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Eosinophilic Gastroenteritis: Clinical Manifestation, Natural Course, and Evaluation of Treatment with Corticosteroids and Vedolizumab

  • Tanja Grandinetti
  • Luc Biedermann
  • Christian Bussmann
  • Alex Straumann
  • Petr HruzEmail author
Original Article
  • 64 Downloads

Abstract

Background

Eosinophilic gastroenteritis (EGE) is a rare, chronic inflammatory condition of the gastrointestinal tract. Little is known about its natural history and treatment outcomes. The aims of our analysis were to describe clinical presentation, response to current medical treatments, and to evaluate the response of refractory EGE to anti-integrin therapy.

Methods

Patients with confirmed diagnosis of EGE fulfilling the diagnostic criteria: (1) the presence of gastrointestinal symptoms, (2) dense eosinophilic infiltration of the gastrointestinal mucosa, and (3) exclusion of other conditions leading to gastrointestinal eosinophilia were included in this analysis. In patients non-responding to corticosteroids and/or anti-TNF treatment the integrin blocker vedolizumab was used.

Results

EGE patients (n = 22) were predominantly female (63%) with a median age at diagnosis of 41.5 years. The most frequent symptoms were abdominal pain (100%), diarrhea (59%), nausea/vomiting (36%), and bloating (27%). No pathognomonic endoscopic alterations were found. Eosinophilic infiltration was observed in the majority of patients in more than one segment. Patients were treated with systemic steroids, topical, and enteral release steroids in 21/22 (95%) patients, proton pump inhibitors in 7/22 (32%), TNFα inhibitors in 3/22 (14%), and vedolizumab in 4/22 (18%) patients. In 3/4 of steroid-refractory patients vedolizumab induced a clinical and histological improvement.

Conclusions

The combination of highly variable clinical presentation, subtle endoscopic abnormalities, and involvement of several GI segments undermines the difficulty to diagnose EGE and the need for structured biopsy sampling. Corticosteroids were efficient in the majority of patients to induce remission. Response to the integrin blocker vedolizumab suggests further assessment in refractory cases.

Keywords

Eosinophilic gastroenteritis Vedolizumab Steroid-refractory 

Abbreviations

EoE

Eosinophilic esophagitis

EGE

Eosinophilic gastroenteritis

EGIDS

Eosinophilic gastrointestinal diseases

HPF

High power field

IgE

Immunoglobulin E

PGA

Patient global assessment

PPI

Proton pump inhibitor

TNFα

Tumor necrosis factor alpha

Notes

Author’s contribution

PH and AS conceptualized and designed the clinical question and drafted the initial manuscript; TG and LB evaluated the patient data and drafted the initial manuscript; CB performed histological analysis and critically reviewed the manuscript. All authors read and approved the final manuscript as submitted.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.

Supplementary material

10620_2019_5617_MOESM1_ESM.docx (26 kb)
Supplementary material 1 (DOCX 25 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Gastroenterology and HepatologyUniversity Hospital BaselBaselSwitzerland
  2. 2.Division of Gastroenterology and HepatologyUniversity Hospital ZurichZurichSwitzerland
  3. 3.Swiss EoE Clinic, Division of GastroenterologyUniversity Hospital ZurichZurichSwitzerland
  4. 4.Institute of Pathology ViollierBaselSwitzerland

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