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The relationship of eosinophilia with outcomes of Hirschsprung disease in children

  • Richard SolaJr.
  • Ashwini S. Poola
  • Rmaah Memon
  • Vivekanand Singh
  • Richard J. Hendrickson
  • Shawn D. St. Peter
  • Jason D. FraserEmail author
Original Article
  • 30 Downloads

Abstract

Purpose

It has been postulated that children with Hirschsprung disease (HD) and mucosal eosinophilia have been thought to have poorer outcome, but supporting evidence is lacking. The objective of our study was to review the outcomes of children with HD and mucosal eosinophilia.

Methods

A single center, retrospective review was conducted on all patients diagnosed with HD between 1999 and 2016. Pathology specimens were evaluated for mucosal eosinophilia. Demographics, complications, and outcomes were analyzed.

Results

A total of 100 patients were diagnosed with HD and 27 had mucosal eosinophilia. Median age at the time of surgery was 12 days (8, 30) and 82 were males. Comparing patients with HD with and without mucosal eosinophilia, there was no statistically significant difference in time to bowel function (2 days vs. 2 days; p = 0.85), time to start feeds (3 days vs. 3 days; p = 0.78) and time to goal feeds (5 days vs. 5 days; p = 0.47). There was no statistically significant difference in feeding issues (13% vs. 9%; p = 1.0) and stooling issues (60% vs. 50%; p = 0.38). There was no statistically significant difference in postoperative complications and readmissions rates (63% vs. 56%; p = 0.53).

Conclusion

Hirschsprung-associated mucosal eosinophilia may not increase postoperative complications, and may not change feeding and bowel management. Further prospective studies are in process to evaluate long term follow-up outcomes for this patient population.

Keywords

Hirschsprung disease Children Eosinophilia 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Langer JC (2013) Hirschsprung disease. Curr Opin Pediatr 25:368–374.  https://doi.org/10.1097/MOP.0b013e328360c2a0 CrossRefGoogle Scholar
  2. 2.
    Best KE, Addor MC, Arriola L et al (2014) Hirschsprung’s disease prevalence in Europe: a register based study. Birth Defects Res Clin Mol Teratol 100:695–702.  https://doi.org/10.1002/bdra.23269 CrossRefGoogle Scholar
  3. 3.
    Langer JC, Rollins MD, Levitt M et al (2017) Guidelines for the management of postoperative obstructive symptoms in children with Hirschsprung disease. Pediatr Surg Int 33:523–526.  https://doi.org/10.1007/s00383-017-4066-7 CrossRefGoogle Scholar
  4. 4.
    Gosain A, Frykman PK, Cowles RA et al (2017) Guidelines for the diagnosis and management of Hirschsprung-associated enterocolitis. Pediatr Surg Int 33:517–521.  https://doi.org/10.1007/s00383-017-4065-8 CrossRefGoogle Scholar
  5. 5.
    Levitt MA, Dickie B, Pena A (2012) The Hirschsprungs patient who is soiling after what was considered a “successful” pull-through. Semin Pediatr Surg 21:344–353.  https://doi.org/10.1053/j.sempedsurg.2012.07.009 CrossRefGoogle Scholar
  6. 6.
    Onishi S, Nakame K, Kaji T et al (2017) The bowel function and quality of life of Hirschsprung disease patients who have reached 18 years of age or older—the long-term outcomes after undergoing the transabdominal soave procedure. J Pediatr Surg 52:2001–2005.  https://doi.org/10.1016/j.jpedsurg.2017.08.036 CrossRefGoogle Scholar
  7. 7.
    Neuvonen MI, Kyrklund K, Rintala RJ, Pakarinen MP (2017) Bowel function and quality of life after transanal endorectal pull-through for Hirschsprung disease: controlled outcomes up to adulthood. Ann Surg 265:622–629.  https://doi.org/10.1097/SLA.0000000000001695 CrossRefGoogle Scholar
  8. 8.
    Jensen ET, Martin CF, Kappelman MD, Dellon ES (2016) Prevalence of eosinophilic gastritis, gastroenteritis, and colitis: estimates from a national administrative database. J Pediatr Gastroenterol Nutr 62:36–42.  https://doi.org/10.1097/mpg.0000000000000865 CrossRefGoogle Scholar
  9. 9.
    Choi JS, Choi SJ, Lee KJ et al (2015) Clinical manifestations and treatment outcomes of eosinophilic gastroenteritis in children. Pediatr Gastroenterol Hepatol Nutr 18:253–260.  https://doi.org/10.5223/pghn.2015.18.4.253 CrossRefGoogle Scholar
  10. 10.
    Behjati S, Zilbauer M, Heuschkel R et al (2009) Defining eosinophilic colitis in children: insights from a retrospective case series. J Pediatr Gastroenterol Nutr 49:208–215.  https://doi.org/10.1097/MPG.0b013e31818de373 CrossRefGoogle Scholar
  11. 11.
    Furuta GT, Katzka DA (2015) Eosinophilic esophagitis. N Engl J Med 373:1640–1648.  https://doi.org/10.1056/NEJMra1502863 CrossRefGoogle Scholar
  12. 12.
    Pacilli M, Eaton S, Clarke A et al (2012) Clinical significance of eosinophilia and chronic inflammatory infiltrate in children’s rectal biopsies. J Pediatr Gastroenterol Nutr 55:519–522.  https://doi.org/10.1097/MPG.0b013e31825b3169 CrossRefGoogle Scholar
  13. 13.
    Lowichik A, Weinberg AG (1997) Eosinophilic infiltration of the enteric neural plexuses in Hirschsprung’s disease. Pediatr Pathol Lab Med 17:885–891Google Scholar
  14. 14.
    Towne BH, Stocker JT, Thompson HE, Chang JH (1979) Acquired aganglionosis. J Pediatr Surg 14:688–690CrossRefGoogle Scholar
  15. 15.
    Spergel JM, Book WM, Mays E et al (2011) Variation in prevalence, diagnostic criteria, and initial management options for eosinophilic gastrointestinal diseases in the United States. J Pediatr Gastroenterol Nutr 52:300–306.  https://doi.org/10.1097/MPG.0b013e3181eb5a9f CrossRefGoogle Scholar
  16. 16.
    Schäppi MG, Smith VV, Milla PJ, Lindley KJ (2003) Eosinophilic myenteric ganglionitis is associated with functional intestinal obstruction. Gut 52:752–755CrossRefGoogle Scholar
  17. 17.
    Juang D, Snyder CL (2012) Neonatal bowel obstruction. Surg Clin N Am 92:685–711.  https://doi.org/10.1016/j.suc.2012.03.008 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Richard SolaJr.
    • 1
  • Ashwini S. Poola
    • 1
  • Rmaah Memon
    • 1
  • Vivekanand Singh
    • 2
  • Richard J. Hendrickson
    • 1
  • Shawn D. St. Peter
    • 1
  • Jason D. Fraser
    • 1
    Email author
  1. 1.Department of General SurgeryThe Children’s Mercy Hospital and ClinicsKansas CityUSA
  2. 2.Department of PathologyThe Children’s Mercy HospitalKansas CityUSA

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