Efficacy of Dietary Treatment for Inducing Disease Remission in Eosinophilic Gastroenteritis

Lucendo, Alfredo J.; Serrano-Montalbán, Beatriz; Arias, Ángel; Redondo, Olga; Tenias, Jose María

doi:10.1097/mpg.0000000000000766

Cited by 82 publications

(56 citation statements)

References 55 publications

(95 reference statements)

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“…When many or no allergens are identified, the more aggressive “empiric elimination diet” or “elemental diet” can be used. Lucendo et al[48] investigated dietary treatment efficacy in EGE through a systematic review and found significant improvement in most cases, especially in those who undertook the elemental diet, which induced clinical remission in > 75% of cases. However, the validity of such a high efficacy rate was questionable since no confirmation of histologic response was available for the majority of cases included in the review.…”

Section: Treatment Modalitiesmentioning

confidence: 99%

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Eosinophilic gastroenteritis: Approach to diagnosis and management

Rached

Hajj

2016

WJGPT

114

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Eosinophilic gastroenteritis (EGE) is a rare and benign inflammatory disorder that predominantly affects the stomach and the small intestine. The disease is divided into three subtypes (mucosal, muscular and serosal) according to klein’s classification, and its manifestations are protean, depending on the involved intestinal segments and layers. Hence, accurate diagnosis of EGE poses a significant challenge to clinicians, with evidence of the following three criteria required: Suspicious clinical symptoms, histologic evidence of eosinophilic infiltration in the bowel and exclusion of other pathologies with similar findings. In this review, we designed and applied an algorithm to clarify the steps to follow for diagnosis of EGE in clinical practice. The management of EGE represents another area of debate. Prednisone remains the mainstay of treatment; however the disease is recognized as a chronic disorder and one that most frequently follows a relapsing course that requires maintenance therapy. Since prolonged steroid treatment carries of risk of serious adverse effects, other options with better safety profiles have been proposed; these include budesonide, dietary restrictions and steroid-sparing agents, such as leukotriene inhibitors, azathioprine, anti-histamines and mast-cell stabilizers. Single cases or small case series have been reported in the literature for all of these options, and we provide in this review a summary of these various therapeutic modalities, placing them within the context of our novel algorithm for EGE management according to disease severity upon presentation.

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Section: Treatment Modalitiesmentioning

confidence: 99%

“…While most reported treatments of EGE aim to achieve clinical remission[48,67], histologic improvement remains the optimal way to assess a patient’s response, even though it does not always correlate with clinical amelioration[79]. Biopsies can be obtained either endoscopically or under ultrasound guidance[27].…”

Section: Follow Up and Treatment End-pointsmentioning

confidence: 99%

Eosinophilic gastroenteritis: Approach to diagnosis and management

Rached

Hajj

2016

WJGPT

114

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“…The patient had an excellent response to steroid therapy and dietary treatment, with resolution of symptoms and eosinophilia several days after therapy. Although there are no head-to-head trials comparing available dietary treatments, most of them showed comparable response rates [9]. The dietary modality used in our case was an empiric six-food elimination diet.…”

Section: Discussionmentioning

confidence: 98%

“…A high heterogeneity of dietary management options has been reported with an overall effectiveness in inducing clinical remission or improvement in 87.2% of children and 88% of adults [9]. …”

Section: Discussionmentioning

confidence: 99%

Abdominal Pain and Ascites: Not Always Related to Portal Hypertension

Nehme¹,

Kisang

Green³

et al. 2016

Cureus

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Eosinophilic gastroenteritis is a rare inflammatory disorder of the gastrointestinal tract with an estimated prevalence of one in 100,000. The typical presentation consists of vague gastrointestinal symptoms with the mucosal involvement of the digestive system. Rarely, it presents as eosinophilic ascites. We report the case of a 22-year-old female who presented with acute onset abdominal pain and ascites. The laboratory studies were remarkable for eosinophilia and the ascitic fluid demonstrated high eosinophilic counts. Push enteroscopy with biopsy supported the diagnosis of eosinophilic gastroenteritis, with likely serosal involvement. Other differential diagnoses were excluded. A prednisone taper along with dietary treatment was initiated. We report complete resolution of symptoms two weeks following the initiation of therapy. Nine months later, she remains asymptomatic without recurrence of ascites.

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“…As with EoE, EGE is frequently associated with a strong family or personal history of allergy and blood eosinophilia [45]; in fact, it is sometimes considered to be a particular form of food allergy due to the predominantly proximal GI location of the eosinophilic infiltration in a significant number of patients. However, because a recent systematic review [53] found that evidence on the efficacy of dietary treatment in EGE is currently lacking, EGE cannot unequivocally be considered to be triggered and maintained by food as EoE is [54].…”

Section: Eosinophilic Gastroenteritismentioning

confidence: 96%