Eosinophils and Crohn's? Pathology included...

[hunter6009]

My son (8) has had symptoms for almost 3 years now (diarrhea, mucous (no blood), frequency/urgency). Started w/ the stomach flu that never went away. Fast forward to now, 3 colonoscopies, 2 upper endo's, CT scans, multiple drugs, and I can't count how many blood/stool samples, we are still working towards remission. Only family history of bowel disease is me, celiac (he's been negative 5 times over for this- I wish it was that easy!).

Long story short, his most recent colonoscopy showed a high eosinophil count in his ascending colon (among many other things). Yesterday at our f/up appt. his Dr. who has yet to confirm a dx (he has said lymphocytic colitis or indeterminate colitis until he gets a clearer picture) doesn't seem to think much of the high eosinophils. He mentioned he could be trending towards Crohn's yesterday. Are eosinophils and Crohn's linked?

He seems less inclined to point towards the pathologist (below) for things like eosinophilic enterocolitis.

Here is his pathology report. Please let me know your thoughts.
Microscopic Description
(A) 1 slide H&E:
The fragments of duodenal mucosa demonstrate mild blunted villous
architecture. The lamina propria cellularity is mildly increased by
lymphocytes and plasma cells. The epithelial lesions are absent. There is
a mild increase in surface intraepithelial lymphocytes.

(B) 1 slide H&E:
The gastric antral and fundic glandular architecture is preserved. There
are no epithelial lesions. The lamina propria contains the usual
cellularity. Microorganisms are not seen.

(C) 1 slide H&E:
The fragments of esophageal mucosa show mild expansion of the basal layer
and mild expansion of the vascular papillae and patchy increase in
lymphocytes.

(D) 1 slide H&E:
The fragments of ileal mucosa demonstrate partially blunted villous
architecture. The lamina propria cellularity is nonuniformly increased by
lymphocytes, plasma cells and occasional neutrophils. Cryptitis and crypt
abscesses are present. Granulomas are absent. Neutrophils infiltrate the
surface mucosa.

(E) 1 slide H&E:
The fragments of colonic mucosa demonstrate occasional elongated crypts.
There are increased surface and crypt intraepithelial lymphocytes. The
lamina propria cellularity is increased by lymphocytes, plasma cells, and
eosinophils. Focally there are up to 78 eosinophils in a high power
field. Prominent lymphoid aggregates are present. Cryptitis and crypt
abscesses are absent.

(F) 1 slide H&E:
The fragments of colonic mucosa demonstrate foci of elongated crypts. The
lamina propria cellularity is increased by lymphocytes, plasma cells and
eosinophils. Lymphocytes infiltrate the surface epithelium and crypts.
Granulomas are absent. Cryptitis and crypt abscesses are absent.

(G) 1 slide H&E:
Sections demonstrate colonic mucosa with occasional fragments demonstrating elongated and irregular dilated crypts. The lamina propria cellularity is nonuniformly mildly increased by lymphocytes, plasma cells and eosinophils. Lymphocytes infiltrate crypts and surface epithelium. Lymphoid aggregates are present.

Comment
The presence of increased intraepithelial lymphocytes within the surface
epithelium and in the crypts along with architectural changes raises the
possibility of an autoimmune enterocolitis. Other differentials include
inflammatory bowel disease.

Diagnosis
(A) GI biopsy, duodenal bulb/duodenum 3rd:
Chronic duodenitis.
(B) GI biopsy, body/antrum:
No diagnostic abnormality.
(C) GI biopsy, distal esophagus:
Chronic esophagitis.
(D) GI biopsy, terminal ileum:
Chronic ileitis and focal mucositis, see comment.
(E) GI biopsy, ascending colon/cecum:
Chronic colitis with increased mucosal eosinophils, see
comment.
(F) GI biopsy, descending colon/transverse colon:
Chronic colitis, see comment.
(G) GI biopsy, rectum/sigmoid:
Chronic colitis, see comment.


We just started Imuran. Steroids have only helped slighty. He's currently on 20mg prednisone and a gluten-free diet. The diet has really helped him actually have some days of normalcy! Hoping to wean him off steroids soon (we've been on/off for 6 months) and the Imuran work! Pentasa did nothing for him (I think it made him worse). Omega fatty acids seems to be helping, too.

Thanks!!

 

[Ihurt]

Geez, I am so sorry your son is going through all this. I do not know what to make of the pathology report. Did you just start him on the gluten free diet?? The reason I ask is because I know it can take up to being on the diet for 5 months or more to see major improvement. I have been on a gluten free diet for over 6 years now. I do not have celiacs but I cannot eat gluten at all! You can have major issues with gluten and not have celiacs. I learned this. I had all sorts of upper gut issues a few years back. It was awful. THere was one point where all I could eat is baby food! I decided to go on the gluten free diet. I had done the diet before but would only give it a couple weeks and I never seen too much improvement. Well I talked to a naturoptahic doctor and she told me I had to be strict on the diet and do it for 5 months before throwing in the towel. So I did it. I did not notice a difference until like the third month. I started feeling a bit better. Well after four months I was feeling a whole lot better. I mean I was able to eat regular size meals again without being miserable.

The key is, you have to be very strict with the diet, no cheating. This I Know will be hard for a child though. I would definitely try the gluten free diet for a long duration. If it is going to help, you should notice a difference in about three to four months. It takes time though.

I hope he can get this straightened out. It is odd how it came about after the tummy bug. I have to say, a lot of my gut issues in my lower gut that I have been having started after I got the stomach flu over year and half ago too...