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Eosinophilic Gastroenteritis

EGE

Eosinophilic gastroenteritis is a rare condition of the gastrointestinal tract. The infiltration of eosinophils into the mucosal, muscular, and serosal layers produces symptoms such as abdominal pain, dysphagia, diarrhea, failure to thrive, amenorrhea, protein and iron malabsorption, bleeding, and anemia. The initial diagnosis can be made through a detailed clinical assessment and laboratory studies showing eosinophilia. Imaging, microbiological, and histopathological studies, however, need to be conducted in order to rule out other more common causes of eosinophilia and confirm the presence of eosinophils in the epithelial lining of the intestines and stomach.


Presentation

The features of eosinophilic gastroenteritis stem from the invasion of eosinophils and a subsequent inflammatory reaction involving the intestinal epithelium [1] [2] [3] [4]. Although virtually any part of the gastrointestinal tract can be affected, the stomach and the proximal small intestine seem to be the most common sites [1] [2]. The severity of symptoms somewhat depends on the depth of inflammation, but the non-specific complaints dominate the clinical presentation - abdominal pain (frequently accompanied by cramping), diarrhea, nausea with vomiting, and dysphagia [1] [2]. Because the mucosal layer is universally affected, malabsorptive syndromes, particularly protein-losing enteropathy and iron deficiency, are a common finding, which often results in weight loss and anemia, respectively [1] [5]. Lower gastrointestinal bleeding is present when eosinophilic gastroenteritis affects the colon [1] [6]. A delayed onset of puberty, amenorrhea, failure to thrive, and growth retardation are notable manifestations in children and adolescents [1] [5] [6]. Ascites with very high peripheral eosinophilia are hallmarks of more severe forms of eosinophilic gastroenteritis in which subserosal layers of the intestinal wall are affected [1]. In rare cases, accompanying disorders may include pancreatitis, acute appendicitis, and duodenal ulcers [1].

Abdominal Pain
  • We present the case of a young man with EG who presented with relapsing severe abdominal pain and enteropathy with protein loss.[ncbi.nlm.nih.gov]
  • In the hEGE group (n 13), initial symptoms included hematemesis, abdominal pain, and vomiting. Three of the subjects had normal endoscopic findings. Eight patients were categorized into the infant group and 5 into the child group.[ncbi.nlm.nih.gov]
  • A 68-year-old woman was admitted with abdominal pain, nausea, vomiting, and watery diarrhea. Laboratory findings revealed elevated serum titers of amylase, lipase, and peripheral blood eosinophil count.[ncbi.nlm.nih.gov]
  • At one-month follow-up, the patient reported reduced abdominal pain.[ncbi.nlm.nih.gov]
  • Typical clinical manifestations include acute onset, abdominal pain, and ascites. Eos in ascites and peripheral blood are the main diagnostic clues.[ncbi.nlm.nih.gov]
Nausea
  • A 68-year-old woman was admitted with abdominal pain, nausea, vomiting, and watery diarrhea. Laboratory findings revealed elevated serum titers of amylase, lipase, and peripheral blood eosinophil count.[ncbi.nlm.nih.gov]
  • Eosinophilic gastroenteritis is a disease that is characterised by an eosinophil-driven inflammation of the digestive tract, presenting with non-specific symptoms, including abdominal pain, nausea, and diarrhoea.[ncbi.nlm.nih.gov]
  • Clinical manifestations range from non-specific gastrointestinal complaints such as nausea, vomiting, crampy abdominal pain, and diarrhea to specific findings such as malabsorption, protein loosing enteropathy, luminal obstruction, eosinophilic ascites[ncbi.nlm.nih.gov]
  • An 18-year-old patient presented with abdominal pain, nausea, and low-grade fever. Sonography showed ascites in the region of the terminal ileum, and the presence of peritoneal nodules suggested peritoneal inflammation.[ncbi.nlm.nih.gov]
  • The clinical manifestations of EGE are protean and can vary from nausea and vomiting to protein-losing enteropathy or even bowel obstruction requiring surgery.[ncbi.nlm.nih.gov]
Lower Abdominal Pain
  • A 48-year-old Japanese woman was admitted to our hospital because of epigastralgia, lower abdominal pain and vomiting. She had a past history of allergic disorders.[ncbi.nlm.nih.gov]
Periumbilical Pain
  • PATIENT CONCERNS: We report a 54-year-old male who was presented with intermittent periumbilical pain and melena, and only revealed verrucous gastritis by endoscopy.[ncbi.nlm.nih.gov]
Recurrent Epigastric Pain
  • We report the case of an adolescent boy with recurrent epigastric pain, nausea and vomiting, in whom sonographic features and eosinophilia of the peripheral blood suggested the diagnosis of EG.[ncbi.nlm.nih.gov]
Dysgeusia
  • A 69-year-old Japanese man presented to our hospital with a history of general malaise, diarrhea, and dysgeusia. Esophagogastroduodenoscopy showed reddish elevated lesions that were edematous all over the gastric mucosa.[ncbi.nlm.nih.gov]
Severe Osteoporosis
  • Oral administration of ketotifen in a patient with eosinophilic colitis and severe osteoporosis.[ncbi.nlm.nih.gov]
  • Oral administration of ketotifen in a patient with eosinophilic colitis and severe osteoporosis. Am J Gastroenterol. 2002 Apr; 97 (4):1072–1074. [ PubMed ] Bolukbas Fusun F, Bolukbas Cengiz, Uzunkoy Ali, Baba Fusun, Horoz Mehmet, Ozturk Ebru.[ncbi.nlm.nih.gov]
Skin Patch
  • No specific allergen was found from the multiple antigen simultaneous test and from the skin patch test. The parasitic immunodiagnosis was negative.[ncbi.nlm.nih.gov]

