Eosinophilic gastroenteritis

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did not show a significant exacerbation or amelioration of either protective or pathological responses (C.E. Lawrence, unpublished observation). 

Unlabeled uses Cromolyn has been used as an alternative therapy in refractory forms of chronic urticaria/angioedema. Oral cromolyn has been used for the treatment of food allergies and mucosal and serosal eosinophilic gastroenteritis. 

Food diary is frequently used to evaluate harmful food influence in chronic allergic disease (atopic dermatitis, allergic eosinophilic gastroenteritis, or esophagitis) (Sampson, 1999a). 

These tests are mainly used for the research purposes. Atopic dermatitis and allergic eosinophilic gastroenteritis are examples for disorders with mixed mechanisms, in which both IgE antibody and cell immunity may play a role (Sampson, 2004). 

Crohn s disease Eosinophilic gastroenteritis Ulcerative colitis Whipple s disease... 

Eosinophilic gastroenteritis after enalapril has been described (13). The authors briefly reviewed this rare condition, which is diagnosed on the basis of the presence of gastrointestinal sjmiptoms, eosinophilic infiltration of the gastrointestinal tract, and the absence of parasitic or extra-intestinal disease. It has also been reported after clofazimine and naproxen. 

Barak N, Hart J, Sitrin MD. Enalapril-induced eosinophilic gastroenteritis. J Clin Gastroenterol 2001 33(2) 157-8. 

The differential diagnosis includes pylorospasm (which may cause an increased muscle thickness, but only transiently), (eosinophilic) gastroenteritis, gastric and duodenal ulcers. If the US findings are not clearly diagnostic, an upper GI examination is next. 

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. 

On barium studies a strikingly nodular pattern in the gastric antrum can be seen with relative sparing ofthe body and fundus (lEELEetal. 1979) (Fig. 3.15). Hummer-Ehret et al. (1998) reported that eosinophilic gastroenteritis could mimic hypertrophic pyloric stenosis on US. 

Teele RL, Katz AJ, Goldman H, Kettell RM (1979) Radio-graphic features of eosinophilic gastroenteritis (allergic gastroenteropathy) of childhood. AJR Am J Roentgenol 132 575-580... 

Eosinophilic gastroenteritis is an uncommon condition of unknown aetiology, although it is generally believed to be due to intestinal allergy. Its clinical manifestations can be very heterogeneous, and the disease may mimic peptic ulcer, subacute (or chronic) intestinal obstruction, gastroenteritis, irritable bowel syndrome, or inflammatory bowel disease. 

It is characterised by a selective eosinophilic infiltration of the stomach and/or small intestine. Primary eosinophilic gastroenteritis includes multiple disease entities depending on the level of histological involvement, and may be mucosal, muscular or serosal (Lee et al. 1993). 

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... 

Eosinophilic gastroenteritis is characterized by infiltration of the gut by eosinophil leukocytes. There appear to be at least two distinct groups one in which the infiltrate is predominantly superficial, which is associated with atopy and in which food hypersensitivity can often be demonstrated, and another in which the infiltrate is most marked in the deeper submucosal, muscle, and serosal layers, but which does not appear to be associated with atopy or demonstrable food hypersensitivity. 

Caldwell, J. H., Sharma, H. M., and Hurtubise, P. E., 1978, Eosinophilic gastroenteritis and extreme allergy Immuno-pathological comparison with non-allergic gastrointestinal disease, Gastroenterology 74 1016. 

Wang F, Han J. Delayed eosinophilic gastroenteritis, a possible side effect of clopidogrel Int J Cardiol 2013 165(3) e53. ... 

Gastrointestinal - eosinophilic gastroenteritis A 54-year-old male treated with pegylated IFNa-2a for chronic hepatitis C infection showed abdominal distension and diarrhoea 28 weeks after initiation of therapy. Elevation of the eosinophil count in blood and ascites and eosinophil infiltration observed in gastrointestinal histopathology led to a diagnosis of eosinophilic enteritis but therapy was not initiated due to spontaneous improvement in both the eosinophil count and abdominal symptoms. This appears to be the first case report of eosinophilic enteritis induced by IFN therapy [45 ]. 

Hirano G, Fukunaga A, Sohda T, Kunimoto H, Yotsumoto K, Sakurai K, et al. Eosinophilic gastroenteritis in a patient with chronic hepatitis C who received treatment with pegylated interferon, din J Gastroenterol 2012 5(2) 127-30. 

Fig.4.23. Eosinophilic gastroenteritis. Linitis plastica appearance caused by eosinophilic gastroenteritis. The clue to the diagnosis relates to the infiltration extending into the duodenum, although this was not appreciated at endoscopy...

Fig. 5.13a,b. Eosinophilic gastroenteritis a Note thickening and straightening of the folds of the descending duodenum together with jejunal involvement, b More prominent involvement of the distal duodenum and jejunum (different patient)... 

---