EOSINOPHILIC GASTROENTERITIS
Abstract
Background. Eosinophilic gastroenteritis (EGE) is a rare disorder of unknown etiology, characterised by infiltrating eosinophils into one or more layers of gastrointestinal tract and various gastrointestinal manifestations. Signs and symptoms are related to the layer and extent of bowel involved with eosinophilic infiltration bowel with mucosa, muscle, subserosa or all three affected. Steroid therapy remains the corner stone of treatment.
Patients and methods. This paper describes a case of 70-yearold male patient with eosinophilic mucosal disease of upper intestinal wall repeatedly admitted because of epigastralgias, nausea, vomiting and losing weight. Because of hypereosinophilia, a biopsy of duodenal mucosa was performed, despite the normal endoscopic appearance. Numerous eosinophilic infiltrates were histologically confirmed in mucosa and submucosa and remission followed metilprednisolon therapy.
Results. After two years signs of ilness reapearred, and again metilprednisolon therapy was followed by remission which still last.
Conclusions. EGE needs to be recognized by the clinician because it can masquerade as the irritable bowel syndrome. The diagnosis of EGE is confirmed by a characteristic biopsy. Treatment is empiric and gauged to the severity of the clinical manifestations.
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References
Klein NC, Hargrove RL, Sleisenger MH et al. Eosinophilic gastroenteritis. In: Klein NC, Hargrove RL, Sleisenger MH et al eds. Medicine (Baltimore) 1970; 49: 299–319.
Ureles AL, Alschibaja T, Lodico D. Idiopathic eosinophilic infiltration of the gastrointestinal tract, diffuse and circumscribed. Am J Med 1961; 30: 899–901.
Talley NJ, Shorter RG, Philips SF et al. Eosinophilic gastroenteritis: A clinicopathological study of patients with disease of the mucosa, muscle layer and subserosal tissues. Gut 1990; 31: 54–8.
Cello JP. Eosinophilic gastroenteritis – a complex disease entity. Am J Med 1979; 67: 1097–104.
Katz AJ, Goldman H, Grand RJ. Gastric mucosal biopsy in eosinophilic (allergic) gastroenteritis. Gastroenterology 1977; 73: 705–9.
Caldwell J, Tennenbaum J, Bronstein H. Serum IgE in eosinophilic gastroenteritis – response to intestinal challenge in two cases. N Engl J Med 1975; 292: 1388–92.
Landres RT, Kuster GGR, Strum WB. Eosinophilic eosophagitis in a patient with vigorous achalasia. Gastroenterology 1978; 74: 1298–303.
Schoonbroodt D, Horsmans Y, Laka A et al. Eosinophilic gastroenteritis presenting with colitis and cholangitis. Dig Dis Sci 1995; 40: 308–14.
Haberkern CM, Christie DL, Haas JE. Eosinophilic gastroenteritis presenting as ileocolitis. Gastroenterology 1978; 74: 896–9.
Matsushita M, Hajiro K, Morita Y et al. Eosinophilic gastroenteritis involving the entire digestive tract. Am J Gastroenterol 1995; 90: 1868–70.
MacCarthy RL, Talley NJ. Barium studies in diffuse eosinophilic gastroenteritis. Gastrointest Radiol 1990; 15: 183–7.
Man F, Chiocca JC. Achalasia due to eosinophil infiltration: Fact or fiction (letter)? Dig Dis Sci 1993; 38: 1561–5.
Anon. Case records of Massachusetts General Hospital. N Engl J Med 1992; 326: 1342–3.
Walker NI, Croese J, Clouston AD et al. Eosinophilic enteritis in Northeastern Australia. Pathology, association with Ancylostoma caninum and implications. Am J Surg Pathol 1995; 19: 328–31.
Fauci AS, Harley JB, Roberts WC et al. The idiopathic hypereosinophilic syndrome: Clinical patholphyssiologic and therapeutic considerations. Ann Intern Med 1982; 97: 78–84.
Blackshaw AJ, Levison DA. Eosinophilic infiltrates of the gastrointestinal tract. J Clin Pathol 1986; 39: 1–12.
Hogan SP, Mishra A, Brandt EB et al. A critical role for eotaxin in experimental oral antigen-induced eosinophilic gastrointestinal allergy. Proc Natl Acad Sci USA 2000; 97: 6681–93.
Talley NJ, Kephart GM, McGovern TW et al. Deposition of eosinophil granule major basic protein in eosinophilic gastroenteritis and celiac disease. Gastroenterology 1992; 103: 137–42.
Lee CM, Changchien CS, Chen PC et al. Eosinophilic gastroenteritis: 10 years experience. Am J Gastroenterol 1993; 88: 70–4.
Lee M, Hodges WG, Huggins TL, Lee EL. Eosinophilic gastroenteritis. South Med J 1996; 89: 189–93.
Van Dellen RG, Lewis JC. Oral administration of cromolyn in a patient with protein-losing enteropathy, food allergy and eosinophilic gastroenteritits. Mayo Clin Proc 1994; 69: 441–1.
Perez-Milan A, Martin-Lorente JL, Lopez-Morante A et al. Subserosal eosinophilic gastroenteritis treated efficaciously with sodium cromoglycate. Dig Dis Sci 1997; 42: 342–6.
Melamed I, Feanny SJ, Sherman PM, Roifman CM. Benefit of ketotifen in patients with eosinophilic gastroenteritis. Am J Med 1991; 90: 310–8.
Neustrom MR, Friesen C. Treatment of eosinophilic gastroenteritis with monteleukast. J Allergy Clin Immunol 1999; 104: 506–11.
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