Workup

Because of the rare occurrence of eosinophilic gastroenteritis in clinical practice, the diagnosis may not be an easy one to make. In fact, studies show that up to 80% of patients experience symptoms for several years before the condition is recognized [1] [4]. For this reason, it is necessary to perform a thorough workup in patients who report nonspecific gastrointestinal complaints, starting with a detailed patient history and a full physical examination. After the course of symptoms and their progression is noted, laboratory studies should be employed, revealing abundant peripheral eosinophilia with average counts of 2000/μL [1]. Additional findings include anemia, hypoalbuminemia (as a result of fecal protein loss that can be tested through a 24h collection of alpha1-antitrypsin), steatorrhea, and high serum immunoglobulin E (IgE) levels [1]. The differential diagnosis of peripheral eosinophilia is broad, which is why stool cultures (to rule out parasitic infections) and skin prick tests (to exclude allergies) are vital constituents of the workup [1]. Computed tomography and ultrasonography are useful imaging studies (ascites and thickening of gastric folds are typically identified), but the nonspecific findings revealed during these procedures necessitates the use of endoscopy and subsequent histopathological examination [1] [5]. Eosinophilic gastroenteritis is confirmed when eosinophils are visualized in the gastrointestinal tract and when all other possible causes of eosinophilia are excluded [1] [5] [6].

Ancylostoma Caninum
  • Croese, Human eosinophilic enteritis caused by dog hookworm Ancylostoma caninum, The Lancet, 335, 8701, (1299), (1990). Y. Vandenplas, M. Quenon, F. Renders, I. Dab and H.[doi.org]
Ischemic Changes
  • A barium study of the small intestine showed thickening of the duodenal wall in 1 patient with subserosal disease and ischemic changes in the proximal ileum in 1 patient with muscular disease.[doi.org]

Treatment

  • Treatment with glucocorticoids is effective.[ncbi.nlm.nih.gov]
  • BACKGROUND: Clinical features and treatment responses in pediatric patients with eosinophilic gastroenteritis are rarely reported.[ncbi.nlm.nih.gov]
  • The treatment and prognosis of eosinophilic gastroenteritis is determined by the severity of the clinical manifestations.[ncbi.nlm.nih.gov]
  • Ketotifen treatment does not appear to prohibit or reverse the inflammatory process in the gastric mucosa in EGE, although long-term effects of steroids may be avoided.[ncbi.nlm.nih.gov]
  • To avoid specific allergen, dietary treatments can be considered as initial treatment strategy before drug treatment. Corticosteroids are the main medication for eosinophilic gastroenteritis and have a dramatic therapeutic efficacy.[ncbi.nlm.nih.gov]

Prognosis

  • Frequency, prognosis and therapeutic implications must guide the diagnostic course. An acute eosinophilic gastroenteritis in a 78-year-old asthmatic woman receiving celecoxib is reported.[ncbi.nlm.nih.gov]
  • The treatment and prognosis of eosinophilic gastroenteritis is determined by the severity of the clinical manifestations.[ncbi.nlm.nih.gov]
  • The prognosis of EGE is relatively good when patients receive timely and proper treatment. Acta Gastro-Enterologica Belgica.[ncbi.nlm.nih.gov]
  • The infant group may have a better prognosis than the child group if treated properly. KEYWORDS: Child; Endoscopy; Eosinophilic Gastroenteritis; Histology; Infants[ncbi.nlm.nih.gov]
  • Prognosis With treatment, prognosis is good with full resolution of symptoms in spite of a possible relapsing course.[orpha.net]

