eMedicine Specialties > Gastroenterology > Intestine
Eosinophilic Gastroenteritis: Treatment & Medication
Updated: Jun 15, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
Elimination of foods implicated by skin testing has variable effects, but resolution of symptoms can sometimes be achieved with amino acid–based elemental diets.
- Supportive treatment with pharmacotherapy, mainly oral glucocorticosteroids, is indicated for those with obstructive symptoms.
- Patients with mucosal layer involvement may benefit from anti-inflammatory medications (eg, oral glucocorticoids, oral cromolyn) and/or diet elimination therapy, particularly if they report a history of food intolerance or allergy.
- Drugs, such as montelukast, ketotifen, suplatast tosilate, and mycophenolate mofetil (inosine monophosphate dehydrogenase inhibitor), and alternative Chinese medicines have been advocated but are generally not successful.
Surgical Care
- Avoid surgery if at all possible, unless it is necessary to relieve persistent pyloric or small bowel obstruction.
- Most patients respond to conservative measures and oral glucocorticosteroids.
- Reoccurrence is possible, even after surgical excision.
Consultations
- Refer patients with persistent abdominal symptoms and peripheral eosinophilia to a GI specialist for workup, endoscopy, and biopsies.
- Refer patients to an allergy/immunology specialist for food skin testing and evaluation of eosinophilia and high IgE levels.
Diet
- The strong association of eosinophilic gastroenteritis with food allergies has prompted the use of restrictive or elemental diets.
- Initially, a trial elimination diet that excludes milk, eggs, wheat and/or gluten, soy, and beef may be helpful. RAST or skin testing can identify food hypersensitivity. If a prohibitive number of food reactions are found, an amino–acid-based diet or elemental diet may be considered.
Activity
- Encourage normal activities.
Medication
Oral glucocorticosteroids with anti-inflammatory properties are the primary therapy, especially for patients with obstructive symptoms and eosinophilic ascites. Most patients with eosinophilic gastroenteritis respond dramatically to oral glucocorticosteroids within 2 months. Successful treatment with other anti-inflammatory medications, such as leukotriene modifiers (eg, montelukast) and mast cell stabilizers (eg, cromolyn), has been reported.
Corticosteroids
Have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.
Fluticasone (Flovent)
Decreases recruitment of inflammatory cells including eosinophils and decreases the release of eotaxins and other inflammatory mediators. Dosage required is higher than dosage used in asthma.
Adult
220-500 mcg PO bid initially for up to 3 mo; spray in mouth and swallow; patient should not eat or drink for 30 min after taking medication
Pediatric
220-440 mcg PO bid for 8 wk as in adults
Avoid use with protease inhibitors
Documented hypersensitivity, first line therapy for status asthmaticus or acute asthma attack; viral, fungal, or bacterial infections
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in impaired liver function, tuberculosis infections, measles/varicella exposure
Budesonide (Pulmicort Respule) oral viscous suspension
Decreases inflammation, reduces capillary permeability.
Adult
Oral viscous budesonide made by mixing 0.5 mg Pulmicort Respule with five 1g packets of sucralose (Splenda) to create a volume of 8-12 mL; administer 2 mg/d
Pediatric
1 mg/d mixed with 5 g of sucralose
Avoid use with protease inhibitors
Documented hypersensitivity; first line therapy for status asthmaticus or acute asthma attack; viral, fungal, or bacterial infections
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in the elderly, in tuberculosis, in ocular HSV
Prednisolone (AK-Pred, Delta-Cortef)
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability. Equivalent dosages of prednisone or methylprednisolone may be used.
Adult
40-60 mg/d PO/IV/IM
Pediatric
0.14-2 mg/kg/d PO/IV/IM qd or divided tid/qid
Decreases effects of salicylates and toxoids (for immunizations); phenytoin, carbamazepine, barbiturates, and rifampin decrease effects of corticosteroids
Documented hypersensitivity; active viral, fungal, or tubercular disease
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in hyperthyroidism, osteoporosis, cirrhosis, peptic ulcer disease, diabetes mellitus, and myasthenia gravis
Mast cell stabilizers
Inhibit degranulation of sensitized mast cells following exposure to allergens.
Cromolyn (Intal, Gastrocrom)
Inhibits release of histamine, leukotrienes, and other mediators from sensitized mast cells. It also inhibits the influx of neutrophils, as well as the formation of the active form of NADPH oxidase which in turn prevents tissue damage caused by oxygen radicals.
Adult
200 mg PO qid 30 min ac and hs
Pediatric
<12 years: Not established
2-12 years: 100 mg PO qid 30 min ac and hs
>12 years: Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Do not use in severe renal or hepatic impairment; symptoms may recur when drug is withdrawn
Leukotriene receptor antagonists
Prevent or reverse some of the pathologic features associated with the inflammatory process mediated by leukotrienes C4, D4, and E4. Successful treatment of eosinophilic gastroenteritis has been reported.
Montelukast (Singulair)
Potent and selective antagonist of leukotriene D4 (LTD4) at the cysteinyl leukotriene receptor, CysLT1.
