Original article—alimentary tract
A Shift in the Clinical Spectrum of Eosinophilic Gastroenteritis Toward the Mucosal Disease Type

https://doi.org/10.1016/j.cgh.2010.04.022Get rights and content

Background & Aims

Eosinophilic gastroenteritis (EG) is a rare disorder characterized by eosinophilic infiltration of the gastrointestinal (GI) tract. Despite the increasing prevalence of eosinophilic GI disorders, the epidemiology of EG has not been well studied. We evaluated the clinical spectrum of EG.

Methods

We reviewed data from patients diagnosed with EG, allergic gastroenteropathy, or eosinophilia and referred to gastroenterologists from 1987 to 2007 (n = 59; 52 with mucosal, 3 with muscularis, and 4 with subserosal disease). The study included subjects diagnosed with EG and those with a history that suggested EG, defined by GI symptoms; eosinophilic infiltration of the GI tract, eosinophilic ascites, or characteristic radiographic findings with eosinophilia; and no parasitic or extraintestinal disease. Findings were compared with those from patients with unexplained GI symptoms and peripheral eosinophilia (n = 11).

Results

Associations between clinical variables and EG subgroups did not differ between patients with EG and peripheral eosinophilia. Fifty percent of patients with EG who underwent food allergy testing had a positive test result; only 32% of those with EG who underwent radiographic imaging had positive test results. Patients with EG received steroid therapy; 75% with mucosal, 67% with muscle, and 100% with subserosal disease received prednisone. Eighty-eight percent of patients who received only steroids (mean follow-up period, 7 mo) and 94% of patients who received steroids in combination with another therapy (mean follow-up period, 4 mo) had improved or resolved disease.

Conclusions

Unlike eosinophilic esophagitis, EG is rare. Results from this large study suggest that EG disease type has shifted toward that of the mucosal layer.

Section snippets

Methods

Our previous experience with eosinophilic gastroenteritis from 1950 through 1986 was reported in 1990 and included 40 subjects.7 The present study was approved by the Mayo Foundation Institutional Review Board.

Results

A total of 59 patients with eosinophilic gastroenteritis were identified: 52 with disease of the mucosa, 3 with disease of the muscle layer, and 4 with subserosal involvement. Eleven patients were identified with unexplained peripheral eosinophilia and gastrointestinal symptoms. Table 1 summarizes the sociodemographic findings for the EG and PEos groups. The mean age at presentation was 47 years for EG and 37 years for PEos patients. Among those with EG, 61% were male, 98% were Caucasian with 1

Discussion

The present study reports our clinical experience with adult EG. A total of 59 patients with EG were seen in our center over the past 20 years and, when combined with our previous experience, a total of 99 patients with EG were seen over a 50-year period. The data suggest that unlike other eosinophilic GI disorders such as eosinophilic esophagitis, EG remains a rare disorder with an average of only 2 to 3 cases diagnosed annually at a large tertiary referral center. This study evaluated

References (24)

  • R. Daneshjoo et al.

    Eosinophilic gastroenteritis 2002

    Curr Gastroenterol Rep

    (2002)
  • N. Mendez-Sanchez et al.

    Eosinophilic gastroenteritis: a review

    Dig Dis Sci

    (2007)
  • Cited by (107)

    • Peripheral eosinophilia and hypoalbuminemia are associated with a higher biopsy diagnostic yield for eosinophilic gastroenteritis

      2021, Clinics and Research in Hepatology and Gastroenterology
      Citation Excerpt :

      The exact etiology of eosinophilic gastrointestinal diseases (EGIDs) remain unknown.[3,5] Because EGE presents in a non-specific manner, with commonly reported symptoms including abdominal pain, nausea, and vomiting, diagnosis can be challenging.[6–12] Some clinical features that may increase suspicion include history of atopic disease, peripheral eosinophilia, hypoalbuminemia, and elevated serum IgE level, which have been reported to be associated with EGIDs in several series.[5, 8–10,12,13]

    View all citing articles on Scopus

    Conflicts of interest The authors disclose no conflicts.

    This article has an accompanying continuing medical education activity on page e88. Learning Objectives—At the end of this activity, the learner should be able to understand the clinical spectrum and clinical presentation of eosinophilic gastroenteritis and understand the imaging and pathological features of eosinophilic gastroenteritis.

    View full text