Allergic Gastroenteropathy

Ta, Waldmann; Rd, Wochner; Laster, Leonard; Rs, Gordon

doi:10.1056/nejm196704062761401

Cited by 174 publications

(14 citation statements)

References 27 publications

(2 reference statements)

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“…Diverse gastrointestinal reactions have been described which include iron deficiency anemia associated with gastrointestinal blood loss (28), protein-losing enteropathy (26), malabsorption syndrome with defects in fat and/or carbohydrate absorption (6,9,15), and a colitis-like syndrome (I2, 17,20,22).…”

Section: Abbreviation Fpie Food Protein-induced Enterocolitismentioning

confidence: 99%

Food Protein-induced Enterocolitis: Altered Antibody Response to Ingested Antigen

et al. 1984

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Section: Abbreviation Fpie Food Protein-induced Enterocolitismentioning

confidence: 99%

Food Protein-induced Enterocolitis: Altered Antibody Response to Ingested Antigen

et al. 1984

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“…A further condition recently recognized is allergic gastroenteropathy (Waldmann, Wochner, Laster, and Gordon, 1967), a protein-losing enteropathy occurring in children who also show anaemia, eosinophilia, and growth retardation. The jejunum also shows a normal villous architecture but there is an eosinophilic infiltration in the lamina propria.…”

Section: Intestinal Lymphangiectasiamentioning

confidence: 99%

The interpretation and significance of morphological abnormalities in jejunal biopsies

Whitehead¹

1971

Journal of Clinical Pathology

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Despite its limitations conventional microscopic examination of jejunal biopsy material is still one of the most tangible approaches to the investigation of small-intestinal malfunction. The biopsy specimens produced by the various modem flexible instruments are adequate, although small and need careful technical processing if maximum information is to be obtained. Suffice it to say that rapid fixation and the minimum of handling which ensures that sections are cut at right angles to the mucosal surface are essential. The avoidance of tangential cutting artefacts and an examination of several or serial levels throughout the biopsy ensures that truly representative morphology is seen in each specimen.Stereoscopic examination while the biopsy is in fixative can also be helpful and gives preliminary information which later can be correlated with the histology, but it should never take the place of a proper histological examination. The extra handling and the wiping away of adherent mucus in order to achieve a good dissecting microscopic view should be avoided because of the inevitable distortion, smearing, and crushing artefact which it may cause. Frequently the net result is a loss of much more information than is gained by the stereoscopic study.In the detection of morphological abnormalities it is mandatory that the observer is acquainted with the normal and, in particular, its variations. The morphology of the small intestine varies along its length, and the normal proximal duodenum not infrequently shows an increased number of stunted and leaf-shaped branching villi when compared with the jejunum. Brunner's glands, traditionally thought to be localized to the duodenum, have a marked variation of distribution often extending to the jejunum, particularly in children (Landboe-Christensen, 1944). Hyperplasia or undue prominence of Brunner's glands is often associated with obvious villous stunting. Biopsies from the proximal duodenum not infrequently show an increased inflammatory cell infiltration with villous atrophy and superficial epithelial degenerative changes which are independent of changes in the remainder of the duodenum and jejunum. Similar appearances are seen in the immediate vicinity of gastrojejunostomy stomas and are probably more closely related to local factors, including hyperacidity and gastric dysfunction. As the ileum is approached the ratio of goblet cells to absorptive cells increases and the villi tend to become broader and shorter than in the jejunum. The number of lymphoid aggregates increases distally and sometimes proximally they are conspicuous. Villi overlying lymphoid areas are often stubby and may be absent.Villous architecture is determined in part by the depth of tissue obtained at biopsy. When the muscularis mucosa is present (Fig. 1) the villi are taller, slimmer, and lie more closely together than when this tethering layer is absent. Without a muscularis mucosa and a measure of mucosal stretching due to too much handling of the biopsy the appearance with broad-based, widely-sep...

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“…This rapid improvement on steroids is typical in eosinophilic gastroenteritis, and no case refractory to such therapy had been documented up to 1970 (Klein et al, 1970). Occasionally, remissions have been obtained with elimination diets (Waldmann et al, 1967;Scudamore et al, 1969;Leinbach and Rubin, 1970) but have not necessarily been sustained without the addition of corticosteroids (Klein et al, 1970). Attempts to treat patients with anti-histaminics have been unsuccessful (Lane, 1967).…”

Section: Discussionmentioning

confidence: 99%

“…The presentation of the present case with diarrhoea, steatorrhoea and faecal blood loss is unusual and presumably reflects predominant mucosal disease. Protein-losing enteropathy and/or malabsorption have been increasingly described in cases with mucosal involvement (Bentlif et al, 1966;Greenberger et al, 1967;Waldmann et al, 1967;Scudamore et al, 1969;Kaplan et al, 1970;Leinbach and Rubin, 1970;Klein et al, 1970). Intestinal blood and protein loss might be explained by exudation through areas of surface epithelium compromised by massive underlying eosinophilic infiltration (Leinbach and Rubin, 1970).…”

Section: Discussionmentioning

confidence: 99%

Co-existent eosinophilic gastroenteritis and hypothalamic-pituitary dysfunction

Haeney¹,

Wilson²

1977

Postgraduate Medical Journal

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SummaryA case of eosinophilic gastroenteritis in a 42-year-old man is described. The patient had diarrhoea, faecal blood loss, a protein-losing enteropathy, malabsorption of fat, xylose and vitamin B12. Co-existent hypopituitarism, diabetes insipidus and hypothalamic dysfunction was demonstrated. Complete clinical recovery occurred with pituitary replacement therapy alone. The association of this endocrine abnormality with the picture of eosinophilic gastroenteritis has not previously been described.

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Allergic Gastroenteropathy

Cited by 174 publications

References 27 publications

Food Protein-induced Enterocolitis: Altered Antibody Response to Ingested Antigen

Food Protein-induced Enterocolitis: Altered Antibody Response to Ingested Antigen

The interpretation and significance of morphological abnormalities in jejunal biopsies

Co-existent eosinophilic gastroenteritis and hypothalamic-pituitary dysfunction

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