Eosinophilic Gastroenteritis: A Review
- 439 Downloads
- 31 Citations
Abstract
Eosinophilic gastroenteritis is a rare benign disease characterized by tissue eosinophilic infiltration that may involve several digestive tract layers. Also known as allergic, or eosinophilic allergic, gastroenteropathy, it usually involves the stomach and small intestine: rarely the colon. It may or may not be accompanied by higher counts of eosinophils in the peripheral blood. The main clinical manifestations depend on the site affected. It has been classified according to clinical and pathological features, and the symptoms depend on the patient’s immunological response to several cytokines released by eosinophils. Because of lack of understanding of the etiology and triggering factors, treatment is based mainly on corticosteroids; although other drugs acting on the immune system have been tested, the results are not always satisfactory. This review focuses on the epidemiology, pathophysiology, clinical features, and treatment of this hitherto under-diagnosed disease.
Key Words
Eosinophilic gastroenteritis Eosinophils Abdominal pain CorticosteroidsReferences
- 1.Rothenberg ME (2004) Eosinophilic gastrointestinal disorders (EGID). J Allergy Clin Immunol 113:11–28, quiz 29PubMedCrossRefGoogle Scholar
- 2.Talley NJ (2002) Eosinophilic gastroenteritis. In Feldman M, Tschumy Jr. WO, Friedman LS, Sleisenger MH (eds) Sleisenger & Fordtran’s gastrointestinal and liver disease. Pathophysiology/diagnosis/management. Saunders, Philadelphia, pp 1972–1980Google Scholar
- 3.Huang FC, Ko SF, Huang SC, Lee SY (2001) Eosinophilic gastroenteritis with perforation mimicking intussusception. J Pediatr Gastroenterol Nutr 33:613–615PubMedCrossRefGoogle Scholar
- 4.Kaijser R (1937) Zur kenntnis der allergischen affektionen des verdaugskanal von standpunkt des chirurgen aus. Arch Klin Chir 188:36–64Google Scholar
- 5.Bischoff SC (1996) Mucosal allergy: role of mast cells and eosinophil granulocytes in the gut. Baillieres Clin Gastroenterol 10:443–459PubMedCrossRefGoogle Scholar
- 6.Min K, Metcalfe D (1991) Eosinophilic gastroenteritis. Immunol Allergy Clin North Am 11:799–813Google Scholar
- 7.Klein NC, Hargrove RL, Sleisenger MH, Jeffries GH (1970) Eosinophilic gastroenteritis. Medicine (Baltimore) 49:299–319Google Scholar
- 8.Leinbach GE, Rubin CE (1970) Eosinophilic gastroenteritis: a simple reaction to food allergens? Gastroenterology 59:874–889PubMedGoogle Scholar
- 9.Cello JP (1979) Eosinophilic gastroenteritis—a complex disease entity. Am J Med 67:1097–1104PubMedCrossRefGoogle Scholar
- 10.Oyaizu N, Uemura Y, Izumi H, Morii S, Nishi M, Hioki K (1985) Eosinophilic gastroenteritis. Immunohistochemical evidence for IgE mast cell-mediated allergy. Acta Pathol Jpn 35:759–766PubMedGoogle Scholar
- 11.Talley NJ, Shorter RG, Phillips SF, Zinsmeister AR (1990) Eosinophilic gastroenteritis: a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues. Gut 31:54–58PubMedCrossRefGoogle Scholar
- 12.Kelly KJ (2000) Eosinophilic gastroenteritis. J Pediatr Gastroenterol Nutr 30(Suppl):S28–S35PubMedCrossRefGoogle Scholar
- 13.Ureles A, Alschibaja T, Lodico D, Stabins S (1961) Idiopathic eosinophilic infiltration of the gastrointestinal tract, diffuse and circumscribed. Am J Med 30:899–909PubMedCrossRefGoogle Scholar
- 14.Khan S (2005) Eosinophilic gastroenteritis. Best Pract Res Clin Gastroenterol 19:177–198PubMedCrossRefGoogle Scholar
