Eosinophilic gastroenteritis

[Clinical characteristics of 17 cases of eosinophilic gastroenteritis]

BACKGROUND/AIMS

Eosinophilic gastroenteritis (EG) is a rare disease characterized by prominent eosinophilic infiltration that may involve a variable depth of one or more gastrointestinal organs. We analyzed the largest number of patients with EG among the studies carried out at a single center in Korea.

METHODS

We retrospectively analyzed the clinical, laboratory, endoscopic, and radiologic features, management, and clinical outcome in 17 patients who were diagnosed as EG from January 1994 to February 2008.

RESULTS

Median age was 36 (2-67 years). Two of the 17 patients had a history of allergy. The most common symptoms were abdominal pain and diarrhea. Fifteen patients (88.2%) had hypereosinophilia. The ESR was moderately raised in 6 out of 14 patients. Eleven patients (64.7%) had predominant involvement of the mucosa, 1 (5.9%) of muscularis, and 5 (29.4%) of subserosa. EGD revealed non-specific findings such as erythema and edema. Abdominal Computed tomography revealed gastrointestinal wall thickenings of the involved organ, and all of 5 cases of the subserosal type had ascites. Thirteen patients (76.5%) were improved by corticosteroid treatment. Among five patients who had been followed for more than one year (12-84 months), two experienced relapse after discontinuing corticosteroids.

CONCLUSIONS

EG should be considered in the differential diagnosis of unexplained gastrointestinal symptoms even in the absence of peripheral eosinophilia and in non-specific endoscopic findings.

Eosinophilic gastroenteritis

A review was undertaken of 220 case reports of eosinophilic gastroenteritis involving the gastrointestinal tract, with particular regard to its clinical presentation and management. The stomach was the single commonest site of involvement (43%), while 36% were found to have two or more sites of disease at the time of presentation. The most common presenting symptoms were episodic abdominal pain (77%) and diarrhoea (42%). A history of allergy was present in 52% of patients, while 8% reported aggravation of symptoms following the ingestion of certain foods. Two thirds of patients had reported symptoms of more than six months duration prior to diagnosis, while in 26%, five years or more had elapsed. Although surgical intervention was undertaken in 44% of patients at some stage in their management, the most successful mode of management was the institution of steroid therapy, where 90% reported rapid clinical improvement. There is no evidence that patients with eosinophilic gastroenteritis have a higher incidence of subsequent gastrointestinal malignancies.

Eosinophilic colitis

Eosinophilic gastroenteritis, a condition of unknown etiology, has frequently been reported involving the stomach and small bowel. The colon is rarely cited as a site for the condition; however, a review of the literature reveals over 20 cases (including ours). The findings indicate that the colon is now a recognized, but rare, site of involvement and that the condition can be diagnosed via the colonoscope. No clear-cut etiology can be defined, but the presence of allergy (33 percent) and of the herring worm (two cases) is noted.

Eosinophilic gastroenteritis in the pediatric patient

Eosinophilic gastroenteritis is a diagnosis to be entertained whenever a patient had abdominal complaints accompanied by striking peripheral eosinophilia. A definitive diagnosis is of greater importance in this illness, since undiagnosed cases often undergo needless exploratory surgery. An infant seen at 2 years, 10 months of age with abdominal pain, nausea, and vomiting was found to have a white blood cell count of 50,000/cu mm with 54% eosinophils and eosinophilic ascites. An antral tissue biopsy yielded a diagnosis of eosinophilic gastroenteritis after many studies had been made to exclude other diagnoses. Treatment with intermittent courses of prednisone kept the patient relatively asymptomatic over the period of 20 years during which she remained under our care. Immunologic studies shed no light on the etiology of this patient's disorder. The literature dealing with diffuse, infiltrative eosinophilic gastroenteritis is reviewed.

Colonoscopic features of eosinophilic gastroenteritis

This report describes the colonoscopic findings in a patient with eosinophilic gastroenteritis and the effect of treatment upon the course of the disease. Clinical manifestations and treatment depend upon the site of bowel involvement. The patient had mucosal involvement of stomach and small intestine, but colonoscopy demonstrated extensive colorectal involvment, most severe distally. We suggest fiberoptic sigmoidoscopy as an alternative diagnostic modality.

