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Inflammatory bowel disease
Outcomes of inflammatory bowel disease in patients with eosinophil-predominant colonic inflammation
  1. Tarik Alhmoud1,
  2. Anas Gremida1,
  3. Diego Colom Steele2,
  4. Imaneh Fallahi2,
  5. Wael Tuqan2,
  6. Nina Nandy1,
  7. Mahmoud Ismail2,
  8. Barakat Aburajab Altamimi2,
  9. Meng-Jun Xiong3,
  10. Audra Kerwin3,
  11. David Martin3
  1. 1Division of Gastroenterology and Hepatology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
  2. 2Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
  3. 3Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
  1. Correspondence to Tarik Alhmoud; talhmoud{at}gmail.com

Abstract

Background Inflammatory bowel disease (IBD) is characterised by acute intestinal mucosal inflammation with chronic inflammatory features. Various degrees of mucosal eosinophilia are present along with the typical acute (neutrophil-predominant) inflammation. The effect of intestinal eosinophils on IBD outcomes remains unclear.

Methods This is a retrospective study. Archived intestinal mucosal biopsy specimens of treatment-naïve IBD patients were examined by two pathologists. The number of eosinophils per high-power field was counted, and the mucosal inflammation was classified according to the eosinophilic inflammatory patterns. Clinical outcomes during the follow-up period were recorded.

Results 142 treatment-naïve IBD patients were included. Mean age was 39 years. 83% of patients had ulcerative colitis, and median follow-up was 3 years. 41% of patients had disease flare(s) and 24% required hospitalisation. Eosinophil count was not associated with risk of disease flare or hospitalisation. Patients with neutrophil-predominant inflammation (>70% neutrophils) had greater risk of disease flare(s): 27(55%) versus 24(36%) and 7(28%) in patients with mixed and eosinophil-predominant inflammation, respectively (p=0.04). Overall, patients with neutrophil-predominant inflammation were more likely to have a disease flare; HR: 2.49, 95% CI (1.0 to 5.6). Hospitalisation rate was higher in patients with neutrophil-predominant inflammation: 17(35%) compared to 17(19%) in patients with eosinophil-rich inflammation (p=0.04). Kaplan–Meier analysis showed higher flare-free survival in patients with eosinophil-predominant inflammation compared to mixed and neutrophil-predominant inflammation.

Conclusion IBD patients with eosinophil-predominant inflammation phenotype might have reduced risk of disease flares and hospitalisation. Larger prospective studies to assess IBD outcomes in this subpopulation are warranted.

  • inflammatory bowel disease
  • ulcerative colitis
  • crohn's colitis
  • mucosal immunology
  • IBD clinical
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgast-2020-000373

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    Footnotes

    • Contributors TA: planned and conducted the study, data collection, analysis, manuscript writing. AG: data collection, data analysis and review, helped writing the manuscript. DCS, IF, WT, NN, MI, BAA: data collection. M-JX and AK: read pathology slides and reported eosinophil counts, helped with data analysis. DM: data collection, helped with study design and writing the manuscript, read pathology slides and described severity of colitis and type of inflammation.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data are included in supplementary tables.