Adult
10 mg PO qd
Pediatric
5 mg PO qd
Decreased effect with coadministration of carbamazepine, fosphenytoin, phenobarbital, phenytoin, rifabutin, and rifampin
Documented hypersensitivity, acute bronchospasm, status asthmaticus, breastfeeding
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Associated with drowsiness, fever, GI distress, dizziness, headache, nasal congestion, and maculopapular rash; in rare cases, patient may present with systemic eosinophilia
Neuropsychiatric events have been reported, and following further FDA evaluation, the prescribing information has been updated to include case reports during postmarketing surveillance that include agitation, aggression, anxiousness, dream abnormalities, hallucinations, depression, insomnia, irritability, restlessness, suicidal thinking and behavior (including suicide), and tremor
More on Eosinophilic Gastroenteritis |
| Overview: Eosinophilic Gastroenteritis |
| Differential Diagnoses & Workup: Eosinophilic Gastroenteritis |
 Treatment & Medication: Eosinophilic Gastroenteritis |
| Follow-up: Eosinophilic Gastroenteritis |
| Multimedia: Eosinophilic Gastroenteritis |
| References |
| « Previous Page | Next Page » |
References
Kim NI, Jo YJ, Song MH, et al. Clinical features of eosinophilic gastroenteritis [in Korean]. Korean J Gastroenterol. Oct 2004;44(4):217-23. [Medline].
Chen MJ, Chu CH, Lin SC, et al. Eosinophilic gastroenteritis: clinical experience with 15 patients. World J Gastroenterol. Dec 2003;9(12):2813-6. [Medline].
Venkataraman S, Ramakrishna BS, Mathan M, et al. Eosinophilic gastroenteritis--an Indian experience. Indian J Gastroenterol. Oct-Dec 1998;17(4):148-9. [Medline].
Aceves SS, Bastian JF, Newbury RO, et al. Oral viscous budesonide: a potential new therapy for eosinophilic esophagitis in children. Am J Gastroenterol. Oct 2007;102(10):2271-9; quiz 2280. [Medline].
Blanchard C, Wang N, Rothenberg ME. Eosinophilic esophagitis: pathogenesis, genetics, and therapy. J Allergy Clin Immunol. Nov 2006;118(5):1054-9. [Medline].
Buchman AL, Wolf D, Gramlich T. Eosinophilic gastrojejunitis associated with connective tissue disease. South Med J. Mar 1996;89(3):327-30. [Medline].
Chehade M, Magid MS, Mofidi S, et al. Allergic eosinophilic gastroenteritis with protein-losing enteropathy: intestinal pathology, clinical course, and long-term follow-up. J Pediatr Gastroenterol Nutr. May 2006;42(5):516-21. [Medline].
De Angelis P, Morino G, Pane A, et al. Eosinophilic esophagitis: management and pharmacotherapy. Expert Opin Pharmacother. Apr 2008;9(5):731-40. [Medline].
Desreumaux P, Bloget F, Seguy D, et al. Interleukin 3, granulocyte-macrophage colony-stimulating factor, and interleukin 5 in eosinophilic gastroenteritis. Gastroenterology. Mar 1996;110(3):768-74. [Medline].
Gay SP, Shaffer HA, Futterer SF, et al. Gastrointestinal case of the day. Eosinophilic gastroenteritis. AJR Am J Roentgenol. Jul 1996;167(1):241, 244. [Medline].
Jaffe JS, James SP, Mullins GE, et al. Evidence for an abnormal profile of interleukin-4 (IL-4), IL-5, and gamma-interferon (gamma-IFN) in peripheral blood T cells from patients with allergic eosinophilic gastroenteritis. J Clin Immunol. Sep 1994;14(5):299-309. [Medline].
Kelly KJ. Eosinophilic gastroenteritis. J Pediatr Gastroenterol Nutr. 2000;30 Suppl:S28-35. [Medline].
Khan S. Eosinophilic gastroenteritis. Best Pract Res Clin Gastroenterol. Apr 2005;19(2):177-98. [Medline].
Lee M, Hodges WG, Huggins TL, Lee EL. Eosinophilic gastroenteritis. South Med J. Feb 1996;89(2):189-94. [Medline].
Matsushita M, Hajiro K, Morita Y, et al. Eosinophilic gastroenteritis involving the entire digestive tract. Am J Gastroenterol. Oct 1995;90(10):1868-70. [Medline].
Moots RJ, Prouse P, Gumpel JM. Near fatal eosinophilic gastroenteritis responding to oral sodium chromoglycate. Gut. Sep 1988;29(9):1282-5. [Medline].
Neustrom MR, Friesen C. Treatment of eosinophilic gastroenteritis with montelukast. J Allergy Clin Immunol. Aug 1999;104(2 Pt 1):506. [Medline].
Rothenberg ME. Eosinophilic gastrointestinal disorders (EGID). J Allergy Clin Immunol. Jan 2004;113(1):11-28; quiz 29. [Medline].
Spergel JM, Beausoleil JL, Mascarenhas M, et al. The use of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis. J Allergy Clin Immunol. Feb 2002;109(2):363-8. [Medline].
Spergel JM, Shuker M. Nutritional management of eosinophilic esophagitis. Gastrointest Endosc Clin N Am. Jan 2008;18(1):179-94; xi. [Medline].
Talley N. Eosinophilic Gastroenteritis. In: Feldman M, Scharschmidt BF, Sleisenger M, Zorab R, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/ Management. 6th ed. Philadelphia, Pa: WB Saunders; 1998:1679-86.
Urek MC, Kujundzic M, Banic M, et al. Leukotriene receptor antagonists as potential steroid sparing agents in a patient with serosal eosinophilic gastroenteritis. Gut. Sep 2006;55(9):1363-4. [Medline].
Van Dellen RG, Lewis JC. Oral administration of cromolyn in a patient with protein-losing enteropathy, food allergy, and eosinophilic gastroenteritis. Mayo Clin Proc. May 1994;69(5):441-4. [Medline].
Zuo L, Rothenberg ME. Gastrointestinal eosinophilia. Immunol Allergy Clin North Am. Aug/2007;27(3):443-55. [Medline].
Further Reading
Keywords
eosinophilic gastroenteritis, EGE, eosinophilic gastroenteropathy, eosinophilic gastrointestinal disorders, EGID, eosinophilic gastritis
