Stanford School of Medicine
 use browser back button to return
  • Surgical Pathology Criteria

    Eosinophilic Proctocolitis


    • Predominantly pediatric proctocolitis characterized by large numbers of tissue eosinophils

    Diagnostic Criteria

    • Predominantly seen between birth and one year of age
    • Markedly increased tissue eosinophils (>60/10 HPF)
      • Predominantly located in lamina propria
      • Frequently associated with lymphoid aggregates
    • Lesser numbers usually present in surface and crypt epithelium and muscularis mucosae ≥1/HPF
    • Crypt abscesses may be composed of a mixture of neutrophils and eosinophils
    • May be segmental or diffuse
    • Mild peripheral eosinophilia may be present
    • Infectious causes must be ruled out
    • Mimics ulcerative colitis when severe
      • Chronic inflammatory infiltrate in lamina propria
      • May have neutrophilic cryptitis and crypt abscesses
      • Mild architectural abnormalities have been reported in severe cases
    Robert V Rouse MD
    Department of Pathology
    Stanford University School of Medicine
    Stanford CA 94305-5342

    Original posting : November 11, 2009

    Differential Diagnosis

    Eosinophilic GI disorders by location

    Eosinophilic Esophagitis Eosinophilic Gastroenteritis Eosinophilic Proctocolitis
    Confined to esophagus Involves stomach and/or small intestine Confined to rectum and colon
    Good response to dietary manipulation Poor response to dietary manipulation Good response to dietary manipulation

    Eosinophilic (Allergic) Proctocolitis Ulcerative Colitis
    May occur <12 months of age Very rare <12 months
    Marked tissue eosinophilia >60/10 HPF May have moderate numbers of eosinophils

    Eosinophils may be numerous in other diseases:

    • Drug related must be ruled out clinically
    • Hypereosinophilic syndrome
      • Requires >1500 eosinophils / microliter
    • Parasitic disease must be ruled out by stool examination
    • Crohn disease
      • May contain many eosinophils in the infiltrate but they do not predominate
    • Milk protein enteropathy must be ruled out clinically
    • Inflammatory fibroid polyp
      • Isolated polypoid lesion
      • Very rare in infants
    • Systemic diseases
      • Churg Strauss vasculitis
      • Polyarteritis nodosa
      • Scleroderma
      • Stevens-Johnson syndrome
    • Graft versus host disease


    • If under 12-24 months of age
      • Good response to dietary manipulation
      • Excellent prognosis
    • If over 24 months of age
      • No response to dietary manipulation
      • Poor prognosis
      • May be associated with other signs of allergy
        • RAST (radioallergosorbent test), elevated IgE, peripheral eosinophilia, asthma, eczema
      • May require steroids


    • Noffsinger A, Fenoglio-Preiser CM, Maru D, Gilinisky N.  Gastrointestinal Diseases, AFIP Atlas of Nontumor Pathology, First Series, Fascicle 5, 2007.
    • Odze RD, Wershil BK, Leichtner AM, Antonioli DA. Allergic colitis in infants. J Pediatr. 1995 Feb;126(2):163-70.
    • Odze RD, Bines J, Leichtner AM, Goldman H, Antonioli DA. Allergic proctocolitis in infants: a prospective clinicopathologic biopsy study. Hum Pathol. 1993 Jun;24(6):668-74.
    • Hurrell JM, Genta RM, Melton SD. Histopathologic diagnosis of eosinophilic conditions in the gastrointestinal tract. Adv Anat Pathol. 2011 Sep;18(5):335-48.
    Printed from Surgical Pathology Criteria:
    © 2009  Stanford University School of Medicine