Abstract
Eosinophilic gastroenteritis is a heterogeneous and uncommon disorder characterized by eosinophilic inflammation of the gastrointestinal tissues. The location and depth of infiltration determine its varied manifestations, and the latter is also the basis for the proposed classification into mucosal, muscular and serosal eosinophilic gastroenteritis. Abdominal pain, vomiting, and diarrhea are each present in nearly 50% of the patients, with some overlap. Peripheral eosinophilia is seen in approximately two-thirds of patients with eosinophilic gastroenteritis.
It is now clear that eotaxin, a specific eosinophil chemoattractant, plays a pivotal role in the process of eosinophil production. The differential diagnosis of eosinophilic gastroenteritis in children includes parasitic infections, inflammatory bowel disease, connective tissue diseases, some malignancies and adverse effects of drugs.
Eosinophilic gastroenteritis itself has been strongly associated with food allergies, and concomitant atopic diseases or a family history of allergies is elicited in about 70% of cases. The pediatric experience is unique with respect to recognition of distinctive entities such as allergic procto-colitis, almost exclusively seen in infants, and eosinophilic esophagitis being increasingly reported among children and young adults. The gold standard for diagnosis, usually demonstrated on endoscopie biopsies, is prominent tissue eosinophilia. However, the diagnosis may be obscured by the patchy nature of the disease, and muscular and serosal eosinophilic gastroenteritis subtypes. In the latter cases, full thickness biopsies would be indicated for a definitive diagnosis.
There are many reports of successful treatment of eosinophilic gastroenteritis in children, using a variety of treatment regimens including elimination diets. Corticosteroids remain the most effective agents for controlling symptoms, but unfortunately the relapsing nature of the disease would mandate prolonged corticosteroid use. Reports of favorable responses to new leukotriene inhibitors in patients with eosinophilic gastroenteritis are encouraging; these responses should stimulate future research on the pathophysiology and management of eosinophilic gastroenteritis.
Similar content being viewed by others
References
Kaijser R. Allergic diseases of the gut from the point of view of the surgeon. Arch Klin Chir 1937; 188: 36–64
Naylor AR. Eosinophilic gastroenteritis. Scott Med J 1990; 35: 163–5
Lee CM, Changchien CS, Chen PC, et al. Eosinophilic gastroenteritis: 10 years experience. Am J Gastroenterol 1993; 88(1): 70–4
Goldstein NA, Putnam PE, Dohar JE. Laryngeal cleft and eosinophilic gastroenteritis: report of 2 cases. Arch Otolaryngol Head Neck Surg 2000; 126: 227–30
Blackshaw AJ, Levison DA. Eosinophilic infiltrates of the gastrointestinal tract. J Clin Pathol 1986; 39: 1–7
Rankin SM, Conroy DM, Williams TJ. Eotaxin and eosinophil recruitment: implications for human disease. Mol Med Today 2000; 6(1): 20–7
Bischoff SC. Mucosal allergy: role of mast cells and eosinophil granulocytes in the gut. Baillieres Clin Gastroenterol 1996; 10(3): 443–59
Mishra A, Hogan SP, Brandt EB, et al. An etiological role for aeroallergens and eosinophils in experimental esophagitis. J Clin Invest 2001; 107: 83–90
Wattenwyl FV, Zimmermann A, Netzer P. Synchronous first manifestation of an idiopathic eosinophilic gastroenteritis and bronchial asthma. Eur J Gastroenterol Hepatol 2001; 13: 721–5
Khan S, Orenstein SR. Eosinophilic gastroenteritis masquerading as pyloric stenosis. Clin Pediatr (Bologna) 2000; 39(1): 55–7
Talley NJ, Shorter RG, Zinsmeister AR. Eosinophilic gastroenteritis: a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues. Gut 1990; 31: 54–8
Whitington PF, Whitington GL. Eosinophilic gastroenteropathy in childhood. J Pediatr Gastroenerol Nutr 1988; 7(3): 379–85
Levison DA, Blackshaw AJ. Eosinophilic infiltrates of the gastrointestinal tract. J Clin Pathol 1986; 39: 1–7
Horton KM, Corl FM, Fishman EK. CT of non-neoplastic diseases of the small bowel: spectrum of disease. J Comput Assist Tomogr 1999; 23(3): 417–28
Stevof C, Rao S, Parsons W, et al. EUS and histopathologic correlates in eosinophilic esophagitis. Gastrointest Endosc 2001; 54(3): 373–7
