Inflamm Bowel Dis. 2020 Nov 19;26(12):1890-1900. doi: 10.1093/ibd/izz323.

Krishnapriya Marangattu Prathapan ¹, Claudia Ramos Rivers ², Alyce Anderson ³, Filippos Koutroumpakis ², Ioannis E Koutroubakis ², Dmitriy Babichenko ⁴, Xiaoqing Tan ⁵, Gong Tang ⁵, Marc Schwartz ², Siobhan Proksell ², Elyse Johnston ², Jana G Hashash ², Michael Dunn ², Annette Wilson ², Arthur Barrie ², Janet Harrison ², Douglas Hartman ⁶, Sandra C Kim ¹, David G Binion ²

Author information

• ¹Division of Gastroenterology, Hepatology and Nutrition, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
• ²Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
• ³University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA.
• ⁴School of Information Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
• ⁵Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
• ⁶Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

Abstract

Background: Peripheral blood eosinophilia (PBE) is a biomarker of an aggressive multiyear natural history in adults with inflammatory bowel diseases (IBDs). Additionally, PBE at diagnosis is associated with higher disease activity in pediatric-onset IBD. We sought to determine if PBE can function as a biomarker of long-term disease severity in pediatric-onset IBD patients who are followed into adulthood.

Methods: We analyzed a consented, prospective, natural history IBD registry at an adult tertiary center from 2009 to 2018. Prevalence of PBE was evaluated in both pediatric- and adult-onset IBD patients. Demographics, clinical characteristics, and health care utilization data were compared in patients with and without PBE.

Results: Among 2800 adult IBD patients, 23.4% had pediatric-onset disease. PBE was found in 34% of the pediatric-onset patients compared with 26.8% of the adult-onset IBD patients (P < 0.001). In the pediatric-onset IBD cohort, PBE was associated with higher rates of allergies (P < 0.0001), but not of asthma, allergic rhinitis, or primary sclerosing cholangitis. In the adult IBD patients with pediatric-onset disease, PBE was associated with higher rates of C-reactive protein elevation (P < 0.0001), erythrocyte sedimentation rate elevation (P < 0.0001), higher health care utilization, and higher average health care charges per year (P < 0.00001).

Conclusions: Peripheral blood eosinophilia was more prevalent in adult IBD patients with pediatric-onset compared with adult-onset disease. Among all IBD patients with long-term follow-up, PBE defined a subgroup with more severe illness. These data suggest that PBE may be a biomarker for a high-risk subgroup with high cost trajectory and long-term severity in pediatric-onset IBD that persists into adulthood.