Lymphocytic Follicles and Aggregates Are a Determinant of Mucosal Damage and Duration of Diarrhea

Abstract

N Context.-Nonspecific changes (nonspecific chronic inflammation) in patients with chronic diarrhea represent the commonest diagnosis in colorectal biopsy interpretation, but these changes are of little clinical significance.Objective.-To find, within this group, histologic and immunohistologic diagnostic criteria to predict the duration and resolution of diarrhea.Design.-Detailed clinical features and histologic findings were analyzed in a cohort of 47 patients with chronic diarrhea, with near-normal histology and no clear-cut known etiologic agent. Immunohistochemistry to mast cells (CD117) and Treg cells (FOXP3) was also assessed in 39 patients.Results.-Increased number of lymphoid follicles and aggregates, increased number of mast cells, and paucity of Treg were the statistically significant key findings (P = .003, P = .008, and P = .04, respectively). The duration of diarrhea was correlated with the number of large lymphoid follicles and aggregates (P = .001, r = .48), number of total lymphoid follicles and aggregates (P = .003, r = .43), density of lymphoid follicles and aggregates (P = .009, r = .38), and total lymphoid follicles and aggregates per biopsy (P = .004, r = .42) and the number of mast cells (P = .001, r = .52). The number of mast cells and Treg cells showed significant difference between resolved and unresolved cases (P = .001 and P = .01 respectively).Conclusions.-Lymphocytic follicles and aggregates colitis, previously regarded as of negligible diagnostic significance, allows the prediction of the behavior of chronic diarrhea in a subset of patients with nonspecific changes on colonic biopsy. The increased number of mast cells and paucity of Treg cells further helps to identify such unresolved cases.

GPR4 deficiency alleviates intestinal inflammation in a mouse model of acute experimental colitis

“…Crosstalk between stromal cells, lymphoid tissue inducer cells (LTi), and immune cells (dendritic cells, T cells, B cells) are critical for ILF development and effector functions in the gut [50]. Increased development of ILFs in the colon is associated with increased intestinal inflammation and tissue damage [51, 52]. In keeping with these reports, we observed a significant increase in ILF development in WT-DSS mouse colons when compared to WT control colons (4.0 ILFs/cm vs. 0.8 ILFs/cm of colon section) (Fig.…”

A Rodent Model of Anxiety: The Effect of Perinatal Immune Challenges on Gastrointestinal Inflammation and Integrity

“…In support of our animal model, lymphoid nodular hyperplasia is associated with viral and bacterial infection and mostly present in the small intestine. In many cases it represents chronic inflammation in lamina propria, with or without subtle cytologic or architectural alteration [55, 56]. Furthermore, children presenting with GI symptoms have been found to have an increase in the number of intestinal lymphoid aggregates [54].…”

Immunohistochemistry and real-time Polymerase Chain Reaction: importance in the diagnosis of intestinal tuberculosis in a Peruvian population

“…9) Eosinophils operationalized as the number of eosinophils per high power field in the intestinal lamina propria [ 21 ]. 10) Lymphoid follicles or lymphoid aggregated, the first defined as aggregates of lymphocytes with germinal center, and the lymphoid aggregated defined as a collection of lymphocytes and plasma cells without a germinal center [ 22 ]. 11) Villus atrophy (evaluated only in the small bowel): It is defined as the decrease in villous height, loss of the normal crypt/villous ratio (3:1), until the complete flattening of the villi [ 23 , 24 ].…”