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Bloos Report Says Non-specific Ileitis With Significant Eosinophilic Infiltrates. Does This Rule Out Crohns ?

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Posted on Wed, 4 Jul 2012
Question: Dr. XXXXXXX this a follow up to my earlier question - My serological marker tests ASCA came back at 1.17 (negative/ undetectable) and negative XXXXXXX result. TTG came back negative.

Biopsy report came back saying the following-
Microscopic Appearance - Sections revealed fragments of ileal mucosa showing intact mucosal lining and normal villous configuration. Stroma shows scattered mixed inflammatory cells including several eosinophils.

Pathological diagnosis - Non - specific ileitis with significant eosinophilic infiltrates.

Does this rule out Crohns? what is non specific ileitis and how can non specific ileitis be treated?

Thanks


I have diarrhea and gas/bloat on and off(2 episodes 4 days each in 9 months), no weight loss, no loss of appetite, no bleeding (stool is not black or red), just XXXXXXX sometimes from passing too fast through the intestines, or its watery when the diarrhea is severe. Physician suspected IBS or lactose intolerance or celiac disease since everything else was normal. I saw a Gastro too, he was of the same opinion since my stool sample returned negative for parasites/ infections - he recommended a colonoscopy to rule out other possibilities.
I got a colonoscopy done, Large intestine was normal but terminal ileum has very small ulcers and some inflammation. GI suspects crohns disease, asked me to get XXXXXXX and ASCA marker tests done, and also sent samples from colonoscopy for biopsy. I also took a TTG test, results for all these will come back in a week. My blood test report is as follows -
Leucocyte count - 9330
Erythrocyte count - 5.49 millions/c
WBC differential count -
Neutrophils - 59.5
Lymphocytes - 32.2
Eosinophils - 2.5
Monocytes - 5.5
Basophils - 0.3.
Erythrocyte Sedimentation rate is 11. I also got a C-reactive protein test, result was 2.79.
all other blood work is normal, stool sample returned no parasites/ there is no blood in stool.

I am a little disturbed over the possibility of Crohns, but since the blood work - specially the differentials, ESR, C-reactive protein are normal, would like to know if there is a possibility of Crohns and how strong that possibility is - and also what else could this be? Could this be a viral infection or intestinal tuberclosis? Are terminal ileal ulcers always crohns? Thanks.
doctor
Answered by Dr. Poorna Chandra K.S (7 hours later)
Hi and thanks for the follow up
The histopathological features in Crohns disease are only suggestive and have to be interpreted with other clinical data.
In your case these are not suggestive of crohns diasease. Non specific colitis s managed with fibres, mesacol and at times topical antibiotics.
However as there is significat eosiniphilic infiltrates discuss with your GI regarding the possibility of Eosinophilic enteritis. This can also present with diarrhoea and bloating. This can be a primary disorder or secondary to a variety of causes
Regards
Dr XXXXXXX
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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Poorna Chandra K.S

Gastroenterologist

Practicing since :2000

Answered : 339 Questions

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Bloos Report Says Non-specific Ileitis With Significant Eosinophilic Infiltrates. Does This Rule Out Crohns ?

Hi and thanks for the follow up
The histopathological features in Crohns disease are only suggestive and have to be interpreted with other clinical data.
In your case these are not suggestive of crohns diasease. Non specific colitis s managed with fibres, mesacol and at times topical antibiotics.
However as there is significat eosiniphilic infiltrates discuss with your GI regarding the possibility of Eosinophilic enteritis. This can also present with diarrhoea and bloating. This can be a primary disorder or secondary to a variety of causes
Regards
Dr XXXXXXX