- 15.Sleisenger MH, Fordtran JS (1993) Gastrointestinal disease: pathophysiology, diagnosis, management. Saunders, Philadelphia, p 2 v (xxx, 2136, cxiii, 2120]Google Scholar
- 16.Persic M, Stimac T, Stimac D, Kovac D (2001) Eosinophilic colitis:a rare entity. J Pediatr Gastroenterol Nutr 32:325–326PubMedCrossRefGoogle Scholar
- 17.von Wattenwyl F, Zimmermann A, Netzer P (2001) Synchronous first manifestation of an idiopathic eosinophilic gastroenteritis and bronchial asthma. Eur J Gastroenterol Hepatol 13:721–725PubMedCrossRefGoogle Scholar
- 18.Rossel M, Ceresa S, Las Heras J, Araya M (2000) [Eosinophilic colitis caused by allergy to cow’s milk protein]. Rev Med Chil 128:167–175PubMedGoogle Scholar
- 19.Corsetti M, Basilisco G, Pometta R, Allocca M, Conte D (1999) Mistaken diagnosis of eosinophilic colitis. Ital J Gastroenterol Hepatol 31:607–609PubMedGoogle Scholar
- 20.Cuffari C, Oligny L, Seidman EG (1998) Dientamoeba fragilis masquerading as allergic colitis. J Pediatr Gastroenterol Nutr 26:16–20PubMedCrossRefGoogle Scholar
- 21.Takeyama Y, Kamimura S, Suzumiya J, Oh K, Okumura M, Akahane H, Maruyama H, Nawa Y, Ohkawara T, Kikuchi M (1997) Case report: eosinophilic colitis with high antibody titre against Ascaris suum. J Gastroenterol Hepatol 12:204–206PubMedGoogle Scholar
- 22.Butterfield JH, Murray JA (2002) Eosinophilic gastroenteritis and gluten-sensitive enteropathy in the same patient. J Clin Gastroenterol 34:552–553PubMedCrossRefGoogle Scholar
- 23.Barak N, Hart J, Sitrin MD (2001) Enalapril–induced eosinophilic gastroenteritis. J Clin Gastroenterol 33:157–158PubMedCrossRefGoogle Scholar
- 24.Lange P, Oun H, Fuller S, Turney JH (1994) Eosinophilic colitis due to rifampicin. Lancet 344:1296–1297PubMedCrossRefGoogle Scholar
- 25.Lee JY, Medellin MV, Tumpkin C (2000) Allergic reaction to gemfibrozil manifesting as eosinophilic gastroenteritis. South Med J 93:807–808PubMedGoogle Scholar
- 26.Bridges AJ, Marshall JB, Diaz-Arias AA (1990) Acute eosinophilic colitis and hypersensitivity reaction associated with naproxen therapy. Am J Med 89:526–527PubMedCrossRefGoogle Scholar
- 27.Mason T, Andablo A (2003) Eosinophilic gastroenteritis. J Gen Intern Med 18:73Google Scholar
- 28.Khan S, Orenstein SR (2000) Eosinophilic gastroenteritis masquerading as pyloric stenosis. Clin Pediatr (Phila) 39:55–57CrossRefGoogle Scholar
- 29.Khalil M, Granieri R (2003) An unusual cause of ascites:a case of eosinophilic gastroenteritis. J Gen Intern Med 18:66–67Google Scholar
- 30.Kuri K, Lee M (1994) Eosinophilic gastroenteritis manifesting with ascites. South Med J 87:956–957PubMedGoogle Scholar
- 31.Justinich C, Katz A, Gurbindo C, Lepage G, Chad Z, Bouthillier L, Seidman E (1996) Elemental diet improves steroid-dependent eosinophilic gastroenteritis and reverses growth failure. J Pediatr Gastroenterol Nutr 23:81–85PubMedCrossRefGoogle Scholar
- 32.Vara-Thorbeck C, Toscano-Mendez R, Osorio D (1997) Eosinophilic gastroenteritis: diagnostic laparoscopy. Surg Laparosc Endosc 7:66–69PubMedCrossRefGoogle Scholar
- 33.Al-Herz W, Barone C, Mehta D, Justinich C, Morales CM, Akhilesh M, Stephen J (2002) Mast cell number in the upper gastrointestinal tract of patients with idiopathic eosinophilic gastroenteritis. J Allergy Clin Immunol 109:S248CrossRefGoogle Scholar
- 34.Ngo P, Furuta G, Burks W (2004) The pathobiology of eosinophilic gastroenteritis of childhood:is it really the eosinophil, allergic mediated, or something else? Curr Gastroenterol Rep 6:436–440PubMedCrossRefGoogle Scholar
