PT - JOURNAL ARTICLE AU - Tarik Alhmoud AU - Anas Gremida AU - Diego Colom Steele AU - Imaneh Fallahi AU - Wael Tuqan AU - Nina Nandy AU - Mahmoud Ismail AU - Barakat Aburajab Altamimi AU - Meng-Jun Xiong AU - Audra Kerwin AU - David Martin TI - Outcomes of inflammatory bowel disease in patients with eosinophil-predominant colonic inflammation AID - 10.1136/bmjgast-2020-000373 DP - 2020 Feb 01 TA - BMJ Open Gastroenterology PG - e000373 VI - 7 IP - 1 4099 - http://bmjopengastro.bmj.com//content/7/1/e000373.short 4100 - http://bmjopengastro.bmj.com//content/7/1/e000373.full SO - BMJ Open Gastro2020 Feb 01; 7 AB - 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.