Eosinophilic Gastroenteritis: An Underdiagnosed Condition

Abstract

EOGE is an underdiagnosed condition. In contrast to eosinophilic esophagitis; the disease might be female-predominant in adults. High index of clinical suspicion is required for diagnosis. Further studies about the long-term outcomes and the efficacy of restriction diet in adult patients are required.

Established and Emerging Eosinophilic Gastrointestinal Diseases (EGIDs): Seeing Red and Looking Ahead

“…In an autopsy study, low-grade eosinophilic infiltration and degranulation in the gut was observed to occur in normal subjects although eosinophil counting (quantitative histology) was not performed [8]. In the present study by Alhmoud et al [1], the limit applied was [25 eosinophils/HPF in the proximal GI tract and 50/HPF in the colon. A similar definition was applied in the more recent Mayo Clinic series with a median count of 82 eosinophils/HPF reported in EG but within a remarkably wide range of 4-300/HPF [4].…”

“…Although Alhmoud et al [1] report eosinophilic colitis is even less common than proximal gut disease, the eosinophil is also important in the colon. Another new distinct colonic EGID has recently been described linked to chronic bacterial infection and the irritable bowel syndrome (IBS) [13].…”

“…In patients with unexplained gastrointestinal (GI) symptoms, eosinophilic GI disease, including eosinophilic gastroenteritis (EG), can be missed unless actively considered [1,2]. Eosinophils, as part of normal host defence, migrate from the bone marrow to the lamina propria of the GI tract [2].…”

“…Eosinophilic gastroenteritis (EG) although rare is a disease with which all gastroenterologists should be familiar as it is treatable and may be misdiagnosed, as pointed out in this issue of Digestive Diseases and Sciences by Alhmoud et al [1]. A landmark Mayo Clinic study defined EG as the presence of GI symptoms and biopsyproven abnormal eosinophilic infiltration in the absence of parasitic or extraintestinal disease that would otherwise account for the tissue eosinophilia; from 1950 to 1987, 40 cases were diagnosed (two not biopsy confirmed) [3].…”

“…The clinical relevance of low-grade eosinophilia in the esophagus remains to be determined. A differential diagnosis in EoE is EG, which can be missed if gastric and duodenal biopsies are not taken with the esophageal samples; if a patient with EoE fails to respond to usual therapy, EG should be considered as a possibility [1].…”