- 35.Beil WJ, Weller PF, Tzizik DM, Galli SJ, Dvorak AM (1993) Ultrastructural immunogold localization of tumor necrosis factor-alpha to the matrix compartment of eosinophil secondary granules in patients with idiopathic hypereosinophilic syndrome. J Histochem Cytochem 41:1611–1615PubMedGoogle Scholar
- 36.Desreumaux P, Bloget F, Seguy D, Capron M, Cortot A, Colombel JF, Janin A (1996) Interleukin 3, granulocyte-macrophage colony-stimulating factor, and interleukin 5 in eosinophilic gastroenteritis. Gastroenterology 110:768–774PubMedCrossRefGoogle Scholar
- 37.Hogan SP, Mishra A, Brandt EB, Royalty MP, Zimmermann N, Foster PS, Rothenberg ME (2001) Molecular dissection of experimental oral antigen–induced eosinophilic gastroenteritis reveals a pathological role for eotaxin and eosinophils. J Allergy Clin Immunol 107:S34Google Scholar
- 38.Prussin C, James SP, Huber MM, Klion AD, Metcalfe DD. Pilot study of anti-IL-5 in eosinophilic gastroenteritis. J Allergy Clin Immunol 111:S275Google Scholar
- 39.Tajima K, Katagiri T (1996) Deposits of eosinophil granule proteins in eosinophilic cholecystitis and eosinophilic colitis associated with hypereosinophilic syndrome. Dig Dis Sci 41:282–288PubMedCrossRefGoogle Scholar
- 40.Chehade M, Qin L, Magid M, Castro R, Sampson H, Beyer K (2003) Expression of TGF-[beta] and IL-10 in patients with allergic eosinophilic gastroenteritis and esophagitis. J Allergy Clin Immunol 111:S291CrossRefGoogle Scholar
- 41.Forbes E, Murase T, Yang M, Matthaei KI, Lee JJ, Lee NA, Foster PS, Hogan SP (2004) Immunopathogenesis of experimental ulcerative colitis is mediated by eosinophil peroxidase. J Immunol 172:5664–5675PubMedGoogle Scholar
- 42.Menzies-Gow A, Ying S, Sabroe I, Stubbs VL, Soler D, Williams TJ, Kay AB (2002) Eotaxin (CCL11) and eotaxin-2 (CCL24) induce recruitment of eosinophils, basophils, neutrophils, and macrophages as well as features of early- and late-phase allergic reactions following cutaneous injection in human atopic and nonatopic volunteers. J Immunol 169:2712–2718PubMedGoogle Scholar
- 43.Kinderman AL, Shim TL (2003) Eosinophilic gastroenteritis:an unusual cause of chronic diarrhea and ascites. J Gen Intern Med 18:68Google Scholar
- 44.Le Connie D, Nguyen H (2004) Eosinophilic gastroenteritis, ascites, and pancreatitis: a case report and review of the literature. South Med J 97:905–906PubMedCrossRefGoogle Scholar
- 45.Lucendo AJ, Carrion G, Navarro M, Pascual JM, Gonzalez P, Castillo P, Erdozain JC (2004) Eosinophilic esophagitis in adults: an emerging disease. Dig Dis Sci 49:1884–1888PubMedCrossRefGoogle Scholar
- 46.Noel RJ, Putnam PE, Collins MH, Assa’ad AH, Guajardo JR, Jameson SC, Rothenberg ME (2004) Clinical and immunopathologic effects of swallowed fluticasone for eosinophilic esophagitis. Clin Gastroenterol Hepatol 2:568–575PubMedCrossRefGoogle Scholar
- 47.Croese J, Fairley SK, Masson JW, Chong AK, Whitaker DA, Kanowski PA, Walker NI (2003) Clinical and endoscopic features of eosinophilic esophagitis in adults. Gastrointest Endosc 58:516–522PubMedCrossRefGoogle Scholar
- 48.Thomas E, Lev R, McCahan JF, Pitchumoni CS (1975) Eosinophilic gastroenteritis with malabsorption, extensive villous atrophy, recurrent hemorrhage and chronic pulmonary fibrosis. Am J Med Sci 269:259–265PubMedCrossRefGoogle Scholar
