Clinical and Experimental Gastroenterology (Jun 2019)
Eosinophilic gastroenteritis: diagnosis and clinical perspectives
Abstract
Tagore Sunkara,1,2 Prashanth Rawla,3 Krishna Sowjanya Yarlagadda,1,2 Vinaya Gaduputi21Division of Gastroenterology and Hepatology, Mercy Medical Center, Des Moines, IA 50314, USA; 2Division of Gastroenterology, St. Barnabas Hospital Health System, New York, NY, 10457, USA; 3Department of Internal Medicine, Sovah Health, Martinsville, VA, 24112, USAAbstract: Eosinophilic gastroenteritis (EGE) is a digestive disorder in children and adults that is characterized by eosinophilic infiltration in the stomach and intestine. The underlying molecular mechanisms predisposing to this disease are unknown, but it seems that hypersensitivity response plays a major role in its pathogenesis, as many patients have a history of seasonal allergies, food sensitivities, asthma, and eczema. Symptoms and clinical presentations vary, depending on the site and layer of the gastrointestinal wall infiltrated by eosinophils. Laboratory results, radiological findings, and endoscopy can provide important diagnostic evidence for EGE; however, the cornerstone of the diagnosis remains the histological examination of gastric and duodenal specimens for evidence of eosinophilic infiltration (>20 eosinophils per high-power field), and finally clinicians make the diagnosis in correlation with and by exclusion of other disorders associated with eosinophilic infiltration. Although spontaneous remission is reported in around 30%–40% of EGE cases, most patients require ongoing treatment. The management options for this disorder include both dietary and pharmacological approaches, with corticosteroids being the mainstay of therapy and highly effective. The subsequent course is quite variable. Some patients have no recurrences, while a few experience recurrent symptoms during or immediately after corticosteroid interruption. An alternative therapeutic armamentarium includes mast-cell stabilizers, leukotriene antagonists, antihistamines, immunomodulators, and biological agents. In this review, we provide a summary of the different diagnostic tools utilized in practice, as well as the different therapeutic approaches available for EGE management.Keywords: eosinophilic gastroenteritis, eosinophils, abdominal pain, steroids
