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

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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.

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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

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Author notes

  1. Tanja Grandinetti and Luc Biedermann have contributed both equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland

    Tanja Grandinetti & Petr Hruz

  2. Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland

    Luc Biedermann & Alex Straumann

  3. Swiss EoE Clinic, Division of Gastroenterology, University Hospital Zurich, Zurich, Switzerland

    Alex Straumann

  4. Institute of Pathology Viollier, Basel, Switzerland

    Christian Bussmann

Authors
  1. Tanja Grandinetti
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  2. Luc Biedermann
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  4. Alex Straumann
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  5. Petr Hruz
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Contributions

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.

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Correspondence to Petr Hruz.

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Grandinetti, T., Biedermann, L., Bussmann, C. et al. Eosinophilic Gastroenteritis: Clinical Manifestation, Natural Course, and Evaluation of Treatment with Corticosteroids and Vedolizumab. Dig Dis Sci 64, 2231–2241 (2019). https://doi.org/10.1007/s10620-019-05617-3

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  • DOI: https://doi.org/10.1007/s10620-019-05617-3

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