Long-term prognosis and its associated predictive factors in patients with eosinophilic gastroenteritis

BACKGROUND Eosinophilic gastroenteritis(EGE)is a chronic recurrent disease with abnormal eosinophilic infiltration in the gastrointestinal tract.Glucocorticoids remain the most common treatment method.However,disease relapse and glucocorticoid dependence remain notable problems.To date,few studies have illuminated the prognosis of EGE and risk factors for disease relapse.AIM To describe the clinical characteristics of EGE and possible predictive factors for disease relapse based on long-term follow-up.METHODS This was a retrospective cohort study of 55 patients diagnosed with EGE admitted to one medical center between 2013 and 2022.Clinical records were collected and analyzed.Kaplan-Meier curves and log-rank tests were conducted to reveal the risk factors for long-term relapse-free survival(RFS).RESULTS EGE showed a median onset age of 38 years and a slight female predominance(56.4%).The main clinical symptoms were abdominal pain(89.1%),diarrhea(61.8%),nausea(52.7%),distension(49.1%)and vomiting(47.3%).Forty-three(78.2%)patients received glucocorticoid treatment,and compared with patients without glucocorticoid treatments,they were more likely to have elevated serum immunoglobin E(IgE)(86.8%vs 50.0%,P=0.022)and descending duodenal involvement(62.8%vs 27.3%,P=0.046)at diagnosis.With a median follow-up of 67 mo,all patients survived,and 56.4%had at least one relapse.Six variables at baseline might have been associated with the overall RFS rate,including age at diagnosis<40 years[hazard ratio(HR)2.0408,95%confidence interval(CI):1.0082–4.1312,P=0.044],body mass index(BMI)>24 kg/m^(2)(HR 0.3922,95%CI:0.1916-0.8027,P=0.014),disease duration from symptom onset to diagnosis>3.5 mo(HR 2.4725,95%CI:1.220-5.0110,P=0.011),vomiting(HR 3.1259,95%CI:1.5246-6.4093,P=0.001),total serum IgE>300 KU/L at diagnosis(HR 0.2773,95%CI:0.1204-0.6384,P=0.022)and glucocorticoid treatment(HR 6.1434,95%CI:2.8446-13.2676,P=0.003).CONCLUSION In patients with EGE,younger onset age,longer disease course,vomiting and glucocorticoid treatment were risk factors for disease relapse,whereas higher BMI and total IgE level at baseline were protective.

Preliminary evidence in treatment of eosinophilic gastroenteritis in children:A case series

BACKGROUND Eosinophilic gastroenteritis is a rare inflammatory disorder in children.However,there is still no standard guideline in the treatment of pediatric eosinophilic gastroenteritis.AIM To report our experience with the diagnosis and treatment of children with eosinophilic gastroenteritis.METHODS From January 2017 to December 2019,a total of 22 children were diagnosed with eosinophilic gastroenteritis.RESULTS Endoscopic examination showed eosinophil infiltration in the duodenum[mean number of eosinophils/high-power field(HPF)=53.1±81.5],stomach(mean number of eosinophils/HPF=36.8±50.5),and terminal ileum(mean number of eosinophils/HPF=49.0±24.0).All 18 children with low eosinophil infiltration(<14%)responded well to the initial drug treatment without relapse,while two of four children with high eosinophil infiltration(>14%)relapsed after initial methylprednisolone/montelukast treatment.In addition,children with high eosinophil infiltration(>14%)showed symptomatic relief and histological remission without further relapse after receiving budesonide/methylprednisolone as initial or relapse treatment.CONCLUSION Methylprednisolone/montelukast is still the best treatment for children with low eosinophil infiltration(<14%).Budesonide can be considered as the initial or relapse treatment for children with high eosinophil infiltration(>14%).

Fecal microbiota transplantation and prednisone for severe eosinophilic gastroenteritis

Eosinophilic gastroenteritis is a rare disease of unknown etiology. It is characterized by patchy or diffuse eosinophilic infiltration of the bowel wall to a variable depth and various gastrointestinal manifestations. We describe a case of severe eosinophilic gastroenteritis presenting as frequent bowel obstruction and diarrhea in a 35-year-old man. The patient was misdiagnosed and underwent surgery because of intestinal obstruction when he was first admitted to a local hospital. Then he was misdiagnosed as having Crohn&#x02019;s disease in another university teaching hospital. Finally, the patient asked for further treatment from our hospital because of the on-going clinical trial for treating refractory Crohn&#x02019;s disease by fecal microbiota transplantation. Physical examination revealed a slight distended abdomen with diffuse tenderness. Laboratory investigation showed the total number of normal leukocytes with neutrophilia as 90.5%, as well as eosinopenia, monocytopenia and lymphocytopenia. Barium radiography and sigmoidoscopy confirmed inflammatory stenosis of the sigmoid colon. We diagnosed the patient as having eosinophilic gastroenteritis by multi-examinations. The patient was treated by fecal microbiota transplantation combined with oral prednisone, and was free from gastrointestinal symptoms at the time when we reported his disease. This case highlights the importance of awareness of manifestations of a rare disease like eosinophilic gastroenteritis.

