Eosinophilic Gastrointestinal Disease

Himali Meshram
MD Pediatrics, MUHS Fellowship in Pediatric Gastroenterology and Hepatology
Consultant Pediatric Gastroenterologist and Hepatologist, Apollo Clinic, Nagpur, India.

First Created: 04/27/2021  Last Updated: 04/27/2021

Introduction

According to the localization of the gastrointestinal tract, primary eosinophilic gastrointestinal diseases include five variants such as eosinophilic esophagitis, eosinophilic gastritis, eosinophilic gastroenteritis, eosinophilic enteritis, and eosinophilic colitis.1

Pathophysiology

Eosinophilic gastroenteritis (EGE) is a rare chronic inflammatory disease of primary gastrointestinal tract characterized by eosinophilic infiltrates into different layers of the gastrointestinal tract from stomach to the rectum as seen in histopathology. It is an immune mediated disorder.1

Incidence

The incidence is approximately 1-30/1000002

Clinical Features

The mean age at diagnosis varies from 5.9 to 12 years in pediatric population.3 They usually present with non-specific symptoms like gastritis or enteritis, hence missed easily. The main symptoms include feeding difficulties, dysphagia, food impaction, chest pain, gastroesophageal reflux.3 Involvement of muscular layer, manifest as obstructive symptoms such as colic pain, nausea and vomiting.1 Few patients present with severe symptoms like weight loss, gastrointestinal bleeding, intestinal obstruction.2

Investigations

Personal or family history of allergies or atopy is found in around 70% cases of eosinophilic gastroenteritis.2 Peripheral eosinophilia is frequently seen in patients with EGE. However not all patients present with peripheral blood eosinophilia.2 20%-80% of patients present with elevated eosinophil count.1 A definite diagnosis depends on gastrointestinal endoscopy and histopathology. Endoscopic features include hyperemia of GI mucosa, erosions, bleeds, ulcers.2 The common sites affected in EGE are stomach (antrum) and small intestine (duodenum).2 Atleast 15-20 eosinophils per high power microscopic fields are required for the histopathological diagnosis. Various histopathological features in eosinophilic gastrointestinal disease include eosinophilic micro abscess, eosinophile degranulation, fibrosis of subepithelal layer, etc.4 In order to increase the positive detection rate of eosinophilic infiltration, atleast 5-6 biopsy specimens should be obtained.2

Treatment

The two important treatment options available for patients with eosinophilic gastrointestinal diseases are diet control and corticosteroids. Diet control includes gradual elimination of possible food allergens including food items like wheat, milk, eggs, nuts, soy, fish; in patients with prior history of food allergy.4 The primary treatment modality for patients with EGE are corticosteroids. For severe cases methylprednisolone infusion can be used. On the basis of response to the treatment the dose can be slowly reduced and stopped. If the patient relapses while the dosage of steroids is decreased, it is recommended that the dose to be increased and the duration of treatment be extended.2


1. Eosinophilic Gastroenteritis: Case Report and Review in Search for Diagnostic Key Points. López-Medina G, Gallo M, Prado A, Vicuña-Honorato I, Castillo Díaz de León R. Case Rep Gastrointest Med. 2015;2015:239506 2. Diagnosis of eosinophilic gastroenteritis is easily missed. Abassa KK, Lin XY, Xuan JY, Zhou HX, Guo YW. World J Gastroenterol. 2017 May 21;23(19):3556-3564 3. Shaheen NJ, Mukkada V, Eichinger CS, Schofield H , Todorova L,Falk GW. Atural history of eosinophilic esophagitis: a systematic review of epidemiology and disease course. Dis Esophagus.2018 Aug 1;31(8) 4. Recent Progress in the Research of Eosinophilic Esophagitis and Gastroenteritis. Kinoshita Y, Ishimura N, Oshima N, Mikami H, Okimoto E, Jiao DJ, Ishihara S. Digestion. 2016;93(1):7-12.

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