Köpeklerde Eozinofilik Gastroenteritis: 14 Köpeğin Retrospektif Analizi ve Endoskopik Biyopsilerde İki Diagnostik Yöntemin Karşılaştırılması

Köpeklerde eozinofilik gastroenterit’in (EGE) klinik ve laboratuvar bulguları hastalık için spesifik değildir. Gastrointestinal kanalda histolojik olarak eozinofillerin belirlenmesi ise zordur. Bu retrospektif çalışmanın amacı EGE’nin klinik ve bazı laboratuvar bulgularının değerlendirilmesi ve dokularda eozinofillerin belirlenmesinde kullanılan iki tekniği karşılaştırmaktı. Bu amaçla EGE’li 14 köpeğin medikal raporları ve biyopsi sonuçları tekrar değerlendirildi. Eozinofil peroksidaz monoklonal antikoru (Epx mAb) ile immunohistokimyasal (IHC) ve hematoksilen eozin (H&E) ile boyanan EGE’li köpeklerin mide ve duodenal kesitlerinde eozinofiller sayıldı. Bütün köpeklerde en yaygın gastrointestinal semptomlar kusma ishal, kilo kaybı iken en yaygın laboratuvar bulgusu hipoalbuminemi ve eozinofili idi. EPX ile saptanan eozinofillerin sayısı H&E ile saptananlara oranla istatistiksel olarak yüksek bulundu (p≤0.05). Bu çalışma EGE’li köpeklerde kusma ishal, kilo kaybı, hipoalbünemi ve eozinofili görülmesine rağmen doğru tanının histopatolojik yöntemle konulması gerektiğini, Epx mAb ile eozinofillerin saptanmasıda H&E boyama yöntemine göre daha güvenilir olduğunu gösterdi.

Anahtar Kelimeler:

Köpek, Eozinofil peroksidaz, Eozinofilik gastroenterit, Hipoalbuminemi, Eozinofili

Canine Eosinophilic Gastroenteritis: Retrospective Analysis of Diagnosis in 14 Dogs and Comparison of Two Different Diagnostic Methods in Endoscopic Biopsies

Clinical manifestations and laboratory findings of eosinophilic gastroenteritis (EGE) in dogs are nonspecific. Identification of eosinophils in the GI tract of dogs with EGE, by histological evaluation is challenging. The aim of this study was to evaluate the clinic and laboratory findings and compare two different methods used to detect eosinophils in order to diagnose the disease. Medical records and biopsies from 14 dogs with EGE were retrospectively reviewed. Sections were immunolabeled with monoclonal antibodies (mAbs) against the eosinophil granule protein eosinophil peroxidase (Epx) and stained by H&E. The number of eosinophils were manually quantified. The most common observed gastrointestinal symptoms were vomiting, diarrhea and weight lost. The most common laboratory findings were hypoalbunemia and hypereosinophilia. The number of eosinophils detected in Epx mAb-labeled stomach and duodenal sections was significantly higher compared with that in H&E-stained sections (p≤0.05). The result of this study suggests that clinical findings may not be enough for the diagnosis of eosinophilic gastroenteritis in dogs. The diagnosis of canine EGE requires histopathological evaluation of GI biopsy. Immunohistochemical detection of Epx provides a more precise method to detect GI tract eosinophils compared to H&E staining and could be used as an alternative and reliable diagnostic tool for EGE.

Keywords:

Dog, Eosinophil peroxidase, Eosinophlic gastroenteritis, Hypoalbuminemia, Eosinophlia,

