Correspondence to: Dr. All rights reserved. This article has been cited by other articles in PMC. Abstract Eosinophilic gastroenteritis EGE in the adult is a distinctive pathologically-based disorder characterized by an eosinophil-predominant mucosal inflammatory process.
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Published by Baishideng Publishing Group Inc. All rights reserved. This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. This article has been cited by other articles in PMC.
Abstract Eosinophilic gastroenteritis EGE is a rare and benign inflammatory disorder that predominantly affects the stomach and the small intestine. Hence, accurate diagnosis of EGE poses a significant challenge to clinicians, with evidence of the following three criteria required: Suspicious clinical symptoms, histologic evidence of eosinophilic infiltration in the bowel and exclusion of other pathologies with similar findings.
In this review, we designed and applied an algorithm to clarify the steps to follow for diagnosis of EGE in clinical practice. The management of EGE represents another area of debate. Prednisone remains the mainstay of treatment; however the disease is recognized as a chronic disorder and one that most frequently follows a relapsing course that requires maintenance therapy. Since prolonged steroid treatment carries of risk of serious adverse effects, other options with better safety profiles have been proposed; these include budesonide, dietary restrictions and steroid-sparing agents, such as leukotriene inhibitors, azathioprine, anti-histamines and mast-cell stabilizers.
Single cases or small case series have been reported in the literature for all of these options, and we provide in this review a summary of these various therapeutic modalities, placing them within the context of our novel algorithm for EGE management according to disease severity upon presentation. Keywords: Eosinophilic, Gastroenteritis, Diagnosis, Management, Algorithm, Review Core tip: Eosinophilic gastroenteritis EGE is a heterogeneous inflammatory bowel disorder, which commonly follows a chronic and relapsing course.
To date, only single cases or small case series provide insights into its diagnosis and management. This manuscript reviews the different diagnostic tools utilized in practice and provides an algorithm for diagnosis. It also provides a summary of the therapeutic modalities applied in EGE management, which are placed within the context of an algorithm for systematic application of the different strategies according to the initial disease severity. Since its first description, about 8 decades ago, reports of subsequent cases have revealed a widely variable and heterogeneous profile of physical manifestations.
Studies from the United States have found a prevalence ranging between 8. Intriguingly, the more recent estimates of EGE in the United States have found a shift from male preponderance[ 4 , 5 ] to female predominance[ 2 ]. Higher socioeconomic status, Caucasian race and excess weight may be risk factors of EGE[ 3 ], and a possible hereditary component genetic factor is suggested by reports of familial cases[ 6 ].
Some studies have found an association with other autoimmune conditions, such as celiac disease[ 8 ], ulcerative colitis[ 9 ] and systemic lupus erythematosus[ 10 ]. These data collectively suggest that EGE may result from immune dysregulation in response to an allergic reaction; yet, a triggering allergen is not always identified.
Other environmental factors, such as parasitic infestation and drugs, may act as predisposing agents as well[ 11 ]. Both immunoglobulin E IgE dependent and delayed TH2 cell-mediated allergic mechanisms have been demonstrated to be involved in the pathogenesis of EGE. Interleukin 5 IL-5 has also been shown to play an essential role in the expansion of eosinophils and their recruitment to the gastrointestinal GI tract, the mechanism underlying the pathogenic hallmark of EGE.
Other mediators-most notably IL-3, IL-4, IL, leukotrienes and tumor necrosis factor TNF -alpha-act to enhance eosinophilic trafficking and have been proposed to help in prolonging lymphocytic and eosinophilic activity[ 11 - 13 ].
Many of these immune-related molecules are currently under consideration as potential targets for molecular therapy of EGE. Once recruited to the GI tract, the activated eosinophils induce a significant inflammatory response by secreting a variety of mediators including the cytotoxic granules that lead to structural damage in the infiltrated intestinal layers[ 12 ]. Thus, EGE can affect any GI segment, but reports have shown that the small intestine and stomach are the most predominant areas[ 4 ].
In clinical practice, the Klein classification system[ 14 ] is used to categorize the disease type according to the involved intestinal layer; the 3 Klein categories are mucosal, muscular and serosal. Furthermore, the muscular and serosal types are commonly associated with concomitant mucosal eosinophilic infiltration, which raises the hypothesis of centrifugal disease progression from the deep mucosa toward the muscular and serosal layers[ 3 ].
Eosinophilic gastroenteritis: Approach to diagnosis and management
Clнnica Ricardo Palma Residente de Medicina. Las manifestaciones clнnicas dependerбn de la capa histolуgica comprometida y el segmento digestivo infiltrado. Se reportan dos casos de GEE de caracterнsticas clнnicas diferentes: Un primer caso de curso crуnico caracterizado principalmente por ascitis recidivante de 13 aсos de evoluciуn y cuadro obstructivo gastro-duodenal, y un segundo caso de carбcter agudo de 14 dнas de evoluciуn, sin ascitis y eosinofilia perifйrica. Se describe el plan diagnуstico que se realizу en ambos casos haciendo hincapiй en que se trata de un diagnуstico de exclusiуn, y de cуmo las diferentes formas de presentaciуn nos llevan a manejos diferentes. En la primera paciente con enfermedad de curso crуnico, la infiltraciуn fue predominante de las capas muscular y serosa, dando caracterнsticas clнnicas, radiolуgicas, endoscуpicas y quirъrgicas de enfermedad infiltrativa del estуmago que condujo a un manejo agresivo de gastrectomнa total, encontrбndose el diagnуstico por patologнa de la pieza operatoria. En la segunda paciente de curso de enfermedad aguda, la infiltraciуn eosinofнlica fue predominantemente de la mucosa, la cual pudo ser diagnosticada mediante biopsias endoscуpicas.
Esofagite eosinofílica: definição e tratamentos
Occasionally, the disease may manifest itself as an acute abdomen or bowel obstruction. Failure to thrive and anaemia may also be present. Lower gastrointestinal bleeding may imply colonic involvement. Subserosal EG 4.