Adult eosinophilic gastroenteritis and hypereosinophilic syndromes

Eosinophilic gastroenteritis (EGE) in the adult is a distinctive pathologically-based disorder characterized by an eosinophil-predominant mucosal inflammatory process. Most often,the disorder is detected during endoscopic investigation for abdominal pain or diarrhea. Other causes of gastric and intestinal mucosal eosinophilia require exclusion,including parasitic infections and drug-induced causes. Occasionally,the muscle wall or serosal surface may be involved. EGE appears to be more readily recognized,in large part,due to an evolution in the imaging methods used to evaluate abdominal pain and diarrhea,in particular,endoscopic imaging and mucosal biopsies. Def inition of EGE,however,may be diffi cult,as the normal ranges of eosinophil numbers in normal and abnormal gastric and intestinal mucosa are not well standardized. Also,the eosinophilic inflammatory process may be either patchy or diffuse and the detection of the eosinophilic infiltrates may vary depending on the method of biopsy fixation. Treatment has traditionally focused on resolution of symptoms,and,in some instances,eosinophil quantification in pre-treatment and post-treatment biopsies. Future evaluation and treatment of EGE may depend on precise serological biomarkers to aid in defi nition of the long-term natural history of the disorder and its response to pharmacological or biological forms of therapy.

Eosinophilic gastroenteritis with cytomegalovirus infection in an immunocompetent child

A 3-year-old boy developed transient protein-losing gastroenteropathy associated with cytomegalovirus (CMV) infection. Both IgG and IgM antibodies to CMV were positive in a serologic blood test. Upper gastrointestinal endoscopy showed multiple erosions throughout the body of the stomach, without enlarged gastric folds. Histological examination of the biopsy specimens indicated eosinophilic gastroenteritis and CMV infection. The patient had complete resolution without specific therapy for CMV in four weeks. An allergic reaction as well as CMV infection played important roles in the pathogenesis of this case.

Eosinophilic gastroenteritis presenting as small bowel obstruction: A case report and review of the literature

Eosinophilic gastroenteritis is a rare disease of unknown etiology. It is characterized by eosinophilic infiltration of the bowel wall to a variable depth and symptoms associated with gastrointestinal tract. Recently, the authors experienced a case of eosinophilic gastroenteritis presenting as small bowel obstruction. A 51-year old woman was admitted to our hospital complaining of abdominal pain and vomiting. Physical examination revealed a distended abdomen with diffuse tenderness. Complete blood count showed mild leukocytosis without eosinophilia. Computed tomography confirmed a dilatation of the small intestine with ascites. An emergency laparotomy was performed for a diagnosis of peritonitis due to intestinal obstruction. Segmental resection of the ileum and end to end anastomosis were performed. Histologically, there was a dense infiltration of eosinophils throughout the entire thickness of ileal wall and eosinophilic enteritis was diagnosed. The patient recovered well, and was free from gastrointestinal symptoms at the time when we reported her disease.

Diagnosis of eosinophilic gastroenteritis is easily missed

AIM To analyze the clinical characteristics of eosinophilic gastroenteritis(EGE)and to investigate the situations of missed diagnosis of EGE.METHODS First,the clinical characteristics of 20 EGE patients who were treated at our hospital were retrospectively summarized.Second,159 patients who underwent gastroscopy and 211 patients who underwent colonoscopy were enrolled.The pathological diagnosis showed only chronic inflammation in their medical records.The biopsy slides of these patients were reevaluated to determine the number of infiltrating eosinophils in order to assess the probability of a missed diagnosis of EGE.Finally,122 patients who experienced refractory upper gastrointestinal symptoms for at least one month were recruited.At least 6biopsy specimens were obtained by gastroscopy,and the number of eosinophils that had infiltrated was evaluated.Those who met the pathological diagnostic criteria of EGE underwent further examination to confirm the diagnosis of EGE.The probability of a missed diagnosis of EGE was prospectively investigated.RESULTS Among the 20 patients with EGE,mucosal EGE was found in 15 patients,muscular EGE was found in 3patients and serosal EGE was found in 2 patients.Abdominal pain was the most common symptom.The number of peripheral blood eosinophils was elevated in all 20 patients,all of whom were sensitive to corticosteroids.Second,among the 159 patients who underwent gastroscopy,7(4.40%)patients met the criteria for pathological EGE(eosinophil count≥25/HPF).Among the 211 patients who underwent colonoscopy,9(4.27%)patients met the criteria for pathological EGE(eosinophil count≥30/HPF).No patients with eosinophil infiltration were diagnosed with EGE in clinical practice before or after endoscopy.Although these patients did not undergo further examination to exclude other diseases that can also lead to gastrointestinal eosinophil infiltration,these might be the cases where the diagnosis of EGE was missed.Finally,among the 122 patients with refractory upper gastrointestinal symptoms,eosinophil infiltration was seen in 7 patients(5.74%).The diagnosis of EGE was confirmed in all 7 patients after the exclusion of other diseases that can also lead to gastrointestinal eosinophil infiltration.A positive correlation was observed between the duration of the symptoms and the risk of EGE(r=0.18,P<0.01).The patients whose symptoms persisted longer than 6 mo more readily developed EGE.None of the patients were considered to have EGE by their physicians before endoscopy.CONCLUSION Although EGE is a rare inflammatory disorder,it is easily misdiagnosed.When a long history of abdominal symptoms fails to improve after conventional therapy,EGE should be considered.

