Eosinophil granulocytes

[Tor]

Hi

I've been in remission for some time with completely normal bowel movements, for the last 2-3 months without any kind of medication (I quit the cholestyramine). But I had a control colonoscopy a few weeks back, and it still showed inflammation consistent with collagenous colitis.

The biopsy report said:

2-6; Multiple pieces of colon mucosa and rectum mucosa that shows lightly increased chronic inflammation cells in lamina propria, whichs contains lymphocytes, plasma cells and relatively many eosinophil granulocytes. The collagenous layer varies in thickness, and is more visible in biopsies from the left colon than the right where it is only focally thickened. The surface epithelium is focally infiltrated by lymphocytes. A similar picture is seen on an earlier biopsy, and is consistent with collagenous colitis. Case has been discussed with senior physician [...]

I was a bit disappointed by this, as I appear to be in clinical remission (except for joint and muscle aches) after 16 months on a gluten free diet. I was also a bit puzzled by the mention of eosinophil granulocytes, which I can't remember has been mentioned in previous reports. A quick look in Google Scholar revealed an article which seems to conclude that an increase of eosinophil granulocytes has been observed in patients with ulcerative colitis in remission (http://gut.bmj.com/content/gutjnl/54/12/1714.full.pdf), and that may make sense in my case as well. It also seems to be a relation between eosinophil granulocytes and histamines/mast cells, and I think that Tex has posted something about that before.

Can anybody else get anything out of this releatively detailed biopsy report?

Best Regards,
Tor

[tex]

Hi Tor,

I believe that your interpretation of the report is pretty much correct. Apparently something in your environment (or in your diet) may still be generating inflammation (possibly low-level inflammation), and I have a hunch that it's probably associated with mast cell activation rather than the T cell-based inflammation that's traditionally claimed to be the source of inflammation associated with MC.

Remember that clinical remission of symptoms always precedes histological resolution. Healing of the damage (caused by inflammation) in the intestines typically takes 3 to 5 years for adults. As far as I can tell, not much research has been published on the histological details of the actual healing process that occurs as IBDs go into remission. IOW, for all we know, your biopsy report might be typical for this stage of the healing process. We simply don't have enough data for comparison.

Tex

[Tor]

Thanks, Tex

Looks like I just have to be content with the "clinical" remission for the time beeing. I don't feel like taking more drastic measures based on guesses when it comes to my diet, so I'll just have to wait and see how it develops with more time.

I'll take another check if the Eneterolab tests is an option from Norway, but it's probably either not doable or too expensive. As I remember, Kenneth Fine originally thougt that the inflammation in the small intestines in people with MC most often was NCGS, while the inflammation in the colon was autoimmune. That might also fit my situation.

Thanks again!

Tor