Maroy B. Nonmucosal eosinophilic gastroenteritis: sonographic appearance at presentation and during follow-up of response to prednisone therapy. J Clin Ultrasound 1998; 26: 483–6
Keshavarzian A, Saverymuttu S, Tai PC, et al. Activated eosinophils in familial eosinophilic gastroenteritis. Gastroenterology 1985; 88: 1041–9
DeSchryver-Kecskemeti K, Clouse RE. A previously unrecognized subgroup of ‘eosinophilic gastroenteritis’: association with connective tissue disease. Am J Surg Pathol 1984; 8(3): 171–80
Koga M, Fujiwara M, Hotta N, et al. MBP deposition in eosinophilic gastroenteritis. Allergy 2000; 55: 985–6
Kelly KJ. Eosinophilic gastroenteritis. J Pediatr Gastroenterol Nutr 2000; 30: S28–35
Sampson HA, Anderson JA. Summary and recommendations: classification of gastrointestinal manifestations due to immunologic reactions to foods in infants and young children. J Pediatr Gastroenterol Nutr 2000; 30: S87–94
Orenstein SR, Shalaby TM, Di Lorenzo C, et al. The spectrum of eosinophilic esophagitis in children. Am J Gastroenterol 2000; 95: 1422–30
Khan S, Orenstein SR, Di Lorenzo C, et al. Eosinophilic esophagitis: strictures, impactions, dysphagia [abstract]. Gastroenterology 2000; 118: 532
Muller MJ, Sewell GS. Coexistence of eosinophilic gastroenteritis and Helicobacter pylori gastritis: causality versus coincidence. Dig Dis Sci 2001; 46(8): 1784–6
Kalantar SJ, Lambert JR, Badov D, et al. Dyspepsia due to eosinophilic gastroenteritis. Dig Dis Sci 1997; 42: 2327–32
Barak N, Hart J, Sitrin MD. Enalapril-induced eosinophilic gastroenteritis. J Clin Gastroenterol 2001; 33(2): 157–8
Justinich C, Katz C, Gurbindo C, et al. Elemental diet improves steroid-dependent eosinophilic gastroenteritis and reverses growth failure. J Pediatr Gastroenterol Nutr 1996; 23: 81–5
Sampson HA, Birnbaum AH. AGA technical review on the evaluation of food allergy in gastrointestinal disorders. Gastroenterology 2001; 120: 1026–40
Redondo-Cerezo E, Cabello MJ, Gonzalez Y, et al. Eosinophilic gastroenteritis, our recent experience: one-year experience of atypical onset of an uncommon disease. Scand J Gastroenterol 2000; 36: 1358–60
Russel MG, Zeijen RN, Brummer RJ, et al. Eosinophilic enterocolitis diagnosed by means of technetium-99m albumin scintigraphy and treated with budesonide (CIR). Gut 1994; 35: 1490–2
Tan AC, Kruimel JW, Naber TH. Eosinophilic gastroenteritis treated with non-enteric coated budesonide tablets. Eur J Gastroenterol Hepatol 2001; 13: 425–7
Faubion WA, Perrault J, Burgart LJ, et al. Treatment of eosinophilic esophagitis with inhaled corticosteroids. J Pediatr Gastroenterol Nutr 1998; 27: 90–3
Befus AD, Dick N, Goodacre R, et al. Mast cells from the human intestinal lamina propria. J Immunol 1987; 138: 2604–10
Selbekk BH. The effect of disodium cromoglycate on in vitro mast cell deganulation in human jejunal mucosa. Allergy 1979; 34: 283–8
Perez-Millan A, Martin-Lorente JL, Lopez-Morante A, et al. Subserosal eosinophilic gastroenteritis treated efficaciously with sodium cromoglycate. Dig Dis Sci 1997; 42(2): 342–4
Gioacchino MD, Pizzicannella G, Fini N, et al. Sodium cromoglycate in the treatment of eosinophilic gastroenteritis. Allergy 1990; 45: 161–6
Melamed I, Feanny SJ, Sherman PM, et al. Benefit of ketotifen in patients with esoinophilic gastroenteritis. Am J Med 1991; 90(3): 310–4
Schwartz DA, Pardi DS, Murray JA. Use of montelukast as steroid sparing agent for recurrent eosinophilic gastroenteritis. Dig Dis Sci 2001; 46(8): 1787–90
Neustrom MR, Friesen C. Treatment of eosinophilic gastroenteritis with montelukast [letter]. J Allergy Clin Immunol 1999; 104(2): 506
Shim JJ, Dabbagh K, Takeyama K, et al. Suplatast tosilate inhibits goblet cell metaplasia of airway epithelium in sensitized mice. J Allergy Clin Immunol 2000; 105: 739–45
Tamaoki J, Kondo M, Sakai N, et al. Effect of suplatast tosilate, a TH-2 cytokine inhibitor, on steroid-dependent asthma: a double-blind randomized study. Lancet 2000; 356: 273–8
Shirai T, Hashimoto D, Suzuki K, et al. Successful treatment of eosinophilic gastroenteritis with suplatast tosilate [letter]. J Allergy Clin Immunol 2001; 107(5): 924–5
Acknowledgments
No sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Khan, S., Orenstein, S.R. Eosinophilic Gastroenteritis. Pediatr-Drugs 4, 563–570 (2002). https://doi.org/10.2165/00128072-200204090-00002
Published:
Issue Date:
DOI: https://doi.org/10.2165/00128072-200204090-00002