British Journal of Medicine and Medical Research, ISSN: 2231-0614,Vol.: 3, Issue.: 3 (July-September)
Pediatric Duodenal Mucosal Biopsies with Eosinophilic Infiltrates: A Clinicopathologic Study
M. S. Miqdady1*, L. A. Darrisaw2, S. H. Abrams3, W. J. Klish3, M. Finegold3 and M. A. Gilger3 1Sheikh Khalifa Medical City, Abu Dhabi, P.O. Box 51900, United Arab Emirate.
2Georgia Bureau of Investigation. Decatur, Georgia 30034, USA.
3Baylor College of Medicine. Houston, Texas 77030, USA.
M. S. Miqdady1*, L. A. Darrisaw2, S. H. Abrams3, W. J. Klish3, M. Finegold3 and M. A. Gilger3
1Sheikh Khalifa Medical City, Abu Dhabi, P.O. Box 51900, United Arab Emirate.
(1) Alex Straumann, Switzerland.
(2) Craig A. Friesen, Children’s Mercy Hospital, USA.
Complete Peer review History: http://www.sciencedomain.org/review-history/988
Aims: To describe the clinicopathologic features of children with Duodenal eosinophilic infiltrates (DEI).
Study Design: Retrospective.
Place and Duration of Study: Pediatric Gastroenterology Division, Texas Children’s Hospital over 24 months (Jan 1, 1998 –Dec 31, 1999).
Methodology: Children with DEI at Texas Children’s Hospital over 24 months were identified. Clinical symptomatology was analyzed by a retrospective medical record review. Two pediatric pathologists re-evaluated all biopsies. Follow-up was done by contacting the patients 12-36 months after the initial diagnosis.
Results: Total number of GI biopsies that included duodenum over the study period was 1145 biopsies. Out of 1145 cases, 780(68%) cases indicated eosinophilic infiltrates (EI) at some GI site. Out of these, 287(37%) cases had DEI. Mean age was 10.4 years. (F: M .2:1). Race: 197(79%) Caucasians, 37(15%) Latin Americans, 9(4%) African Americans and 6(2%) Arabs. Clinical symptomatology: 249 records were available for evaluation. 69.9% complained of abdominal pain, 55% had vomiting, 34.9% with diarrhea and 32.9% had weight loss. 105 patients were available for follow up; 38% continued to have abdominal pain, 15.2% with vomiting, 10.5% diarrhea and 7.6% had a persistent weight loss. Peripheral eosinophilia was present in 35.2%. Medical treatment included proton pump inhibitors (57.0%), H2-blockers (55.4%), steroids (26.5%), and elemental diet (9.6%). Histopathology: 6% had <10 eosinophils /hpf, 51.8% with 10-20eos/hpf, and 42.2% with >20 eos/hpf. There were no significant differences in the number of eos/hpf between those with or without a specific symptom. Fourteen children (5.6%) subsequently developed IBD; their histopathological data did not differ from the rest.
Conclusion: 1) children with DEI present with variable chronic symptoms 2) symptoms persisted in a significant number of patients despite therapy, 3) Close observation is warranted since a small number of patients may develop IBD.
Eosinophils; duodenum; gastrointestinal; mucosa; eosinophilia and endoscopy.
Full Article - PDF Page 555-565
DOI : 10.9734/BJMMR/2013/2697Review History Comments