Medication Summary
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), macrolides, and mast cell stabilizers (eg, cromolyn), has been reported.
Corticosteroids
Class Summary
Have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.
Fluticasone inhaled (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.
Budesonide (Pulmicort Respule) oral viscous suspension
Decreases inflammation, reduces capillary permeability.
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.
Mast cell stabilizers
Class Summary
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.
Leukotriene receptor antagonists
Class Summary
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.
Macrolides
Clarithromycin (Biaxin, Biaxin XL)
Semisynthetic macrolide antibiotic that reversibly binds to P site of 50S ribosomal subunit of susceptible organisms and may inhibit RNA-dependent protein synthesis by stimulating dissociation of peptidyl t-RNA from ribosomes, thereby inhibiting bacterial growth.
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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.
