Difference between revisions of "Eosinophilic colitis"

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#redirect [[Colon#Eosinophilic colitis]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Eosinophilic_colitis_-_alt_--_high_mag.jpg
| Width      =
| Caption    = Eosinophilic colitis. [[H&E stain]].
| Synonyms  =
| Micro      = abundant eosinophils - no agreed upon number - "most use 20/HPF", there is variation along the large bowel - normal in rectum <10/HPF, normal in cecum <30/HPF
| Subtypes  =
| LMDDx      =
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[colon]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence =
| Bloodwork  = +/-eosinophilia
| Rads      =
| Endoscopy  =
| Prognosis  =
| Other      =
| ClinDDx    =
| Tx        = dependent on underlying cause
}}
'''Eosinophilic colitis''', abbreviated '''EC''', is an inflammatory process involving the [[colon]] ([[colitis]]) characterized by abundant [[eosinophil]]s.
 
'''Eosinophilic proctitis''' redirects to this article, as the histology is quite similar.
 
==General==
*Rare.
*May be a component of ''[[eosinophilic gastroenteritis]]''.<ref name=pmid22012125/>
 
Clinical features:<ref name=pmid22012125/>
*Abdominal pain
*Diarrhea +/-blood.
*+/-Weight loss.
 
==Gross==
Features - endoscopic:<ref name=pmid22012125>{{Cite journal  | last1 = Alfadda | first1 = AA. | last2 = Storr | first2 = MA. | last3 = Shaffer | first3 = EA. | title = Eosinophilic colitis: an update on pathophysiology and treatment. | journal = Br Med Bull | volume = 100 | issue =  | pages = 59-72 | month =  | year = 2011 | doi = 10.1093/bmb/ldr045 | PMID = 22012125 | PMC = 3165205 }}</ref>
*Edema.
*Granular appearance.
 
==Microscopic==
Features:<ref name=pmid22012125/>
*Abundant eosinophils - no agreed upon number.
**"Most use 20/[[HPF]]" <ref name=pmid19554649>{{Cite journal  | last1 = Okpara | first1 = N. | last2 = Aswad | first2 = B. | last3 = Baffy | first3 = G. | title = Eosinophilic colitis. | journal = World J Gastroenterol | volume = 15 | issue = 24 | pages = 2975-9 |  month = Jun | year = 2009 | doi =  | PMID = 19554649 | PMC = 2702104 }}</ref> - a definition that suffers from [[HPFitis]].
***There is variation along the large bowel - normal in rectum <10/HPF, normal in cecum <30/HPF.<ref name=pmid19554649/>
*+/-Eosinophilic crytitis.<ref name=pmid24278727>{{Cite journal  | last1 = Bates | first1 = AW. | title = Diagnosing eosinophilic colitis: histopathological pattern or nosological entity? | journal = Scientifica (Cairo) | volume = 2012 | issue =  | pages = 682576 | month =  | year = 2012 | doi = 10.6064/2012/682576 | PMID = 24278727 }}</ref>
 
DDx:<ref name=pmid22012125/>
*[[Inflammatory bowel disease]]:
**[[Crohn's disease]].
**[[Ulcerative colitis]].
*Infection:
**[[Pinworm]].
**[[Strongyloidiasis]].
*Autoimmune disease:
**[[Scleroderma]].
**[[Eosinophilic granulomatosis with polyangiitis]] (Churg-Strauss syndrome).
**[[Celiac disease]].
*[[Drug reaction]]s.
 
===Images===
www:
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702104/figure/F1/ EC (nih.gov)].<ref name=pmid19554649>{{Cite journal  | last1 = Okpara | first1 = N. | last2 = Aswad | first2 = B. | last3 = Baffy | first3 = G. | title = Eosinophilic colitis. | journal = World J Gastroenterol | volume = 15 | issue = 24 | pages = 2975-9 |  month = Jun | year = 2009 | doi =  | PMID = 19554649 | PMC = 2702104 }}</ref>
<gallery>
Image: Eosinophilic colitis -- intermed mag.jpg | EC - intermed. mag. (WC)
Image: Eosinophilic colitis -- high mag.jpg | EC - high mag. (WC)
Image: Eosinophilic colitis - alt -- high mag.jpg | EC - high mag. (WC)
Image: Eosinophilic colitis -- very high mag.jpg | EC - very high mag. (WC)
Image: Eosinophilic colitis - alt -- very high mag.jpg | EC - very high mag. (WC)
</gallery>
 
==Sign out==
<pre>
DESCENDING COLON, BIOPSY:
- COLONIC MUCOSA WITH MILD EOSINOPHILIA, SEE COMMENT.
- NEGATIVE FOR DYSPLASIA.
 
