Eosinophilic Gastroenteritis Treatment & Management
- Author: MyNgoc T Nguyen, MD; Chief Editor: Julian Katz, MD more...
Most patients with eosinophilic gastroenteritis respond to conservative measures and oral glucocorticosteroids. 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.
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.
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.
The strong association of eosinophilic gastroenteritis with food allergies has prompted the use of restrictive or elemental diets. However, there is a lack of good, high-quality clinical data regarding the efficacy of dietary interventions.
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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