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Eosinophilic Gastroenteritis Treatment & Management

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

Approach Considerations

Most patients with eosinophilic gastroenteritis respond to conservative measures and oral glucocorticosteroids.[10] Patients can be monitored every 6 months.

Avoid surgery if at all possible, unless it is necessary to relieve persistent pyloric or small bowel obstruction. Reoccurrence is possible, even after surgical excision.

Consultations

Refer patients with persistent abdominal symptoms and peripheral eosinophilia to a gastroenterologist for workup, endoscopy, and biopsies.

Refer patients to an allergy/immunology specialist for food skin testing and evaluation of eosinophilia and high IgE levels.

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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.

Dietary considerations

The strong association of eosinophilic gastroenteritis with food allergies has prompted the use of restrictive or elemental diets.[10] However, there is a lack of good, high-quality clinical data regarding the efficacy of dietary interventions.[14]

Educate patients to avoid foods that they cannot tolerate and to seek medical care when needed. 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.

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Surgical Care

 

 

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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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  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].

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  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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