Eosinophilic Gastroenteritis Treatment & Management

  • Author: MyNgoc T Nguyen; Chief Editor: Julian Katz, MD   more...
 
Updated: Jan 4, 2012
 

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.
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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.
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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.
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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.
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Activity

  • Encourage normal activities.
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Contributor Information and Disclosures
Author

MyNgoc T Nguyen  MD, Clinical Assistant Professor, Department of Peds, University of California at San Francisco

MyNgoc T Nguyen 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  Chief of Gastroenterology, Kaiser Permanente Medical Center; Clinical Faculty, University of California at San Francisco

Disclosure: Nothing to disclose.

Specialty Editor Board

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 Motility Society, American Society for Gastrointestinal Endoscopy, and Israel Medical Association

Disclosure: Takeda Pharmaceuticals Grant/research funds Conducting research; Takeda Pharmaceuticals Consulting fee Consulting; Takeda Pharmaceuticals Honoraria Speaking and teaching; Vecta Consulting fee Consulting; XenoPort Consulting fee Consulting; Eisai Honoraria Speaking and teaching; Wyeth Pharmaceuticals Conducting research; AstraZeneca Grant/research funds Conducting research; Eisai Consulting fee Consulting

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

Disclosure: Medscape Salary Employment

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.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

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, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

  1. 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].

  2. 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].

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

  4. 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. Oct 2011;52(5):272-8. [Medline].

  5. 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. Sep 2011;46(9):1074-80. [Medline].

  6. 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. Dec 9 2011;[Medline].

  7. 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].

  8. Blanchard C, Wang N, Rothenberg ME. Eosinophilic esophagitis: pathogenesis, genetics, and therapy. J Allergy Clin Immunol. Nov 2006;118(5):1054-9. [Medline].

  9. Buchman AL, Wolf D, Gramlich T. Eosinophilic gastrojejunitis associated with connective tissue disease. South Med J. Mar 1996;89(3):327-30. [Medline].

  10. 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].

  11. De Angelis P, Morino G, Pane A, et al. Eosinophilic esophagitis: management and pharmacotherapy. Expert Opin Pharmacother. Apr 2008;9(5):731-40. [Medline].

  12. 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].

  13. 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].

  14. 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].

  15. Kelly KJ. Eosinophilic gastroenteritis. J Pediatr Gastroenterol Nutr. 2000;30 Suppl:S28-35. [Medline].

  16. Khan S. Eosinophilic gastroenteritis. Best Pract Res Clin Gastroenterol. Apr 2005;19(2):177-98. [Medline].

  17. Lee M, Hodges WG, Huggins TL, Lee EL. Eosinophilic gastroenteritis. South Med J. Feb 1996;89(2):189-94. [Medline].

  18. 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].

  19. Moots RJ, Prouse P, Gumpel JM. Near fatal eosinophilic gastroenteritis responding to oral sodium chromoglycate. Gut. Sep 1988;29(9):1282-5. [Medline].

  20. Neustrom MR, Friesen C. Treatment of eosinophilic gastroenteritis with montelukast. J Allergy Clin Immunol. Aug 1999;104(2 Pt 1):506. [Medline].

  21. Rothenberg ME. Eosinophilic gastrointestinal disorders (EGID). J Allergy Clin Immunol. Jan 2004;113(1):11-28; quiz 29. [Medline].

  22. 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].

  23. Spergel JM, Shuker M. Nutritional management of eosinophilic esophagitis. Gastrointest Endosc Clin N Am. Jan 2008;18(1):179-94; xi. [Medline].

  24. 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.

  25. 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].

  26. 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].

  27. Zuo L, Rothenberg ME. Gastrointestinal eosinophilia. Immunol Allergy Clin North Am. Aug/2007;27(3):443-55. [Medline].

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