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Eosinophilic Gastroenteritis Clinical Presentation

  • Author: MyNgoc T Nguyen, MD; Chief Editor: Julian Katz, MD  more...
 
Updated: Dec 29, 2015
 

History

Patients with eosinophilic gastroenteritis may have various clinical presentations depending on the region of the gastrointestinal (GI) tract involved and the depth of the bowel wall involvement. The disease most often involves the stomach and the small bowel. A history of atopy and allergies is present in many of the cases.[7, 8]

Rarely, eosinophilic gastrointestinal disease may be associated with autoimmune connective tissue disease.[9]

Note the following:

  • The mucosal form of eosinophilic gastroenteritis is characterized by vomiting, dyspepsia, abdominal pain, diarrhea, blood loss in the stools, iron deficiency anemia, malabsorption, protein-losing enteropathy, and failure to thrive.
  • The muscularis form, characterized by infiltration of eosinophils predominantly in the muscularis layer, may present with gastrointestinal obstructive symptoms mimicking pyloric stenosis or gastric outlet syndrome.
  • The serosal form, which is less common, presents with significant bloating, exudative ascites, and higher peripheral eosinophil counts.
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Physical Examination

The heterogeneity in the clinical presentation of eosinophilic gastroenteritis is determined by the site and depth of eosinophilic intestinal infiltration.

Approximately 50% of patients have a history of atopy (eg, hay fever, asthma, food allergy). In children, a history of allergy is even more common.

Children and adolescents can present with growth retardation, failure to thrive, delayed puberty, or amenorrhea. Adults have abdominal pain, diarrhea, or dysphagia.

Patients with muscle layer involvement typically present with pyloric or intestinal obstruction. The eosinophilic involvement often is localized to the stomach but can involve the small bowel. Cramping and abdominal pain associated with nausea and vomiting occur frequently. Food allergy and past history of allergy are less common in these patients than in patients with mucosal layer disease.

Involvement of the serosal layer is the least common form of the disease. The entire GI wall usually is involved. These patients typically present with eosinophilic ascites. Serosal and visceral peritoneal inflammation leads to leakage of fluids.

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Contributor Information and Disclosures
Author

MyNgoc T Nguyen, MD Clinical Associate Professor, Department of Pediatrics, University of California, San Francisco, School of Medicine

MyNgoc T Nguyen, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology

Disclosure: Nothing to disclose.

Coauthor(s)

Jean-Luc Szpakowski, MD 

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Julian Katz, MD Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

Ronnie Fass, MD, FACP, FACG Chief of Gastroenterology, Head of Neuroenteric Clinical Research Group, Southern Arizona Veterans Affairs Health Care System; Professor of Medicine, Division of Gastroenterology, University of Arizona School of Medicine

Ronnie Fass, MD, FACP, FACG is a member of the following medical societies: American College of Gastroenterology, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, American Neurogastroenterology and Motility Society, American Society for Gastrointestinal Endoscopy, Israeli Medical Association

Disclosure: Received grant/research funds from Takeda Pharmaceuticals for conducting research; Received consulting fee from Takeda Pharmaceuticals for consulting; Received honoraria from Takeda Pharmaceuticals for speaking and teaching; Received consulting fee from Vecta for consulting; Received consulting fee from XenoPort for consulting; Received honoraria from Eisai for speaking and teaching; Received grant/research funds from Wyeth Pharmaceuticals for conducting research; Received grant/research funds f.

Acknowledgements

Simmy Bank, MD Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine

Disclosure: Nothing to disclose.

References
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  2. Mehta P, Furuta GT. Eosinophils in gastrointestinal disorders: eosinophilic gastrointestinal diseases, celiac disease, inflammatory bowel diseases, and parasitic infections. Immunol Allergy Clin North Am. 2015 Aug. 35 (3):413-37. [Medline].

  3. Ito J, Fujiwara T, Kojima R, Nomura I. Racial differences in eosinophilic gastrointestinal disorders among Caucasian and Asian. Allergol Int. 2015 Jul. 64 (3):253-9. [Medline].

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  5. Chen MJ, Chu CH, Lin SC, et al. Eosinophilic gastroenteritis: clinical experience with 15 patients. World J Gastroenterol. 2003 Dec. 9(12):2813-6. [Medline].

  6. Venkataraman S, Ramakrishna BS, Mathan M, et al. Eosinophilic gastroenteritis--an Indian experience. Indian J Gastroenterol. 1998 Oct-Dec. 17(4):148-9. [Medline].

  7. Tien FM, Wu JF, Jeng YM, Hsu HY, Ni YH, Chang MH, et al. Clinical features and treatment responses of children with eosinophilic gastroenteritis. Pediatr Neonatol. 2011 Oct. 52(5):272-8. [Medline].

  8. Zhang L, Duan L, Ding S, Lu J, Jin Z, Cui R, et al. Eosinophilic gastroenteritis: clinical manifestations and morphological characteristics, a retrospective study of 42 patients. Scand J Gastroenterol. 2011 Sep. 46(9):1074-80. [Medline].

  9. Lecouffe-Desprets M, Groh M, Bour B, Le Jeunne C, Puechal X. Eosinophilic gastrointestinal disorders associated with autoimmune connective tissue disease. Joint Bone Spine. 2015 Dec 18. [Medline].

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  11. Savino A, Salvatore R, Cafarotti A, Cecamore C, De Sanctis S, Angelucci D, et al. Role Of Ultrasonography in the Diagnosis and Follow-Up of Pediatric Eosinophilic Gastroenteritis: a Case Report and Review of the Literature. Ultraschall Med. 2011 Dec 9. [Medline].

  12. [Guideline] Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011 Jul. 128(1):3-20.e6; quiz 21-2. [Medline].

  13. [Guideline] Sharaf RN, Shergill AK, Odze RD, Krinsky ML, Fukami N, Jain R, et al. Endoscopic mucosal tissue sampling. Gastrointest Endosc. 2013 Aug. 78(2):216-24. [Medline]. [Full Text].

  14. Lucendo AJ, Serrano-Montalban B, Arias A, Redondo O, Tenias JM. Efficacy of dietary treatment for inducing disease remission in eosinophilic gastroenteritis. J Pediatr Gastroenterol Nutr. 2015 Jul. 61 (1):56-64. [Medline].

  15. Prussin C. Eosinophilic gastroenteritis and related eosinophilic disorders. Gastroenterol Clin North Am. 2014 Jun. 43 (2):317-27. [Medline].

  16. Elliott JA, McCormack O, Tchrakian N, et al. Eosinophilic ascites with marked peripheral eosinophilia: a diagnostic challenge. Eur J Gastroenterol Hepatol. 2014 Apr. 26 (4):478-84. [Medline].

  17. Gupta N, Aggarwal A, Gupta R, Sule S, Wolf DC. The management of eosinophilic gastroenteritis. Scand J Gastroenterol. 2015. 50 (11):1309-14. [Medline].

 
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Biopsy specimen of eosinophilic gastroenteritis.
Biopsy specimen of eosinophilic gastroenteritis.
Biopsy specimen of eosinophilic gastroenteritis.
 
 
 
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