Eosinophilic Gastroenteritis-associated Duodenal Ulcer Successfully Treated with Crushed Budesonide

Kubo, Kimitoshi; Kimura, Noriko; Mabe, Katsuhiro; Matsuda, Soichiro; Tsuda, Momoko

doi:10.2169/internalmedicine.4706-20

Cited by 8 publications

(6 citation statements)

References 16 publications

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“…EGIDs presenting with duodenal ulcers are rare, especially in children (Markowitz et al 2000;Kubo et al 2020), and may cause perforations (Deslandres et al 1997;Riggle et al 2015). In this patient, the duodenal ulcers were considered to have been caused by H. pylori infection, but the symptoms did not improve even after H. pylori eradication, and the peripheral blood eosinophil level remained high.…”

Section: Discussionmentioning

confidence: 81%

Eosinophilic Duodenal Ulcer Exacerbation after <i>Helicobacter pylori</i> Eradication in a 14-Year-Old Boy

Fujita

Tominaga

Tanaka

et al. 2022

Tohoku J. Exp. Med.

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Eosinophilic gastrointestinal disorders (EGIDs) cause various gastrointestinal symptoms due to infiltration of eosinophils into the gastrointestinal tract. Helicobacter pylori (H. pylori) is a microorganism that is associated with various diseases such as autoimmune diseases. In recent years, H. pylori is considered protective in inflammatory bowel diseases and gastrointestinal autoimmune disorders but is not known to be protective in EGIDs. A 14-year-old boy presented with epigastric pain and nausea, without diarrhea. His symptoms were not associated with meals. Blood examination showed an eosinophil count of 1,666 cells/µL (17.0%) and an interleukin-5 (IL-5) level of less than 3.9 pg/mL. Esophagogastroduodenoscopy showed chronic gastritis and duodenal ulcers. Capsule endoscopy and colonoscopy showed no abnormal findings. The patient was diagnosed with chronic gastritis due to H. pylori infection and eosinophilic duodenal ulcers. H. pylori eradication was performed. However, the abdominal pain worsened with elevated peripheral eosinophil count [2,314/µL (26%)] and serum IL-5 level (8.0 pg/mL). Montelukast administration improved the symptoms and laboratory findings [peripheral eosinophil count, 330/µL (5.9%); IL-5, < 3.9 pg/mL]. EGIDs should be considered as a cause of duodenal ulcers. H. pylori may be protective in EGIDs. Montelukast monotherapy may be considered as a first line treatment for eosinophilic duodenal lesions.

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Section: Discussionmentioning

confidence: 81%

Eosinophilic Duodenal Ulcer Exacerbation after <i>Helicobacter pylori</i> Eradication in a 14-Year-Old Boy

Fujita

Tominaga

Tanaka

et al. 2022

Tohoku J. Exp. Med.

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“…Endoscopic findings associated with non-EoE EGIDs include shallow mucosal erosions but also deep ulcers, perforated ulcers, diffuse friability, thickened folds, nodularity or granularity, mucosal edema and redness, as well as normalappearing mucosa (7,14,18,21,56,58,59,61,(64)(65)(66)(67)(68)(69)(70)(78)(79)(80)(81)(82)(83)(84)(85)(86)(87)(88). In a multicenter retrospective cohort of 317 children and 56 adult patients with non-EoE EGIDs, the most common finding was normal appearance of the mucosa in the stomach (66%), duodenum (83%), jejunum (67%), and ileum (81%) (7).…”

Section: Statement 10 In Patients With Eoc the Colonoscopy Findings I...mentioning

confidence: 99%

Joint ESPGHAN/NASPGHAN Guidelines on Childhood Eosinophilic Gastrointestinal Disorders Beyond Eosinophilic Esophagitis

