A Quantitative Assessment of Mucosal Eosinophils in the Gastrointestinal Tract of Children Without Detectable Organic Disease

Background: Accurate measurements of mucosal eosinophil concentrations in gastrointestinal tracts of healthy children are necessary to differentiate health and disease states in general, and better define eosinophilic gastrointestinal diseases. Study: We retrospectively reviewed gastrointestinal biopsies from children with macroscopically normal endoscopies, who, after a minimal follow-up of one year, were not diagnosed with any organic disease. Peak eosinophil concentrations and distributions were assessed from each segment of the gastrointestinal tract. Results: Three centers (Italy, United Kingdom, and Israel) contributed 202 patients (median age 13 years IQR 9.5–15.5, range 1–18 years). Median (IQR, range) eosinophil concentrations (eos/mm²) were: esophagus 0 (0–0, 0–84), stomach 0 (0–4, 0–84), duodenal bulb 20 (13–30, 7–67), second part of duodenum 20 (13–29, 0–105), terminal ileum 29 (14–51, 0–247), cecum 53 (37–89, 10–232), ascending colon 55 (25–84, 0–236), transverse colon 38 (21–67, 4–181), descending colon 29 (17–59, 0–114), sigmoid colon 25 (13–40, 0–215) and rectum 13 (4–28, 0–152). Significant geographical variance was present, however, no differences in eosinophil concentrations were identified between children with resolving symptoms vs. those with functional diagnoses, nor across age groups. Conclusions: Standardized eosinophil concentrations from the gastrointestinal tracts of children without organic disease will serve to better define both health and disease states. No differences were found between resolved symptoms vs. functional diagnoses nor between age groups in this pediatric cohort.