Eosinophils enteropathy

Whilst eosinophils appear unimportant in the induction of protective responses to GI helminths, they are present in large numbers in the inflamed gut and it has therefore been suggested that they play a part in the induction of enteropathy. Moreover, eosinophils have been implicated in the induction of intestinal inflammation eosinophilic gastroenteritis, ulcerative colitis and Crohn s disease. However, IL-5-deficient mice, or GM-CSF transgenic mice (which typically have a blood eosinophilia of approximately 25%) infected with T. spiralis did not show a significant exacerbation or amelioration of either protective or pathological responses (C.E. Lawrence, unpublished observation). 

In some cases, invasive tests such as endoscopy are needed. For most gastroenterological allergies, small bowel biopsy shows a patchy enteropathy with nonspecific inflammatory infiltrate (lymphocytes, monocytes, eosinophils). If the diagnosis is positive, the mucosa improves when the offending proteins are removed from the diet. Histology of the biopsy samples often confirms the diagnosis but does not indicate which foods are responsible for the reaction (Sampson, 2004). 

Almost all patients with eosinophilic gastroenteritis have a peripheral eosinophilia. A history of allergy can be obtained in half of the patients. The stomach can be solely involved, but more commonly the small bowel also participates in the disease process. If patients only have eosinophilic gastritis, they present with epigastric pain, nausea and vomiting or hematemesis and/or melena, while patients with eosinophilic enteritis will have diarrhea, malabsorption or a protein-losing enteropathy. 

The mucosal form (the most common variant) is characterised by vomiting, abdominal pain, diarrhoea, blood loss, iron deficiency anaemia, malabsorption, and protein-losing enteropathy. The muscular form is characterised by eosinophilic infiltration in the muscular layer leading to a thickening of the bowel wall that may cause bowel obstruction. The serological form occurs in only a minority of cases, and is characterised by exudative ascites and a higher peripheral eosinophil count than that associated with... 

Two main forms of food-induced gastroenteropathy can be distinguished from coeliac disease eosinophilic gastroenteritis and enteropathy with villous atrophy. The very considerable literature concerning coeliac disease (gluten-sensitive enteropathy) will not be reviewed here, except to say that it is a malabsorption syndrome characterized by typical subtotal villous atrophy of the jejunal mucosa and response to a gluten-free diet. Multiple... 

Waldman et aL (1967) described a group of milk-sensitive children who presented with failure to thrive and protein-losing enteropathy. The patients had other associated atopic features and peripheral eosinophilia half also had jejunal eosinophilic infiltration. Other reports have linked similar clinical patterns with hypersensitivity to other foods and provided... 

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