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Nakagome S, Koizumi E, Goto O, Kitamura M, Kawami N, Higuchi K, Onda T, Omori J, Akimoto N, Iwakiri K. A successful treatment case of refractory hemorrhagic ulcer with eosinophilic gastritis by endoscopic hand suturing. DEN OPEN 2023; 3:e207. [PMID: 36636717 PMCID: PMC9829097 DOI: 10.1002/deo2.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/13/2022] [Accepted: 12/25/2022] [Indexed: 01/11/2023]
Abstract
A 78-year-old man was admitted to our hospital with a tarry stool. Esophagogastroduodenoscopy identified tiny oozing on the greater curvature at the antrum. Despite repeated endoscopic hemostasis by coagulation and clipping, rebleeding occurred. On the third rebleeding, we performed endoscopic hand suturing to completely close the ulcer surface. Biopsy showing massive infiltration of eosinophils at the ulcer edge indicated eosinophilic gastritis. After the endoscopic closure by endoscopic hand suturing, the patient had no symptoms of bleeding thereafter and was discharged 19 days after the procedure by taking oral prednisolone. The patient remained well and was continuously treated with a small dose of steroids in outpatient. This is the first case report of the successful application of endoscopic hand suturing to a refractory hemorrhagic ulcer. Further accumulation of clinical experiences is desired to confirm the usefulness of this technique for the prevention of refractory ulcer bleeding.
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Affiliation(s)
- Shun Nakagome
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
| | - Eriko Koizumi
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
| | - Osamu Goto
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan,Endoscopy CenterNippon Medical School HospitalTokyoJapan
| | - Michika Kitamura
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
| | - Noriyuki Kawami
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
| | - Kazutoshi Higuchi
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
| | - Takeshi Onda
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
| | - Jun Omori
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
| | - Naohiko Akimoto
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
| | - Katsuhiko Iwakiri
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
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Worm M, Reese I, Ballmer-Weber B, Beyer K, Bischoff SC, Bohle B, Brockow K, Claßen M, Fischer PJ, Hamelmann E, Jappe U, Kleine-Tebbe J, Klimek L, Koletzko B, Lange L, Lau S, Lepp U, Mahler V, Nemat K, Raithel M, Saloga J, Schäfer C, Schnadt S, Schreiber J, Szépfalusi Z, Treudler R, Wagenmann M, Werfel T, Zuberbier T. Update of the S2k guideline on the management of IgE-mediated food allergies. Allergol Select 2021; 5:195-243. [PMID: 34263109 PMCID: PMC8276640 DOI: 10.5414/alx02257e] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 01/02/2023] Open
Abstract
Not available.
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Affiliation(s)
- Margitta Worm
- Allergology and Immunology, Department of Dermatology, Venereology, and Allergology, Charité – Universitätsmedizin Berlin, Germany
| | - Imke Reese
- Nutritional Counseling and Therapy, Focus on Allergology, Munich, Germany
| | - Barbara Ballmer-Weber
- University Hospital Zurich, Department of Dermatology, Zurich, Switzerland, and Cantonal Hospital St. Gallen, Department of Dermatology and Allergology, St. Gallen, Switzerland
| | - Kirsten Beyer
- Clinic of Pediatrics m. S. Pneumology, Immunology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Germany
| | - Stephan C. Bischoff
- Institute of Nutritional Medicine and Prevention, University of Hohenheim, Stuttgart, Germany
| | - Barbara Bohle
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria
| | - Knut Brockow
- Department of Dermatology and Allergology, Biederstein, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Martin Claßen
- Klinik für Kinder und Jugendmedizin/Päd. Intensivmedizin, Eltern-Kind-Zentrum Prof. Hess Klinikum Bremen-Mitte
| | - Peter J. Fischer
- Practice for Pediatric and Adolescent Medicine m. S. Allergology and Pediatric Pneumology, Schwäbisch Gmünd
| | - Eckard Hamelmann
- University Clinic for Pediatric and Adolescent Medicine, Evangelisches Klinikum Bethel gGmbH, Bielefeld
| | - Uta Jappe
- Research Group Clinical and Molecular Allergology, Research Center Borstel, Airway Research Center North (ARCN), member of the German Center for Lung Research (DZL), Borstel
- Interdisciplinary Allergy Outpatient Clinic, Medical Clinic III, University Hospital Schleswig-Holstein, Lübeck
| | | | | | - Berthold Koletzko
- Pediatric Clinic and Pediatric Polyclinic, Dr. von Haunersches Kinderspital, Department of Metabolic and Nutritional Medicine, Ludwig-Maximilians-University, Munich
| | - Lars Lange
- Pediatric and Adolescent Medicine, St.- Marien-Hospital, Bonn
