Pediatric Duodenal Mucosal Biopsies with Eosinophilic Infiltrates: A Clinicopathologic Study

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.