Etiology

  • Eosinophilic gastroenteritis (EGE) is an uncommon disease of unknown etiology reported in both adult and pediatric age group.[ncbi.nlm.nih.gov]
  • Eosinophilic gastroenteritis is a rare heterogeneous disorder of undetermined etiology that is characterized by eosinophilic infiltration of the gastrointestinal tissues and various clinical manifestations.[ncbi.nlm.nih.gov]
  • Eosinophilic gastroenteritis is a rare disease of unknown etiology. It is characterized by eosinophilic infiltration of the bowel wall to a variable depth and symptoms associated with gastrointestinal tract.[ncbi.nlm.nih.gov]
  • Eosinophilic gastroenteritis (EG) is a rare gastrointestinal disorder of undetermined etiology and is manifest by eosinophilic infiltration of any area of gastrointestinal tract, most frequently stomach and small intestine.[ncbi.nlm.nih.gov]
  • Eosinophilic gastroenteritis is an uncommon disease with an obscure etiology, although associations with allergy, the idiopathic hypereosinophilic syndrome, and connective tissue disease have been reported.[ncbi.nlm.nih.gov]

Epidemiology

  • Using a large, population-based database, we investigated epidemiologic features of eosinophilic gastroenteritis (EoGE) and eosinophilic colitis (EoC) in the United State.[ncbi.nlm.nih.gov]
  • The epidemiology, pathophysiology, and treatment of EGE are also discussed, along with a review of the current literature.[ncbi.nlm.nih.gov]
  • Background/Aims: The epidemiology of eosinophilic gastroenteritis remains unclear. We aim to determine the prevalence of eosinophilic gastroenteritis in patients with lower abdominal symptoms.[ncbi.nlm.nih.gov]
  • Up to now, epidemiology and pathophysiology of eosinophilic gastroenteritis are still unclear.[ncbi.nlm.nih.gov]
  • Our aims are to determine the epidemiology, clinical features and outcomes of EOGE cases in a tertiary-care hospital. METHODS: Retrospective cohort study of patients with gastrointestinal eosinophilic infiltration from 2004 through 2014.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology is based on infiltration of the eosinophils involving various parts of gastrointestinal system, but also different layers of the wall.[ncbi.nlm.nih.gov]
  • […] describe a 24-year-old woman with eosinophilic gastroenteritis presenting as epigastric pain with a history of severe iron deficiency anemia, asthma, eczema, and allergic rhinitis, and we review the literature regarding presentation, diagnostic testing, pathophysiology[ncbi.nlm.nih.gov]
  • The epidemiology, pathophysiology, and treatment of EGE are also discussed, along with a review of the current literature.[ncbi.nlm.nih.gov]
  • Up to now, epidemiology and pathophysiology of eosinophilic gastroenteritis are still unclear.[ncbi.nlm.nih.gov]
  • […] etiology characterized by peripheral eosinophilia, eosinophilic invasion of the gastrointestinal tract, and clinical symptoms related to the site and tissue layer involved mostly involved stomach and proximal intestine 2 Eosinophilic Gastroenteritis Pathophysiology[powershow.com]

Prevention

  • Case reports may help to disseminate knowledge about the disease, thereby increasing the likelihood of early diagnosis and intervention to prevent complications.[ncbi.nlm.nih.gov]
  • Ultrasonographic detection of features such as bowel wall thickness, ascites and peritoneal nodules may be largely suggestive of EG and may prevent other invasive exams and abdominal surgery.[ncbi.nlm.nih.gov]
  • Atopic gastrointestinal diseases are in many cases reversible; however, chronic treatment is often necessary to prevent relapse.[ncbi.nlm.nih.gov]
  • This condition can respond to low dose steroid therapy, thereby preventing grave complications like ascites and intestinal obstruction that might need surgical intervention. The natural history of EGE has not been well documented.[ncbi.nlm.nih.gov]
  • Currently, no preventative measures are available for Eosinophilic Gastroenteritis Early detection and treatment of the disease are important to prevent the symptoms from becoming too severe/adverse What is the Prognosis of Eosinophilic Gastroenteritis[dovemed.com]

References

Article

  1. Ingle SB, Hinge (Ingle) CR. Eosinophilic gastroenteritis: An unusual type of gastroenteritis. World J Gastroenterol. 2013;19(31):5061-5066.
  2. Chen MJ, Chu CH, Lin SC, Shih SC, Wang TE. Eosinophilic gastroenteritis: clinical experience with 15 patients. World J Gastroenterol. 2003;9:2813–2816.
  3. Hsu YQ, Lo CY. A case of eosinophilic gastroenteritis. Hong Kong Med J. 1998;4:226–228.
  4. Christopher V, Thompson MH, Hughes S. Eosinophilic gastroenteritis mimicking pancreatic cancer. Postgrad Med J. 2002;78:498–499.
  5. Freeman HJ. Adult eosinophilic gastroenteritis and hypereosinophilic syndromes. World J Gastroenterol. 2008;14(44):6771-6773.
  6. Baig MA, Qadir A, Rasheed J. A review of eosinophilic gastroenteritis. J Natl Med Assoc. 2006;98:1616–1619.

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Last updated: 2019-06-28 09:52