Papadopoulou,

Amil‐Dias,

Auth

et al. 2024

J. pediatr. gastroenterol. nutr.

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INTRODUCTION: Eosinophilic Gastrointestinal Disorders beyond Eosinophilic Esophagitis (non-EoE EGIDs) are rare chronic inflammatory disorders of the gastrointestinal (GI) tract. Diagnosis is based on clinical symptoms and histologic findings of eosinophilic inflammation after exclusion of a secondary cause or systemic disease. Currently, no guidelines exist for the evaluation of non-EoE EGIDs. Therefore, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) formed a task force group to provide consensus guidelines for childhood non-EoE EGIDs. METHODS: The working group was composed of pediatric gastroenterologists, adult gastroenterologists, allergists/immunologists, and pathologists. An extensive electronic literature search of the MEDLINE, EMBASE, and Cochrane databases was conducted up to February 2022. General methodology was used in the formulation of recommendations according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to meet current standards of evidence assessment. RESULTS: The guidelines provide information on the current concept of non-EoE EGIDs, disease pathogenesis, epidemiology, clinical manifestations, diagnostic and disease surveillance procedures, and current treatment options. Thirty-four statements based on available evidence and 41 recommendations based on expert opinion and best clinical practices were developed. CONCLUSION: Non-EoE EGIDs literature is limited in scope and depth, making clear recommendations difficult. These consensus-based clinical practice guidelines are intended to assist clinicians caring for children affected by non-EoE EGIDs and to facilitate high-quality randomized controlled trials of various treatment modalities using standardized, uniform disease definitions.

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“…For example, intact capsules with timed release in the colon should be used for EoC; capsules can be opened, and the granules swallowed without modification for EoN; and capsules must be opened and the granules crushed for EoG. [167][168][169][170] Other pharmacotherapies for the treatment of non-EoE EGIDs include biologic and non-biologic therapy. Three biologics have been evaluated in EoG/EoN.…”

Section: Endoscopic Therapymentioning

confidence: 99%

“…5 or 10 mg per day) may be needed 165 . However, given the desire to avoid chronic systemic steroid exposure, use of topical budesonide has been reported 167–170 . Generally, enteral‐release budesonide formulations can be strategically modified to target the area of the GI tract that is involved.…”

Section: Therapeuticsmentioning

confidence: 99%

Review article: Emerging insights into the epidemiology, pathophysiology, diagnostic and therapeutic aspects of eosinophilic oesophagitis and other eosinophilic gastrointestinal diseases

Low,

Dellon

2023

Aliment Pharmacol Ther

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SummaryBackgroundEosinophilic gastrointestinal diseases (EGIDs) are chronic, immune‐mediated disorders characterised clinically by gastrointestinal symptoms and histologically by a pathologic increase in eosinophil‐predominant inflammation in the gastrointestinal tract, in the absence of secondary causes of eosinophilia.AimsTo highlight emerging insights and research efforts into the epidemiology, pathophysiology, diagnostic and therapeutic aspects of eosinophilic oesophagitis (EoE) and non‐EoE EGIDs, and discuss key remaining knowledge gaps.MethodsWe selected and reviewed original research, retrospective studies, case series, randomised controlled trials, and meta‐analyses.ResultsStandardised nomenclature classifies EGIDs as EoE, eosinophilic gastritis (EoG), eosinophilic enteritis (EoN), and eosinophilic colitis (EoC). Incidence and prevalence of EoE are rising, emphasising the need to better understand how environmental risk factors and genetic features interact. Advances in understanding EoE pathophysiology have led to clinical trials of targeted therapy and the approval (in the United States) of dupilumab for EoE. Several therapies that are under investigation hope to satisfy both histologic and clinical targets. For non‐EoE EGIDs, efforts are focused on better defining clinical and histopathologic disease determinants and natural history, as well as establishing new therapies.ConclusionsUnmet needs for research are dramatically different for EoE and non‐EoE EGIDs. In EoE, non‐invasive diagnostic tests, clinicopathologic models that determine the risk of disease progression and therapeutic failure, and novel biologic therapies are emerging. In contrast, in non‐EoE EGIDs, epidemiologic trends, diagnostic histopathologic thresholds, and natural history models are still developing for these more rare disorders.

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Eosinophilic Gastroenteritis-associated Duodenal Ulcer Successfully Treated with Crushed Budesonide

Cited by 8 publications

References 16 publications

Eosinophilic Duodenal Ulcer Exacerbation after <i>Helicobacter pylori</i> Eradication in a 14-Year-Old Boy

Eosinophilic Duodenal Ulcer Exacerbation after <i>Helicobacter pylori</i> Eradication in a 14-Year-Old Boy

Joint ESPGHAN/NASPGHAN Guidelines on Childhood Eosinophilic Gastrointestinal Disorders Beyond Eosinophilic Esophagitis

Review article: Emerging insights into the epidemiology, pathophysiology, diagnostic and therapeutic aspects of eosinophilic oesophagitis and other eosinophilic gastrointestinal diseases

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