COMMENT:
Focally, there are up to 40 eosinophils / 0.2376 mm*mm (approx. field area at 400X). This
is a non-specific finding. No eosinophilic crypt abscesses are seen. No (neutrophilic)
cryptitis is present. Clinical correlation is suggested.
</pre>
 
<pre>
DESCENDING COLON, BIOPSY:
- COLONIC MUCOSA WITH MILD EOSINOPHILIA, SEE COMMENT.
- NEGATIVE FOR ACTIVE COLITIS.
- NEGATIVE FOR DYSPLASIA.
 
COMMENT:
There are up to 40 eosinophils / 0.2376 mm*mm (field area at 400X). This is a
non-specific finding.  The differential diagnosis includes inflammatory bowel
disease, infection (especially helminths), a drug reaction, and autoimmune
disorders (e.g. Churg-Strauss syndrome, celiac disease, scleroderma). Clinical
correlation is required.
</pre>
 
==See also==
*[[Colon]].
*[[Eosinophilic esophagitis]].
*[[Eosinophilic gastritis]].
*[[Eosinophil]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Colon]]

Latest revision as of 21:47, 28 November 2016

Eosinophilic colitis
Diagnosis in short

Eosinophilic colitis. H&E stain.
LM abundant eosinophils - no agreed upon number - "most use 20/HPF", there is variation along the large bowel - normal in rectum <10/HPF, normal in cecum <30/HPF
Site colon
Blood work +/-eosinophilia
Treatment dependent on underlying cause

Eosinophilic colitis, abbreviated EC, is an inflammatory process involving the colon (colitis) characterized by abundant eosinophils.

Eosinophilic proctitis redirects to this article, as the histology is quite similar.

General

Clinical features:[1]

  • Abdominal pain
  • Diarrhea +/-blood.
  • +/-Weight loss.

Gross

Features - endoscopic:[1]

  • Edema.
  • Granular appearance.

Microscopic

Features:[1]

  • Abundant eosinophils - no agreed upon number.
    • "Most use 20/HPF" [2] - a definition that suffers from HPFitis.
      • There is variation along the large bowel - normal in rectum <10/HPF, normal in cecum <30/HPF.[2]
  • +/-Eosinophilic crytitis.[3]

DDx:[1]

Images

www:

  • EC - intermed. mag. (WC)

  • EC - high mag. (WC)

  • EC - high mag. (WC)

  • EC - very high mag. (WC)

  • EC - very high mag. (WC)

Sign out

DESCENDING COLON, BIOPSY:
- COLONIC MUCOSA WITH MILD EOSINOPHILIA, SEE COMMENT.
- NEGATIVE FOR DYSPLASIA.

COMMENT:
Focally, there are up to 40 eosinophils / 0.2376 mm*mm (approx. field area at 400X). This
is a non-specific finding. No eosinophilic crypt abscesses are seen. No (neutrophilic)
cryptitis is present. Clinical correlation is suggested.

DESCENDING COLON, BIOPSY:
- COLONIC MUCOSA WITH MILD EOSINOPHILIA, SEE COMMENT.
- NEGATIVE FOR ACTIVE COLITIS.
- NEGATIVE FOR DYSPLASIA.

COMMENT:
There are up to 40 eosinophils / 0.2376 mm*mm (field area at 400X). This is a 
non-specific finding.  The differential diagnosis includes inflammatory bowel 
disease, infection (especially helminths), a drug reaction, and autoimmune 
disorders (e.g. Churg-Strauss syndrome, celiac disease, scleroderma). Clinical 
correlation is required.

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Alfadda, AA.; Storr, MA.; Shaffer, EA. (2011). "Eosinophilic colitis: an update on pathophysiology and treatment.". Br Med Bull 100: 59-72. doi:10.1093/bmb/ldr045. PMC 3165205. PMID 22012125. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165205/.
  2. ↑ 2.0 2.1 2.2 Okpara, N.; Aswad, B.; Baffy, G. (Jun 2009). "Eosinophilic colitis.". World J Gastroenterol 15 (24): 2975-9. PMC 2702104. PMID 19554649. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702104/.
  3. ↑ Bates, AW. (2012). "Diagnosing eosinophilic colitis: histopathological pattern or nosological entity?". Scientifica (Cairo) 2012: 682576. doi:10.6064/2012/682576. PMID 24278727.
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