- 49.Kaplan SM, Goldstein F, Kowlessar OD (1970) Eosinophilic gastroenteritis. Report of a case with malabsorption and protein-losing enteropathy. Gastroenterology 58:540–545PubMedGoogle Scholar
- 50.Garcia-Sancho T, Rodriguez-Montes J, Sastre A, Jimenez P, Suarez-Miguelez J, Garcia-Sancho M (1995) Gastroduodenal: acute abdomen due to eosinophilic gastroenteritis: review of 11 cases. Br J Surg 82:46CrossRefGoogle Scholar
- 51.Tran D, Salloum L, Tshibaka C, Moser R (2000) Eosinophilic gastroenteritis mimicking acute appendicitis. Am Surg 66:990–992PubMedGoogle Scholar
- 52.Whitaker IS, Gulati A, McDaid JO, Bugajska-Carr U, Arends MJ (2004) Eosinophilic gastroenteritis presenting as obstructive jaundice. Eur J Gastroenterol Hepatol 16:407–409PubMedCrossRefGoogle Scholar
- 53.Box JC, Tucker J, Watne AL, Lucas G (1997) Eosinophilic colitis presenting as a left-sided colocolonic intussusception with secondary large bowel obstruction: an uncommon entity with a rare presentation. Am Surg 63:741–743PubMedGoogle Scholar
- 54.Garcia-Sancho T, Garcia-Sancho M, Rodriguez-Montes J, Sastre A, Asenio P (1995) Gastroduodenal:pseudotumoural eosinophilic colitis. Br J Surg 82:46–47CrossRefGoogle Scholar
- 55.Madhotra R, Eloubeidi MA, Cunningham JT, Lewin D, Hoffman B (2002) Eosinophilic gastroenteritis masquerading as ampullary adenoma. J Clin Gastroenterol 34:240–242PubMedCrossRefGoogle Scholar
- 56.Lucendo Villarin AJ, Carrion Alonso G, Navarro Sanchez M, Martin Chavarri S, Gomez Senent S, Castillo Grau P, Pascual Turrion JM, Gonzalez Sanz-Agero P (2005) Eosinophilic esophagitis in adults, an emerging cause of dysphagia. Description of 9 cases. Rev Esp Enferm Dig 97:229–239PubMedGoogle Scholar
- 57.Patel SM, Falchuk KR (2005) Three brothers with dysphagia caused by eosinophilic esophagitis. Gastrointest Endosc 61:165–167PubMedCrossRefGoogle Scholar
- 58.Dahms BB (2004) Reflux esophagitis:sequelae and differential diagnosis in infants and children including eosinophilic esophagitis. Pediatr Dev Pathol 7:5–16PubMedCrossRefGoogle Scholar
- 59.Potter JW, Saeian K, Staff D, Massey BT, Komorowski RA, Shaker R, Hogan WJ (2004) Eosinophilic esophagitis in adults: an emerging problem with unique esophageal features. Gastrointest Endosc 59:355–361PubMedCrossRefGoogle Scholar
- 60.Cury EK, Schraibman V, Faintuch S (2004) Eosinophilic infiltration of the esophagus: gastroesophageal reflux versus eosinophilic esophagitis in children—-discussion on daily practice. J Pediatr Surg 39:e4–e7PubMedCrossRefGoogle Scholar
- 61.Alexakis N, Campbell F, Eardley N, Smart HL, Garvey C, Neoptolemos JP (2005) T cell lymphoplasmacellular and eosinophilic infiltration of the pancreas with involvement of the gallbladder and duodenum in non-alcoholic duct-destructive chronic pancreatitis. Langenbecks Arch Surg 390:32–38PubMedCrossRefGoogle Scholar
- 62.Euscher E, Vaswani K, Frankel W (2000) Eosinophilic pancreatitis: a rare entity that can mimic a pancreatic neoplasm. Ann Diagn Pathol 4:379–385PubMedCrossRefGoogle Scholar
- 63.Tefferi A (2005) Blood eosinophilia: a new paradigm in disease classification, diagnosis, and treatment. Mayo Clin Proc 80:75–83PubMedCrossRefGoogle Scholar
- 64.Tella R, Gaig P, Lombardero M, Garcia-Ortega P, Bartra J, Papo M, Batlle X (2004) Allergic eosinophilic gastroenteritis in a child with Crohn’s disease. J Invest Allergol Clin Immunol 14:159–161Google Scholar
- 65.Buljevac M, Urek MC, Stoos-Veic T (2005) Sonography in diagnosis and follow–up of serosal eosinophilic gastroenteritis treated with corticosteroid. J Clin Ultrasound 33:43–46PubMedCrossRefGoogle Scholar