| | - Susanne Lau
- Clinic of Pediatrics m. S. Pneumology, Immunology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Germany
| | - Ute Lepp
- Practice for Pulmonary Medicine and Allergology, Buxtehude
| | | | - Katja Nemat
- Practice for Pediatric Pneumology/Allergology at the Children’s Center Dresden (Kid), Dresen
| | | | - Joachim Saloga
- Department of Dermatology, University Medical Center, Johannes Gutenberg-University Mainz
| | - Christiane Schäfer
- Nutritional Therapy, Focus on Allergology and Gastroenterology, Schwarzenbek, Germany
| | - Sabine Schnadt
- German Allergy and Asthma Association, Mönchengladbach, Germany
| | - Jens Schreiber
- Pneumology, University Hospital of Otto von Guericke University, Magdeburg, Germany
| | - Zsolt Szépfalusi
- University Hospital for Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria
| | - Regina Treudler
- Clinic of Dermatology, Venereology and Allergology, University Medical Center Leipzig, Germany
| | | | - Thomas Werfel
- Clinic of Dermatology, Allergology and Venerology, Hannover Medical School, Germany, and
| | - Torsten Zuberbier
- Department of Dermatology, Venerology and Allergology, Charité – Universitätsmedizin Berlin
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3
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Ozdogan E, Caglayan LD, Mizikoglu O, Arikan C. Upper Gastrointestinal Bleeding as the First Presentation of Eosinophilic Gastrointestinal Disease. JPGN REPORTS 2020; 1:e017. [PMID: 37206599 PMCID: PMC10191568 DOI: 10.1097/pg9.0000000000000017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/08/2020] [Indexed: 05/21/2023]
Abstract
Gastrointestinal bleeding is a rare but potentially life-threatening manifestation of eosinophilic gastrointestinal disorders (EGIDs). Here, we describe a case series comprising 5 pediatric patients between 7 and 12 years of age, who presented to the emergency department with hematemesis and were subsequently diagnosed with EGID. Accompanying allergic history, peripheral eosinophilia, and total IgE elevation were common. Despite a more severe presentation, response to medical and dietary therapy was favorable. A comprehensive review of the literature revealed 26 other cases with similar findings that reinforced the importance of prompt recognition and early dietary and immunomodulating therapy in the control of this disease.
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Affiliation(s)
- Elif Ozdogan
- From the Department of Pediatric Gastroenterology, Hepatology and Nutrition, Koc University School of Medicine, Istanbul, Turkey
| | | | - Ozlem Mizikoglu
- Organ Transplantation Center, Liver Transplantation, Koc University School of Medicine, Istanbul, Turkey
| | - Cigdem Arikan
- From the Department of Pediatric Gastroenterology, Hepatology and Nutrition, Koc University School of Medicine, Istanbul, Turkey
- Organ Transplantation Center, Liver Transplantation, Koc University School of Medicine, Istanbul, Turkey
- Research Center for Translational Medicine (KUTTAM), Koc University, Istanbul, Turkey
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Daidone A, Barbi E, Villanacci V, Di Leo G. Severe anaemia after gastric biopsy in an infant with eosinophilic gastritis. Ital J Pediatr 2019; 45:69. [PMID: 31171002 PMCID: PMC6555022 DOI: 10.1186/s13052-019-0661-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/22/2019] [Indexed: 12/26/2022] Open
Abstract
Background Eosinophilic gastrointestinal disorders (EGID) are characterized by eosinophilic inflammation and are subclassified according to the affected site(s) as eosinophilic esophagitis, eosinophilic gastritis, eosinophilic enteritis and eosinophilic colitis. Clinical presentation includes dyspeptic symptoms, vomiting, abdominal pain, diarrhoea and gastrointestinal bleeding. Peripheral eosinophilia is usually found but is not required for the diagnosis. The treatment is based on dietary elimination therapy, consisting of removal of common food triggers, most frequently cow’s milk in infants. Corticosteroids are used as first line drug therapy in EG if dietary therapy fails to achieve an adequate clinical response or is impractical. Case presentation A four month old infant was admitted for an episode of melena and hematemesis. An esophagogastroduodenoscopy showed haemorrhagic gastritis with ulcerative lesions and fibrin. A significant gastric bleeding was noted after the procedure. The gastric mucosa biopsies showed an eosinophilic infiltration. Conclusions A clinically relevant anaemia is a quite rare complication in infants with eosinophilic gastritis and a biopsy may worsen bleeding, to a potentially severe level of low haemoglobin. In infants with low haemoglobin levels and suspect eosinophilic gastritis a watchful follow up after the biopsy should be considered, as well as the possibility of postponing the biopsy to reduce the bleeding risk.
