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Eosinophilic Gastroenteritis

 Eosinophilic Gastroenteritis


DISEASE OVERVIEW

Eosinophilic gastroenteritis is a rare digestive disease characterized by the triad of eosinophilic infiltration of segments of the gastrointestinal tract, abnormalities of gastrointestinal function (varying from dyspepsia and obstruction to diarrhea and ascites) and exclusion of other diseases with peripheral eosinophilia. Eosinophilic esophagitis is increasingly being recognized and is not included in this report

SIGNS & SYMPTOMS

Eosinophilic gastroenteritis may affect any part of the gastrointestinal tract from the esophagus to the rectum. Symptoms include dysphagia (sometimes presenting as food impaction), heartburn, abdominal pain, nausea, vomiting, diarrhea, weight loss, and bloating (ascites is possible). The eosinophilic infiltration may involve one or more layers of the gastrointestinal wall. The particular symptoms present in each person depend upon the layer and the location of involvement. Most commonly, the stomach wall and the small bowel are involved. Mucosal involvement leads to protein-losing enteropathy and malabsorption. Muscle layer involvement causes abdominal pain, vomiting, dyspeptic symptoms and bowel obstruction. Subserosal involvement predominantly causes ascites with marked eosinophilia. Sometimes eosinophilic pleural effusion is present. Eosinophilic gastroenteritis is a chronic, waxing and waning condition.

CAUSES

The exact cause of eosinophilic gastroenteritis is unknown. Some cases of this disease may be caused by a hypersensitivity to certain foods or other unknown allergens. Often, a family history of allergy is present. Atopy (asthma, hay fever or eczema) is present in a subset of patients. Food allergies are common.

DISORDERS WITH SIMILAR SYMPTOMS

Symptoms of the following disorders can be similar to those of eosinophilic gastroenteritis. Comparisons may be useful for a differential diagnosis:

Whipple’s disease is an uncommon digestive disorder of microbial origin that affects the lining of the small intestine and results in malabsorption of nutrients. This disorder may also affect other organs of the body. (For more information on this disorder, choose “Whipple” as your search term in the Rare Disease Database.)

Refractory celiac disease is a chronic intestinal malabsorption disorder caused by intolerance to gluten, an insoluble component of wheat and other grains. Clinical and/or histologic improvement of symptoms follows withdrawal of dietary gluten-containing grains. (For more information on this disorder, choose “refractory celiac disease” as your search term in the Rare Disease Database.)

Mastocytosis is a genetic disorder characterized by abnormal accumulations of a particular type of cell (mast cells) normally found in connective tissue. The liver, spleen, lungs, bone, skin and sometimes the membrane surrounding the brain and spine (meninges) may be affected. (For more information on this disorder, choose “mastocytosis” as your search term in the Rare Disease Database.)

Tropical sprue, a disorder of unknown cause, is characterized by malabsorption, multiple nutritional deficiencies, and abnormalities in the small bowel mucosa. It appears to be acquired and related to environmental and nutritional conditions and is most prevalent in the Caribbean, South India and Southeast Asia. (For more information on this disorder, choose “tropical sprue” as your search term in the Rare Disease Database.)

Hypereosinophilic syndrome is characterized by marked blood eosinophilia. It is related to disordered production of myeloid precursor cells or lymphoid T cells. It has a marked clinical heterogenicity. Hematologic malignancy has to be excluded.

Crohn’s disease, also known as ileitis, regional enteritis, or granulomatous colitis, is a form of inflammatory bowel disease characterized by severe, chronic inflammation of the wall of the gastrointestinal tract.

DIAGNOSIS

Some patients present with elevated IgE and eosinophilia of tissue and blood. A careful history may suggest to the physician that a biopsy is required. The results of the biopsy (endoscopic or full-thickness surgical biopsy) are usually diagnostic.

Treatment

Eliminating foods to which a person is allergic may prove helpful in some cases. The corticosteroid drug prednisone is usually an effective treatment for eosinophilic gastroenteritis. Sometimes budesonide can be helpful. Immunosuppressive drugs like azathioprine may be worth trying. Surgery may be necessary in severe cases in which there is an obstruction of the intestines. Other treatment is symptomatic and supportive.

TYPE OF DOCTOR AND DEPARTMENT: Pulmonologist SPECIALIST CAN DIAGNOSE THIS DISEASE.

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