Eosinophilic Gastroenteritis

doi:10.1016/j.gtc.2008.02.003

Gastroenterology Clinics of North America

Volume 37, Issue 2, June 2008, Pages 333-348

https://doi.org/10.1016/j.gtc.2008.02.003 Get rights and content

Eosinophilic gastroenteritis is an infrequently diagnosed condition that is characterized by prominent eosinophilic infiltration of the stomach or small intestine, generally localized to one level of the intestinal wall; the variable organ locus and wall depth produce heterogeneous clinical presentations. A strong association with atopy is present in most cases, supported by circumstantial evidence and the demonstration of Th-2 proinflammatory cytokine profiles in animal studies. A high degree of suspicion is required to establish the diagnosis, which must be based on intense gastrointestinal eosinophilia. Management is directed toward removal of offending allergens and use of anti-inflammatory agents. Novel and emerging treatments on the horizon are biologic therapies and selective anti-eosinophil agents.

Section snippets

Epidemiology

Because of a notable scarcity of published data on the epidemiology, it is difficult to determine the true burden of EG. An English language literature review does not reveal a well-analyzed published case series describing primary EG in the last 3 years, suggesting that it is an uncommon and perhaps difficult-to-diagnose disorder. Nevertheless, several case reports of EG have emerged recently in different parts of the world [1], [2], [3], [4], [5]. The diagnosis affects most ethnicities, and

Pathogenesis

EG may be primary, also known as allergic, or secondary to one of many conditions that provoke eosinophilic inflammation (see later section on differential diagnosis), with parasitic infections being the leading cause. The cause cannot be precisely determined in a small but important minority of patients, who are regarded as having idiopathic EG.

Clinical Presentations

Patients who have EG have heterogeneous clinical presentations, some of which overlap with more familiar diagnoses, such as functional GI disorders and inflammatory bowel disease. Presenting symptoms may be vague and nonspecific (eg, recurrent abdominal pain [23]) or dramatic (eg, gastric ulcer perforation [24]). Symptom onset may be at any age, but most patients are diagnosed as young adults, between the third and fifth decades of life. Often patients experience symptoms for many months and

Differential Diagnosis

A broad range of conditions are associated with gastrointestinal mucosal eosinophilia and the following is a brief review of some of the important differential diagnoses.

Diagnostic Evaluation

Diagnosis of EG requires suspecting the disease, excluding other disorders in the differential diagnoses, confirming the definitive diagnosis, and assessing for potential complications. Currently accepted diagnostic criteria are the presence of gastrointestinal symptoms, an intense eosinophilic infiltrate on histopathologic examination, and exclusion of other causes of intestinal eosinophilia. Tests considered useful in the evaluation of EG and its differentials are presented in Table 1[62].

Management

Various treatments may be beneficial in EG [76]. Our current knowledge of the treatment of EG is derived virtually exclusively from small studies and anecdotal experience. Evidence for the true efficacy of any therapy suffers from the lack of well-designed and controlled studies. Nevertheless, corticosteroids and dietary therapy are two treatment interventions for which the data are convincingly favorable. Emerging treatments in development are biologics and selective anti-eosinophil agents.

Natural History

There is a dearth of information about the long-term course of patients who have treated or untreated EG. Most experts regard primary EG as a chronic disorder characterized by relapses and remissions, and hence the recommendations for close follow-up and perhaps repeated endoscopic surveillance in selected cases. The natural history of EG has not been well described, but clinical studies point to a chronic relapsing course for patients who have this diagnosis. The long-term follow-up (2.5 to

Summary

EG is an uncommon, yet important, entity in the spectrum of primary EGIDs, selectively affecting the stomach and small intestine with an eosinophilic inflammatory process. Multiple clinical presentations are recognized because of the variability in the location and depth of eosinophilic infiltration. History of atopy and allergies is present in 25% to 75% of cases. Recent investigations providing an insight into the pathogenesis of EG support a critical role for allergens, eosinophils,

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