Document Type : Original Article
Authors
1
Pediatric Health Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
2
Department of Pediatrics, Faculty of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran.
3
Department of Pathology, School of Medicine, Pediatric Pathology Research Center, Mofid Pediatric Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
4
Department of Pediatric Surgery, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
5
Department of Community Medicine, School of Medicine, Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
6
Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
7
Department of Allergy and Clinical Immunology, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Abstract
Background: Considering that non-eosinophilic esophagitis eosinophilic gastrointestinal disorders (EGIDs) could mimic serious surgical conditions, including hypertrophic pyloric stenosis, intussusception, and bowel perforation, this study investigates these disorders as major causes of gastrointestinal surgery in children.
Materials and Methods: Children who had undergone gastrointestinal surgery between March 2017 and March 2018 at Mofid Children’s Hospital in Tehran City, Iran, were randomly selected to perform a rigorous and complete re-evaluation of the pathology to determine the presence of eosinophils or eosinophil-related inflammation in the tissue samples collected after surgery. Traditional hematoxylin and eosin staining was used to quantify eosinophils and their footprints. Trichrome staining was also applied to measure the tissue fibrosis.
Results: A total of 72 pediatric patients with a median age of 2.5 years, suffering from constipation and abdominal pain were studied. The majority of patients were primarily diagnosed with Hirschsprung’s syndrome (38.9%), followed by imperforated anus (34.7%) and ileal atresia (16.7%). Among the studied patients ten (13.9%) were confirmed to have tissue eosinophilia, compatible with the conventional method of non-EoE-EGID diagnosis. More evidence supporting the presence of tissue eosinophils was infiltration of 1-26 eosinophils in the muscular and subserosal layers of more than 97% of samples, degranulated eosinophils and multi-nucleated cells in 6(8.3%) tissue samples, and different levels of tissue fibrosis in 37 patients (51.4%).
Conclusion: Non-EoE EGIDs should be considered in the context of severe relapsing gastrointestinal complications requiring urgent or emergent surgical interventions, particularly in subjects without a convenient response after surgery.
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