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Bastan I, Robinson NA, Ge XN, Rendahl AK, Rao SP, Washabau RJ, Sriramarao P. Assessment of eosinophil peroxidase as a potential diagnostic and prognostic marker in dogs with inflammatory bowel disease. Am J Vet Res. 2017; 78:36-41.
Bischoff SC, Mayer J, Nguyen Q-T, Stolte M, Manns MP. Immunohistological assessment of intestinal eosinophil activation in patients with eosinophilic gastroenteritis and inflammatory bowel disease. Am J Gastroenterol. 1999; 94:3521-3529.
Carlson M, Raab Y, Peterson C, Hällgren R, Venge P. Increased intraluminal release of eosinophil granule proteins EPO, ECP, EPX, and cytokines in ulcerative colitis and proctitis in segmental perfusion. Am J Gastroenterol. 1999; 94:1876-1883.
Craven M, Simpson JW, Ridyard AE, Chandler ML. Canine inflammatory bowel disease: retrospective analysis of diagnosis and outcome in 80 cases (1995-2002) Journal of Small Animal Practice. 2004; 45: 336–342.
Cerquetella M, Spaterna A, Laus F, Tesei B, Rossi G, Antonelli E, Villanacci V, Bassotti G Inflammatory bowel disease in the dog: Differences and similarities with humans. World J Gastroenterol. 2010 Mar 7; 16(9): 1050–1056.
Collins MH, Capocelli K, Yang G-Y. Eosinophilic gastrointestinal disorders pathology. Front Med. 2018;4:261.
Day MJ, Bilzer T, Mansell J, Wilcock B, Hall EJ, Jergens A, Minami T, Willard M, Washabau R. Histopathological standards for the diagnosis of gastrointestinal inflammation in endoscopic biopsy samples from the dog and cat: A report from the World Small Animal Veterinary Association Gastrointestinal Standardization Group. J Comp Pathol. 2008;138:1-43.
Fonseca-Alves CE, Correa AG, Elias F. Eosinophilic gastroenteritis in basset hound dog. Open Journal of Animal Sciences. 2012; 2: 110–112.
Forbes E, Murase T, Yang M, Matthaei KI, Lee JJ, Lee NA, Foster PS, Hogan SP. Immunopathogenesis of experimental ulcerative colitis is mediated by eosinophil peroxidase. J Immunol. 2004;172:5664-5675.
Furuta GT, Nieuwenhuis EES, Karhausen J, Gleich G, Blumberg RS, Lee JJ, Ackerman SJ. Eosinophils alter colonic epithelial barrier function: role for major basic protein. Am J Physiol Gastrointest Liver Physiol. 2005; 289: 890-897.
German AJ, Hall EJ, Day MJ. Analysis of leucocyte subsets in the canine intestine. J Comp Pathol. 1999;120:129-145.
German AJ, Hall EJ, Day MJ. Immune cell populations within the duodenal mucosa of dogs with enteropathies. J Vet Intern Med 2001;15:14–25.
Guilford WG. Idiopathic inflammatory bowel disease. In: Guilford WG, Center SA, Strombeck DR, Williams DA, Meyer DJ, eds. Strombeck's Small Animal Gastroenterology. 3rd ed. Philadelphia: WB Saunders, 1996:451–486.
Haas E, Rutgen BC, Gerner W, Richter B, Tichy A, Galler A, Bilek A, Thalhammer JG, Saalmüller A, Luckschander-Zeller N. Phenotypic characterization of canine intestinal intraepithelial lymphocytes in dogs with inflammatory bowel disease. J Vet Intern Med. 2015;28:1708-1715.
Hogan SP. Functional role of eosinophils in gastrointestinal inflammation. Immunol Allergy Clin North Am. 2009;29:129-140.
Hogan SP, Waddell A, Fulkerson PC. Eosinophils in infection and intestinal immunity. Curr Opin Gastroenterol. 2013;29:7-14.
Ingle SB, Patle YG, Murdeshwar HG, Pujari GP. A case of early eosinophilic gastroenteritis with dramatic response to steroids. J Crohns Colitis 2011; 5: 71-72
Kristjansson G, Venge P, Wanders A, Lööf L, Hällgren R. Clinical and subclinical intestinal inflammation assessed by the mucosal patch technique: studies of mucosal neutrophil and eosinophil activation in inflammatory bowel diseases and irritable bowel syndrome. Gut. 2004;53:1806-1812.
Mehta P, Furuta GT. Eosinophils in gastrointestinal disorders- eosinophilic gastrointestinal diseases, celiac disease, inflammatory bowel diseases and parasitic infections. Immunol Allergy Clin North Am. 2015;35:413-437.
Protheroe C, Woodruff SA, de Petris G, Mukkada V, Ochkur SI, Janarthanan S, Lewis JC, Pasha S, Lunsford T, Harris L, Sharma VK, McGarry MP, Lee NA, Furuta GT, Lee JJ. A novel histologic scoring system to evaluate mucosal biopsies from patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2009;7:749-755
Powell N, Walker MM, Talley NJ. Gastrointestinal eosinophils in health, disease and functional disorders. Nat Rev Gastroenterol Hepatol. 2010;7:146-156.
Samiullah, Bhurgri H, Sohail U. Eosinophilic disorders of the gastrointestinal tract. Prim Care. 2016; 43:495-504.
Sattasathuchana P, Steiner JM. Canine eosinophilic gastrointestinal disorders. Anim Health Res Rev. 2014;15:76-86.
Smyth CM, Akasheh N, Woods S, et al. Activated eosinophils in association with enteric nerves in inflammatory bowel disease. PLoS ONE. 2013;8: 64216.
Talley NJ, Kephart GM, McGovern TW, et al. Deposition of eosinophil granule major basic protein in eosinophilic gastroenteritis and celiac disease. Gastroenterol. 1992;103:137-145.
Rothenberg ME, Mishra A, Brandt EB, et al. Gastrointestinal eosinophils. Immunol Rev. 2001;179:139-155.
Washabau RJ, Day MJ, Willard MD, et al. WSAVA International Gastrointestinal Standardization Group. Endoscopic, biopsy, and histopathologic guidelines for the evaluation of gastrointestinal inflammation in companion animals. J Vet Intern Med. 2010;24:10-26.
Willetts L, Parker K, Wesselius LJ, Protheroe CA, Jaben E, Graziano P, Moqbel R, Leslie KO, Lee NA, Lee JJ. Immunodetection of occult eosinophils in lung tissue biopsies may help predict survival in acute lung injury. Resp Res. 2011;12:116.
Young KM, Meadows RL. Eosinophils and their disorders. In: Weiss DJ. and Wardrop KJ (eds) Schalm’s Veterinary Hematology, 6 edn. Singapore: Blackwell Publishing. 2010; 281–289.