Eosinophilic Gastroenteritis

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Eosinophilic Gastroenteritis

• First described by Kaijser in 1937
• a rare inflammatory disease of unknown 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

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Eosinophilic Gastroenteritis Pathophysiology (1)

• an allergic or immunologic disorder most common
  proposed cause
• The release of IL-3, GM-CSF, and IL-5 with
  autocrine and/or paracrine activities by
  eosinophils may be involved in the persistence of
  intestinal eosinophil infiltration
  (Gastroenterology 1996110768-774)

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Eosinophilic Gastroenteritis Pathophysiology (2)

• The Klein classification
• 1. Predominant mucosal disease defined as
  infiltration of the mucosa by eosinophils and/or
  evidence of mucosal edema on contrast studies or
  endoscopy, with no evidence of gastrointestinal
  obstruction or eosinophilic ascites(57.5, Gut
  19903154 -58), (48, Abdom Imaging
  199520406-413)

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Eosinophilic Gastroenteritis Pathophysiology (3)

• 2. Predominant disease of the muscularis defined
  as evidence of gastrointestinal stenosis or
  obstruction on contrast studies and/or
  eosinophilic infiltration of the gastrointestinal
  tract without evidence of eosinophilic
  ascites(30, Gut 19903154-58), (33, Abdom
  Imaging 199520406-413)

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Eosinophilic Gastroenteritis Pathophysiology (4)

• 3. Predominant subserosal disease defined as
  eosinophilic infiltration of the gastrointestinal
  tract and eosinophilic ascites (12.5, Gut
  19903154-58), (19, Abdom Imaging
  199520406-413)

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Eosinophilic Gastroenteritis Clinical Aspects (1)

• usually during the third decade of life
• no sex or race predilection
• malefemale ratio 31 (Abdom Imaging
  199520406-413)
• Clinical course chronic, exacerbations and
  remissions

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Eosinophilic Gastroenteritis Clinical Aspects (2)

• Predominant mucosal disease nausea, vomiting,
  abdominal pain, diarrhea, protein-losing
  enteropathy, blood loss, iron-deficiency anemia,
  malabsorption

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Eosinophilic Gastroenteritis Clinical Aspects (3)

• Predominant muscularis disease intermittent
  obstructive symptoms related to thickening and
  rigidity of the wall of the gastrointestinal
  tract, and complications of obstruction such as
  perforation and aspiration
• Predominant subserosal disease clinically like
  predominant mucosal or muscularis disease, but
  must have eosinophilic ascites

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Eosinophilic Gastroenteritis Clinical Aspects (4)

• Laboratory findings
• 1. peripheral eosinophilia
• 2. iron-deficiency anemia with guaiac-positive
  stools
• 3. a low d-xylose excretion level and steatorrhea

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Eosinophilic Gastroenteritis Clinical Aspects (5)

• 4. decreased total protein, albumin, and
  immunoglobulins level
• 5. Charcot-Leyden crystals (extruded mucosal
  eosinophils)
• 6. eosinophilic ascites

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Eosinophilic Gastroenteritis Clinical Aspects (6)

• Diagnosis criteria (Talley et al.)
• 1. gastrointestinal symptoms (abdominal pain,
  nausea, vomiting, weight loss, bloating, and
  diarrhea)
• 2. eosinophilic infiltration of the
  gastrointestinal tract
• 3. exclusion of parasitic disease
• 4. lack of other organ system involvement

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Eosinophilic Gastroenteritis Radiographic
Findings (1)

• Predominant Mucosal Disease
• nonspecific mucosal fold thickening, polyps,
  ulcerations, luminal narrowing, hypersecretion,
  irritability, spasm, areae gastricae, and
  esophageal abnormalities associated with
  eosinophilic esophagitis

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Eosinophilic Gastroenteritis Radiographic
Findings (2)

• Predominant Muscularis Disease
• stenosis, rigidity, and dysmotility, in addition
  to findings associated with predominant mucosal
  disease and eosinophilic esophagitis
• the antrum and/or proximal small bowel are most
  commonly involved

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Eosinophilic Gastroenteritis Radiographic
Findings (3)

• Predominant Subserosal Disease
• eosinophilic ascites, adherent loops of bowel,
  omental and mesenteric thickening, eosinophilic
  lymphadenopathy, eosinophilic pleural effusion,
  any of the findings in predominant mucosal and/or
  muscularis disease

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Eosinophilic GastroenteritisTreatment

• Elimination diets
• Usual therapy oral prednisolone 20-40 mg/day for
  2 weeks, with gradual tapering over a 2- to
  3-month period.
• Oral sodium cromoglycate, 200 mg four times daily
• Ketotifen
• Surgery

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Eosinophilic GastroenteritisPrognosis

• Excellent when treated properly
• rarely mortality
• many of the deaths reported in patients with
  alleged eosinophilic gastroenteritis may actually
  be due to polyarthritis nodosa, visceral lymphoma
  or gastric cancer, or the hypereosinophilic
  syndrome