Eosinophilic gastroenteritis involving the ileocecal area

Eosinophilic gastroenteritis, an idiopathic inflammation of the alimentary canal, is characterized by infiltration of the intestinal wall by eosinophils, massive submucosal edema, and peripheral eosinophilia. It is generally confined to the gastric antrum and proximal small intestine. A young woman had an eosinophilic infiltrate that involved the distal ileum and right colon only. Barium studies showed severe narrowing and shortening of the cecum and ascending colon. Symptoms of intestinal obstruction did not respond satisfactorily to conservative measures. Adhesions over the ileocecal area as well as thickening and induration of the terminal ileum and proximal right colon were found on hemicolectomy. The remaining intestine and the peritoneal cavity were felt to be normal. Histologic examination showed a cellular infiltrate with prominent eosinophils in the mucosa, submucosal edema and fibrosis. During a 40-month follow-up period after the hemicolectomy, the patient has not shown clear evidence of recurrence or extension of the disease to the stomach or proximal small intestine. It is concluded that idiopathic eosinophilic gastroenteritis may primarily involve the ileocecal area. In that location it must be specifically differentiated from intestinal tuberculosis, amebiasis, and Crohn's disease.

Eosinophilic gastroenteritis

Eosinophilic gastroenteritis is an uncommon condition affecting one or more segments of the gastrointestinal tract, mainly the stomach and small bowell, the principal changes being a variable degree of both oedema and eosinophilic infiltration. Occurring at any age it is commonest in the third decade, is often associated with abdominal pain and peripheral blood eosinophilia, and responds to steroids: allergy or asthma occurs in some 25% of patients. The oedema and eosinophilia involve the submucosa generally but any layer of the gut may be affected. The aetiology is discussed: no allergic or other cause has been determined and it is probable that further knowledge of the role of the eosinophil may be necessary before the precise nature of the lesion can be understood. An association of eosinophilic gastroenteritis with malabsorptive or protein-losing enteropathies is noted.

Co-existent eosinophilic gastroenteritis and hypothalamic-pituitary dysfunction

A case of eosinophilic gastroenteritis in a 42-year-old man is described. The patient had diarrhoea, faecal blood loss, a protein-losing enteropathy, malabsorption of fat, xylose and vitamin B12. Co-existent hypopituitarism, diabetes insipidus and hypothalamic dysfunction was demonstrated. Complete clinical recovery occurred with pituitary replacement therapy alone. The association of this endocrine abnormality with the picture of eosinophilic gastroenteritis has not previously been described.

Fibrous inflammatory polyps of the ileum and cecum: review of five cases with emphasis on differentiation from mesenchymal neoplasm

Five case histories of patients with fibrous inflammatory polyps of the ileocecum are reported. Clinical impression in all five cases was that these tumefactions represented gastrointestinal malignancies. Gross pathologic examination revealed polypoid intramural growths ranging from 2.5 to 7.0 cm in greatest dimension. Transmural desmoplasia through the bowel wall into subserosal fat was initially thought to be indicative of neoplastic invasion. Microscopic evaluation revealed a fibroblastic and vascular proliferative process. Pseudosarcomatous changes were identified in cellular fibroblastic areas with plemorphism and mitotic activity. The manner of dissection among bundles of muscularis mucosae and muscularis propria suggests an inflammatory process as opposed to the pushing aside of whole large muscle bundles as seen in mesenchymal neoplasms arising in bowel wall. All five patients experienced survival of 6 to 17 years following surgery. These lesions are thought by us to represent localized exuberant polypoid granulation tissue proliferations which simulate mesenchymal neoplasm.

Eosinophilic infiltration of the gastro-intestinal tract (eosinophilic gastroenteritis)

Two further cases of eosinophilic infiltration of the gastro-intestinal tract (eosinophilic gastroenteritis) are presented, involving the small intestine of a 73-year old male and the stomach of a 39-year old male. Peripheral blood eosinophilia was present in one case. Clinico-pathological correlations are discussed.

Eosinophilic gastroenteritis

Two cases of eosinophilic gastroenteritis are reported, with a discussion of eosinophilia in general and the incidence of various disorders which may be associated with it.

Eosinophilic granuloma of the ileum

A case of eosinophilic granuloma of the ileum is described in association with a high (50%) eosinophil count. A review of published suggested classifications, aetiology and therapy is made.