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 and the small bowel. A history of atopy and allergies is present in many of the cases. [8, 9]
Rarely, eosinophilic gastrointestinal disease may be associated with autoimmune connective tissue disease. [10]
Note the following:
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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.
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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.
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The serosal form, which is less common, presents with significant bloating, exudative ascites, and higher peripheral eosinophil counts.
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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Biopsy specimen of eosinophilic gastroenteritis.
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Biopsy specimen of eosinophilic gastroenteritis.
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Biopsy specimen of eosinophilic gastroenteritis.