- 66.Lantto E, Jarvi K, Krekela I, Lantto T, Taavitsainen M, Vedenkangas H, Vorne M (1992) Technetium-99m hexamethyl propylene amine oxine leucocytes in the assessment of disease activity in inflammatory bowel disease. Eur J Nucl Med 19:14–18PubMedCrossRefGoogle Scholar
- 67.Lee K, Hahm K, Kim Y, Kim J, Cho S, Jie H, Park C, Yim H (1997) The usefulness of Tc-99m HMPAO labeled WBC SPECT in eosinophilic gastroenteritis. Clin Nucl Med 22:536–541PubMedCrossRefGoogle Scholar
- 68.Straumann A, Spichtin HP, Bucher KA, Heer P, Simon HU (2004) Eosinophilic esophagitis: red on microscopy, white on endoscopy. Digestion 70:109–116PubMedCrossRefGoogle Scholar
- 69.Kim N, Kim JW, Hwang JH, Lee DH, Lee HS, Lee KH, Kim SW (2005) Visualization of jejunal bleeding by capsule endoscopy in a case of eosinophilic enteritis. Korean J Intern Med 20:63–67PubMedGoogle Scholar
- 70.Guilhon de Araujo Sant’Anna AM, Dubois J, Miron MC, Seidman EG (2005) Wireless capsule endoscopy for obscure small-bowel disorders: final results of the first pediatric controlled trial. Clin Gastroenterol Hepatol 3:264–270PubMedCrossRefGoogle Scholar
- 71.Carpenter H, Talley NJ (2000) The importance of clinicopathological correlation in the diagnosis of inflammatory conditions of the colon: histological patterns with clinical implications. Am J Gastroenterol 95:878–896PubMedCrossRefGoogle Scholar
- 72.Tan AC, Kruimel JW, Naber TH (2001) Eosinophilic gastroenteritis treated with non-enteric-coated budesonide tablets. Eur J Gastroenterol Hepatol 13:425–427PubMedCrossRefGoogle Scholar
- 73.Melamed I, Feanny SJ, Sherman PM, Roifman CM (1991) Benefit of ketotifen in patients with eosinophilic gastroenteritis. Am J Med 90:310–314PubMedGoogle Scholar
- 74.Bolukbas FF, Bolukbas C, Uzunkoy A, Baba F, Horoz M, Ozturk E (2004) A dramatic response to ketotifen in a case of eosinophilic gastroenteritis mimicking abdominal emergency. Dig Dis Sci 49:1782–1785PubMedCrossRefGoogle Scholar
- 75.Neustrom MR, Friesen C (1999) Treatment of eosinophilic gastroenteritis with montelukast. J Allergy Clin Immunol 104:506PubMedGoogle Scholar
- 76.Daikh BE, Ryan CK, Schwartz RH (2003) Montelukast reduces peripheral blood eosinophilia but not tissue eosinophilia or symptoms in a patient with eosinophilic gastroenteritis and esophageal stricture. Ann Allergy Asthma Immunol 90:23–27PubMedCrossRefGoogle Scholar
- 77.Quack I, Sellin L, Buchner NJ, Theegarten D, Rump LC, Henning BF (2005) Eosinophilic gastroenteritis in a young girl—long term remission under Montelukast. BMC Gastroenterol 5:24PubMedCrossRefGoogle Scholar
- 78.Di Gioacchino M, Pizzicannella G, Fini N, Falasca F, Antinucci R, Masci S, Mezzetti A, Marzio L, Cuccurullo F (1990) Sodium cromoglycate in the treatment of eosinophilic gastroenteritis. Allergy 45:161–166PubMedCrossRefGoogle Scholar
- 79.Shirai T, Hashimoto D, Suzuki K, Osawa S, Aonahata M, Chida K, Nakamura H (2001) Successful treatment of eosinophilic gastroenteritis with suplatast tosilate. J Allergy Clin Immunol 107:924–925PubMedCrossRefGoogle Scholar
- 80.Al-Herz W, Mehta D, McGeady S (2001) Eosinophilic gastroenteritis in children and adolescents. J Allergy Clin Immunol 107:S193Google Scholar
- 81.Straumann A, Spichtin HP, Grize L, Bucher KA, Beglinger C, Simon HU (2003) Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years. Gastroenterology 125:1660–1669PubMedCrossRefGoogle Scholar