Prevalence of primary eosinophilic colitis in patients with chronic diarrhea and diarrhea-predominant irritable bowel syndrome

Abstract

Introduction: Primary eosinophilic colitis (PEC) is an inflammatory disease caused by the infiltration of eosinophils into the mucosa of the colon, determined after having ruled out other possible causes. It is characterized by abdominal pain and diarrhea and its prevalence is unknown. Aims: To know the prevalence of PEC in patients with chronic diarrhea and in those with clinical criteria for diarrhea-predominant irritable bowel syndrome (IBS-D). Patients and methods: All patients with chronic noninflammatory diarrhea that were consecutively seen over a decade were studied through colonoscopy, with systematic biopsy. Patients with a known or decompensated organic disease, alarm features, abnormal minimal laboratory test results, and factors associated with eosinophilia were excluded. Patients with the clinical criteria for IBS-D (Rome III) were selected from the general group. Eosinophilic colitis was defined as the presence of > 35 eosinophils/100 epithelial cells per field in any of the segments. Results: From the 683 patients seen, a total of 545 patients (361 women) were included in the study. Twenty-two cases of PEC were detected, resulting in a prevalence of 4.0%. A total of 343 patients had IBS-D criteria (223 women), with 16 cases of PEC detected, for a prevalence of 4.7%. Colonoscopy was normal, or almost normal, in all the PEC cases detected. Conclusions: The prevalence of PEC was 4.0% in the patients with chronic diarrhea and 4.7% in the patients with IBS-D. Peripheral eosinophilia appeared to be the main distinctive clinical characteristic, but systematic biopsy was essential for making the diagnosis. Resumen: Introducción y objetivos: La colitis eosinofílica primaria (CEoP) es una enfermedad inflamatoria causada por infiltración de eosinófilos en la mucosa del colon, sin otras posibles causas identificadas, que se caracteriza por dolor abdominal y diarrea. Su prevalencia se desconoce. Objetivos: Conocer la prevalencia de CEoP en pacientes con diarrea crónica y en aquellos con criterios clínicos del síndrome del intestino irritable con predominio de diarrea (SII-D). Pacientes y métodos: Todos los pacientes con diarrea crónica no inflamatoria, atendidos en forma consecutiva durante una década, fueron estudiados mediante colonoscopia con toma sistemática de biopsias. Se excluyeron aquellos con enfermedad orgánica conocida o descompensada, con datos de alarma, estudios de investigación limitada anormales y factores asociados a eosinofilia. Del grupo general, se seleccionaron aquellos con criterios clínicos de SII-D (Roma III). Colitis eosinofílica se definió como la presencia de > 35 eosinófilos/100 células epiteliales por campo en cualquiera de los segmentos. Resultados: Fueron atendidos 683 pacientes. Se incluyeron 545 enfermos (361 mujeres), entrequienes se detectaron 22 casos de CEoP, para una prevalencia del 4.0%. Trescientos cuarentay tres sujetos tenían criterios de SII-D (223 mujeres), entre los que se detectaron 16 casos deCEoP, para una prevalencia del 4.7%. La colonoscopia fue normal o casi normal en todos loscasos detectados. Conclusiones: La prevalencia de CEoP fue de 4.0% de los enfermos con diarrea crónica y en 4.7% en aquellos con SII-D. La eosinofilia periférica parece ser la principal característica clínica distintiva, pero la toma sistemática de biopsias es indispensable para establecer el diagnóstico.

Keywords

• Colitis eosinofílica
• Diarrea crónica
• Síndrome de intestino irritable
• Colonoscopia