall. We report on a case with a synchronous first manifestation of eosinophilic gastroenteritis and bronchial asthma, which also occurred synchronously in all further episodes. The diagnosis was first made at the end of the second episode during which the patient lost more than 13 kg in weight. Under steroid therapy, symptoms of both diseases disappeared quickly in the third episode. We assume that participation of the gastrointestinal tract in patients with bronchial asthma occurs more frequently than expected. In asthma patients with abdominal symptomatology, eosinophilic gastroenteritis should also be considered.
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Affiliation(s)
- F von Wattenwyl
- Gastrointestinal Unit, Inselspital, University Hospital of Berne, Switzerland
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Lim K, Black R. Eosinophilic colitis masquerading as colonic cancer. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 2000; 70:682-4. [PMID: 10976901 DOI: 10.1046/j.1440-1622.2000.01934.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- K Lim
- Department of Surgery, Repatriation General Hospital, Daw Park, South Australia, Australia
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