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Eosinophilic Gastroenteritis

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characterized by peripheral eosinophilia, eosinophilic invasion of the ... of intestinal eosinophil infiltration (Gastroenterology 1996;110:768-774) ... – PowerPoint PPT presentation

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Title: Eosinophilic Gastroenteritis


1
Eosinophilic Gastroenteritis
  • First described by Kaijser in 1937
  • a rare inflammatory disease of unknown etiology
  • characterized by peripheral eosinophilia,
    eosinophilic invasion of the gastrointestinal
    tract, and clinical symptoms related to the site
    and tissue layer involved
  • mostly involved stomach and proximal intestine

2
Eosinophilic Gastroenteritis Pathophysiology (1)
  • an allergic or immunologic disorder most common
    proposed cause
  • The release of IL-3, GM-CSF, and IL-5 with
    autocrine and/or paracrine activities by
    eosinophils may be involved in the persistence of
    intestinal eosinophil infiltration
    (Gastroenterology 1996110768-774)

3
Eosinophilic Gastroenteritis Pathophysiology (2)
  • The Klein classification
  • 1. Predominant mucosal disease defined as
    infiltration of the mucosa by eosinophils and/or
    evidence of mucosal edema on contrast studies or
    endoscopy, with no evidence of gastrointestinal
    obstruction or eosinophilic ascites(57.5, Gut
    19903154 -58), (48, Abdom Imaging
    199520406-413)

4
Eosinophilic Gastroenteritis Pathophysiology (3)
  • 2. Predominant disease of the muscularis defined
    as evidence of gastrointestinal stenosis or
    obstruction on contrast studies and/or
    eosinophilic infiltration of the gastrointestinal
    tract without evidence of eosinophilic
    ascites(30, Gut 19903154-58), (33, Abdom
    Imaging 199520406-413)

5
Eosinophilic Gastroenteritis Pathophysiology (4)
  • 3. Predominant subserosal disease defined as
    eosinophilic infiltration of the gastrointestinal
    tract and eosinophilic ascites (12.5, Gut
    19903154-58), (19, Abdom Imaging
    199520406-413)

6
Eosinophilic Gastroenteritis Clinical Aspects (1)
  • usually during the third decade of life
  • no sex or race predilection
  • malefemale ratio 31 (Abdom Imaging
    199520406-413)
  • Clinical course chronic, exacerbations and
    remissions

7
Eosinophilic Gastroenteritis Clinical Aspects (2)
  • Predominant mucosal disease nausea, vomiting,
    abdominal pain, diarrhea, protein-losing
    enteropathy, blood loss, iron-deficiency anemia,
    malabsorption

8
Eosinophilic Gastroenteritis Clinical Aspects (3)
  • Predominant muscularis disease intermittent
    obstructive symptoms related to thickening and
    rigidity of the wall of the gastrointestinal
    tract, and complications of obstruction such as
    perforation and aspiration
  • Predominant subserosal disease clinically like
    predominant mucosal or muscularis disease, but
    must have eosinophilic ascites

9
Eosinophilic Gastroenteritis Clinical Aspects (4)
  • Laboratory findings
  • 1. peripheral eosinophilia
  • 2. iron-deficiency anemia with guaiac-positive
    stools
  • 3. a low d-xylose excretion level and steatorrhea

10
Eosinophilic Gastroenteritis Clinical Aspects (5)
  • 4. decreased total protein, albumin, and
    immunoglobulins level
  • 5. Charcot-Leyden crystals (extruded mucosal
    eosinophils)
  • 6. eosinophilic ascites

11
Eosinophilic Gastroenteritis Clinical Aspects (6)
  • Diagnosis criteria (Talley et al.)
  • 1. gastrointestinal symptoms (abdominal pain,
    nausea, vomiting, weight loss, bloating, and
    diarrhea)
  • 2. eosinophilic infiltration of the
    gastrointestinal tract
  • 3. exclusion of parasitic disease
  • 4. lack of other organ system involvement

12
Eosinophilic Gastroenteritis Radiographic
Findings (1)
  • Predominant Mucosal Disease
  • nonspecific mucosal fold thickening, polyps,
    ulcerations, luminal narrowing, hypersecretion,
    irritability, spasm, areae gastricae, and
    esophageal abnormalities associated with
    eosinophilic esophagitis

13
Eosinophilic Gastroenteritis Radiographic
Findings (2)
  • Predominant Muscularis Disease
  • stenosis, rigidity, and dysmotility, in addition
    to findings associated with predominant mucosal
    disease and eosinophilic esophagitis
  • the antrum and/or proximal small bowel are most
    commonly involved

14
Eosinophilic Gastroenteritis Radiographic
Findings (3)
  • Predominant Subserosal Disease
  • eosinophilic ascites, adherent loops of bowel,
    omental and mesenteric thickening, eosinophilic
    lymphadenopathy, eosinophilic pleural effusion,
    any of the findings in predominant mucosal and/or
    muscularis disease

15
Eosinophilic GastroenteritisTreatment
  • Elimination diets
  • Usual therapy oral prednisolone 20-40 mg/day for
    2 weeks, with gradual tapering over a 2- to
    3-month period.
  • Oral sodium cromoglycate, 200 mg four times daily
  • Ketotifen
  • Surgery

16
Eosinophilic GastroenteritisPrognosis
  • Excellent when treated properly
  • rarely mortality
  • many of the deaths reported in patients with
    alleged eosinophilic gastroenteritis may actually
    be due to polyarthritis nodosa, visceral lymphoma
    or gastric cancer, or the hypereosinophilic
    syndrome
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