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Affiliation(s)
| | - Egidio Barbi
- University of Trieste, Trieste, Italy.,Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Grazia Di Leo
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
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Gonzalez-Canalizo V, Segues N, Medina A, Torrente S, Aguilar-Gama V, Ortega P, Bujanda L. Severe upper gastrointestinal bleeding due to eosinophilic gastritis. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 42:307-308. [PMID: 30017211 DOI: 10.1016/j.gastrohep.2018.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/15/2018] [Accepted: 05/24/2018] [Indexed: 02/07/2023]
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Rechenauer T, Raithel M, Götze T, Siebenlist G, Rückel A, Baenkler HW, Hartmann A, Haller F, Hoerning A. Idiopathic Mast Cell Activation Syndrome With Associated Salicylate Intolerance. Front Pediatr 2018; 6:73. [PMID: 29637062 PMCID: PMC5881244 DOI: 10.3389/fped.2018.00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/12/2018] [Indexed: 11/13/2022] Open
Abstract
Idiopathic mast cell activation syndrome can be a rare cause for chronic abdominal pain in children. It remains a diagnosis by exclusion that can be particularly challenging due to the vast variety of possible clinical manifestations. We present a 13-year-old boy who suffered from a multitude of unspecific complaints over a long period of time. In this case, an assessment of mast cell-derived metabolites and immunohistochemical analysis of bioptic specimen was worthwhile. After ruling out, primary (oncologic) and secondary causes for mast cell activation, pharmacologic treatment adapted to the patient's salicylate intolerance resulted in a major relief of symptoms.
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Affiliation(s)
- Tobias Rechenauer
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Thomas Götze
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Gregor Siebenlist
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Aline Rückel
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Hanns-Wolf Baenkler
- Medical Clinic III for Rheumatology and Immunology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Florian Haller
- Institute of Pathology, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - André Hoerning
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Hematemesis as Initial Presentation in a 10-Week-Old Infant with Eosinophilic Gastroenteritis. Case Rep Pediatr 2017; 2017:2391417. [PMID: 28299223 PMCID: PMC5337357 DOI: 10.1155/2017/2391417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/26/2017] [Indexed: 12/27/2022] Open
Abstract
Eosinophilic gastroenteritis is a rare condition characterized by eosinophilic inflammation in the gastrointestinal tract resulting in a variety of gastrointestinal symptoms. There is currently a dearth of information on this topic in the pediatric literature, as very few cases have been reported. In this report, we present a case of eosinophilic gastroenteritis in a 10-week-old patient with initial presenting symptom of hematemesis. To our knowledge, this is the youngest case reported in the literature and is unique in its initial presentation.
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A Case of Proton Pump Inhibitor-Resistant Multiple Gastric Ulcers Caused by Eosinophilic Gastroenteritis. Clin Gastroenterol Hepatol 2015; 13:A23-4. [PMID: 26272422 DOI: 10.1016/j.cgh.2015.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 08/04/2015] [Indexed: 02/07/2023]
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Kim HU. Diagnostic and Treatment Approaches for Refractory Peptic Ulcers. Clin Endosc 2015; 48:285-90. [PMID: 26240800 PMCID: PMC4522418 DOI: 10.5946/ce.2015.48.4.285] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 05/20/2015] [Accepted: 05/22/2015] [Indexed: 12/15/2022] Open
Abstract
Refractory peptic ulcers are defined as ulcers that do not heal completely after 8 to 12 weeks of standard anti-secretory drug treatment. The most common causes of refractory ulcers are persistent Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs). Simultaneous use of two or more H. pylori diagnostic methods are recommended for increased sensitivity. Serologic tests may be useful for patients currently taking proton pump inhibitors (PPIs) or for suspected false negative results, as they are not affected by PPI use. NSAID use should be discontinued when possible. Platelet cyclooxygenase activity tests can confirm surreptitious use of NSAIDs or aspirin. Cigarette smoking can delay ulcer healing. Therefore, patients who smoke should be encouraged to quit. Zollinger-Ellison syndrome (ZES) is a rare but important cause of refractory gastroduodenal ulcers. Fasting plasma gastrin levels should be checked if ZES is suspected. If an ulcer is refractory despite a full course of standard PPI treatment, the dose should be doubled and administration of another type of PPI considered.