Eosinophilic gastroenteritis with abdominal pain and ascites:A case report

BACKGROUND Eosinophilic gastroenteritis(EGE)is a rare disease that presents many unspecific gastroenterological symptoms.The disease includes three types depending on the depth of eosinophil infiltration in the gastrointestinal tract.The serosal type is the most rare,presenting as ascites.CASE SUMMARY A 34-year-old man presented with abdominal pain,diarrhea without bloody stool,or nausea.Laboratory test results revealed a peripheral blood eosinophil count(4.85×10^(9)/L),which was remarkedly elevated.Computed tomography scan demonstrated extensive intestinal wall edema thickening in the duodenum,jejunum,ascending colon and transverse colon;multiple exudative effusion surrounding the intestinal tract,and ascites in the abdominal cavity.A series of examinations excluded eosinophil elevation in secondary diseases.Endoscopic multipoint biopsy detected eosinophilic infiltration in the mucous layer of the transverse colon,with≥50 eosinophils/high power field.All symptoms vanished after a few days of steroid therapy and ascites disappeared within 2 wk.CONCLUSION EGE should be considered in patients with abdominal pain,ascites,and eosinophilia.Multiple point biopsies are essential for diagnosis.

Eosinophilic Gastroenteritis in Tropical Area: about 6 Cases from Senegal

The aetiologies of hypereosinophilia are dominated by digestive parasitosis and drug intake. In the tropics, because of the frequency of parasitosis, eosinophilic digestive pathologies of primary origin, which are rare, may be overlooked. We report 6 cases of eosinophilic gastroenteritis with polymorphic digestive manifestations testifying to the different locations of eosinophilic infiltration in the digestive parietal layer. Three patients had ascites rich in eosinophils, indicative of serous involvement, while the other two had a muscular form, and the last a mucosal involvement. The evolution was favourable in all cases with corticosteroid therapy, but a recurrence was noted in 4 cases when treatment was stopped.

Steroid responsive eosinophilic gastric outlet obstruction in a child

Gastric outlet obstruction is a rare complication of eosinophilic gastroenteritis, most commonly treated surgically. We report a case of eosinophilic gastric outlet obstruction in a child that responded to conservative medical management. A brief review of this clinical entity is also provided.

Eosinophilic gastroenteritis: Pathogenesis, diagnosis, and treatment

Eosinophilic gastroenteritis(EGE)is a gastrointestinal disorder of unclear etiology that is characterized by eosinophilic infiltration of the stomach and small intestine,and consists of mucosal,muscular,and serosal subtypes.Eosinophilic infiltration of the gastrointestinal tract is a fundamental histopathological characteristic of EGE and is driven by several T-helper type 2(Th2)-dependent cytokines and induced by food allergy.Due to the lack of a diagnostic gold standard,EGE has a high rate of delayed diagnosis or misdiagnosis.However,several new diagnostic strategies have been developed,such as novel genetic biomarkers and imaging tests.Although dietary therapy and corticosteroids remain the common choices for EGE treatment,recent decades have seen the emergence of novel treatment alternatives,such as biologics that target particular molecules involved in the pathogenic process.Preliminary investigations and clinical trials have demonstrated the efficacy of biologics and provided additional insights for the era of refractory or corticosteroid-dependent EGE biologics.

Food Allergy Mimicking Pylorus Hypertrophy

Food allergy (FA) is a disease with increasing prevalence and a wide spectrum of clinical manifestations. These include the eosinophilic disorders, which can involve any segment of the gastrointestinal tract (GIT), including the stomach. In this context, three patients with a confirmed diagnosis of food allergy, who were initially diagnosed with pyloric hypertrophy, are presented. All cases showed an adequate response to nutritional management. It is essential to consider food allergy, such as eosinophilic gastroenteritis, as part of the differential diagnosis of gastric outlet obstruction in those patients who present vomiting secondary to pyloric hypertrophy.