Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review

Abstract

Eosinophilic gastrointestinal disorders, including eosinophilic esophagitis, gastroenteritis, and colitis, refer to a spectrum of clinical diseases that present with variable degrees of infiltration of the gastrointestinal tract by eosinophils in the absence of other known causes of tissue eosinophilia. Clinical symptoms and laboratory findings are usually non-specific and may or may not be accompanied by peripheral blood eosinophilia. The extent of eosinophilic infiltration of the gastrointestinal wall varies from mucosal to transmural and serosal involvement. Diagnosis requires presence of gastrointestinal symptoms, demonstration of gastrointestinal eosinophilia by biopsy, and exclusion of other known causes of tissue eosinophilia. Many studies have pointed toward the eosinophil as the major offender; however, the exact functional role of the eosinophil in the pathogenesis of eosinophilic gastrointestinal disorders remains unclear. The roles of T-helper-2 cytokines and other mediators, such as eotaxin-1 and interleukin-5, have gained significant importance in the pathobiology of eosinophilic gastrointestinal disorders. Current understanding of treatment is based on case reports and a few case series, as there is a lack of large prospective studies. Steroids are currently the mainstay of therapy, but the roles of other drugs such as leukotriene inhibitors, mast cell stabilizers, interleukin-5 inhibitors, and anti-immunoglobulin E, along with other targets in the immune pathway, are currently being explored.

De novo food allergy in pediatric liver transplantation recipients

“…EGIDs were found in 4 cases or 8.7% of survived LT which was relatively high when compared to the report of 4 in 10,000 in healthy children, however, this was similar to the previous reports of 3-26% in post-LT children. [16][17][18][19] The significant culprit foods were cow's milk, hen's egg, shellfish, fish, wheat, and soy. Reactions to these ''major allergens'' are similar to those occurring in Thai children population.…”

Eosinophilic Enterocolitis: An Exceedingly Rare Entity

“…According to the classification made by Klein [4], there is a good correlation between the clinical manifestations and the pathological findings. This patient in particular had manifestations of mucosal involvement (abdominal pain and mild protein-losing enteropathy), muscular layer disease (bowel wall thickening), and serosal involvement (eosinophilic ascites), representing a panmural form of the disease [1].…”

“…The Klein Classification [4] subdivided the disease according to the layer of intestinal wall most extensively infiltrated by eosinophils into mucosa-predominant, muscularis-propria, and serosa-predominant forms. As such, clinical manifestations will depend on the predominantly affected layers, with no distinct clinical presentations differentiating isolated colonic disease from a more diffuse involvement of the gastrointestinal tract [3].…”

“…Treatment of eosinophilic enterocolitis remains a challenge and lacks specific guidelines as there are no randomized controlled trials to date on specific therapy [4].…”

“…However, management of eosinophilic colitis in adults is more challenging than eosinophilic gastroenteritis, and a trial of oral corticosteroids, usually for 2 weeks plus a 2-week taper, remains the most common approach [5]. Nevertheless, relapse is common, frequently requiring more prolonged therapy or low-dose maintenance therapy [4]. Other therapies targeting immune modulation have been described in case reports and small case series and will probably be useful in the future to treat recurrent or refractory symptoms [5].…”