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Affiliation(s)
- Heung Up Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
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Raithel M, Hagel A, Albrecht H, Zopf Y, Naegel A, Baenkler HW, Buchwald F, Schultis HW, Kressel J, Hahn EG, Konturek P. Excretion of urinary histamine and N-tele methylhistamine in patients with gastrointestinal food allergy compared to non-allergic controls during an unrestricted diet and a hypoallergenic diet. BMC Gastroenterol 2015; 15:41. [PMID: 25888445 PMCID: PMC4389952 DOI: 10.1186/s12876-015-0268-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 03/11/2015] [Indexed: 12/28/2022] Open
Abstract
Background Patients with gastrointestinal food allergy are characterised by increased production of mast cell derived mediators upon allergen contact and present often with unspecific symptoms. The aim of this study was to evaluate urinary histamine and methylhistamine excretion in patients with food allergy and to compare their values with food-tolerant controls. Methods In a retrospective case control study the urinary excretion parameters were analysed from 56 patients (40.9, 19 – 58 years) in whom later food challenge tests confirmed food allergy. During their diagnostic work-up urine was collected during a 12-h period under an unrestricted diet with staple foods and a hypoallergenic potato-rice-diet (each 2 days). Healthy controls underwent the same diet types to define normal excretion parameters. Urinary histamine and n-methylhistamine were determined by ELISA or tandem mass spectrometry, respectively, and were expressed as median (25 – 75% range, μg/mmol creatinine x m2BSA). Results During unrestricted diet urinary histamine was significantly higher in gastrointestinal food allergy than healthy controls (1.42, 0.9 – 2.7 vs 0.87, 0.4 – 1.3; p < 0.0001), while the difference between both groups became marginal during potato-rice diet (1.30, 0.7 – 2.1 vs 1.05, 0.5 – 1.5; p = 0.02). N-methylhistamine was found to be significantly elevated in gastrointestinal food allergy both during unrestricted diet (7.1, 5.0 – 11.2) and potato-rice diet (5.7, 3.7 – 8.7) compared to controls (p < 0.0001). Interestingly, urinary methylhistamine excretion (p < 0.004) and clinical symptom score (p < 0.02) fell significantly when the diet was switched from unrestricted to hypoallergenic food, but was not correlated with symptom scores. Conclusions In gastrointestinal food allergy significantly higher levels of urine histamine and methylhistamine excretion were found under unrestricted diet, reflecting an increased secretion of histamine due to offending foods. Measurement of urinary n-methylhistamine levels may help to find out patients with increased histamine production and/or food-allergen induced clinical symptoms, respectively.
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Affiliation(s)
- Martin Raithel
- Department of Medicine 1, Functional Tissue Diagnostics, Gastroenterology, University Hospital Erlangen, University Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany.
| | - Alexander Hagel
- Department of Medicine 1, Functional Tissue Diagnostics, Gastroenterology, University Hospital Erlangen, University Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany.
| | - Heinz Albrecht
- Department of Medicine 1, Functional Tissue Diagnostics, Gastroenterology, University Hospital Erlangen, University Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany.
| | - Yurdaguel Zopf
- Department of Medicine 1, Functional Tissue Diagnostics, Gastroenterology, University Hospital Erlangen, University Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany.
| | - Andreas Naegel
- Department of Medicine 1, Functional Tissue Diagnostics, Gastroenterology, University Hospital Erlangen, University Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany.
| | - Hanns-Wolf Baenkler
- Department of Medicine 3, Allergology, University Hospital Erlangen, University Erlangen-Nürnberg, Erlangen, 91054, Germany.
| | | | | | - Juergen Kressel
- Department of Medicine 1, Functional Tissue Diagnostics, Gastroenterology, University Hospital Erlangen, University Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany.
| | - Eckhart Georg Hahn
- Department of Medicine 1, Functional Tissue Diagnostics, Gastroenterology, University Hospital Erlangen, University Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany.
| | - Peter Konturek
- Thuringia Clinics, Gastroenterology, Saalfeld, 07318, Germany.
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12
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Abstract
Eosinophilic gastroenteritis (EG) is a rare disorder characterized by eosinophilic infiltration of the gastrointestinal tract. No medication at present is approved by the Food and drug administration of United States for the treatment of EG. The rarity of the disease limits our experience with the different management options. It also limits the ability to conduct randomized controlled trials that could clearly delineate the efficacy of new therapeutic agents. This review assesses the various management options that have been tried on patients with EG.
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Affiliation(s)
- Nancy Gupta
- Department of Medicine, Westchester Medical Center, New York Medical College , Valhalla, NY , USA
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