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| ==Overview==
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| Eosinophilic gastroenteritis (EG) is a rare, heterogenous disorder characterized by localized patchy or diffuse [[eosinophilic]] infiltration of the gastrointestinal tract.<ref name="baig">{{cite journal| author=Baig MA, Qadir A, Rasheed J| title=A review of eosinophilic gastroenteritis. | journal=J Natl Med Assoc | year= 2006 | volume= 98 | issue= 10 | pages= 1616-9 | pmid=17052051 | doi= | pmc=2569760 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17052051 }} </ref> Most of the data available in the literature are based on few documented case reports/case series. The presentation of eosinophilic gastroenteritis may vary depending on the location, depth and extent of bowel wall involvement. The cause of eosinophilic gastroenteritis is idiopathic although there is a significant association with allergy. Non-specific gastrointestinal symptoms such as episodic abdominal pain, vomiting and diarrhea are common. Eosinophilic gastroenteritis is a diagnosis of exclusion and other causes of GIT symptoms with gastrointestinal tissue eosinophilia must be ruled out. Biopsy of the GIT is the primary diagnostic modality. The mainstay of treatment is corticosteroid therapy. Majority of patients respond well to treatment but the disease may run a chronic relapsing course.<ref name="klein">{{cite journal| author=Klein NC, Hargrove RL, Sleisenger MH, Jeffries GH| title=Eosinophilic gastroenteritis. | journal=Medicine (Baltimore) | year= 1970 | volume= 49 | issue= 4 | pages= 299-319 | pmid=5426746 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5426746 }} </ref><ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref>
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| ==Historical Perspective==
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| The first description of eosinophilic gastroenteritis was by Kaijser et al. in 1937, and it was described as an allergic disease of the gut.<ref name="pmid15028974">{{cite journal| author=Whitaker IS, Gulati A, McDaid JO, Bugajska-Carr U, Arends MJ| title=Eosinophilic gastroenteritis presenting as obstructive jaundice. | journal=Eur J Gastroenterol Hepatol | year= 2004 | volume= 16 | issue= 4 | pages= 407-9 | pmid=15028974 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15028974 }} </ref><ref name="pmid28299223">{{cite journal| author=Shetty V, Daniel KE, Kesavan A| title=Hematemesis as Initial Presentation in a 10-Week-Old Infant with Eosinophilic Gastroenteritis. | journal=Case Rep Pediatr | year= 2017 | volume= 2017 | issue= | pages= 2391417 | pmid=28299223 | doi=10.1155/2017/2391417 | pmc=5337357 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28299223 }} </ref> Klein et al. subsequently classified it into three types (predominant mucosal, muscular, and subserosal layer disease) based on the depth of eosinophilic infiltration.<ref name="pmid5426746">{{cite journal| author=Klein NC, Hargrove RL, Sleisenger MH, Jeffries GH| title=Eosinophilic gastroenteritis. | journal=Medicine (Baltimore) | year= 1970 | volume= 49 | issue= 4 | pages= 299-319 | pmid=5426746 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5426746 }} </ref>
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| ==Classification==
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| Eosinophilic gastroenteritis can be subdivided into three groups according to the Klein classification:<ref name="talley">{{cite journal| author=Talley NJ, Shorter RG, Phillips SF, Zinsmeister AR| title=Eosinophilic gastroenteritis: a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues. | journal=Gut | year= 1990 | volume= 31 | issue= 1 | pages= 54-8 | pmid= 2318432 | doi= | pmc=1378340 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2318432 }} </ref><ref name="baig">{{cite journal| author=Baig MA, Qadir A, Rasheed J| title=A review of eosinophilic gastroenteritis. | journal=J Natl Med Assoc | year= 2006 | volume= 98 | issue= 10 | pages= 1616-9 | pmid=17052051 | doi= | pmc=2569760 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17052051 }} </ref><ref name="pmid8420276">{{cite journal| author=Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS et al.| title=Eosinophilic gastroenteritis: 10 years experience. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 1 | pages= 70-4 | pmid=8420276 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8420276 }} </ref>
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| * '''Mucosal eosinophilic gastroenteritis'''
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| # Most common subtype of eosinophilic gastroenteritis.
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| # Mucosal infiltration by eosinophils, and/or presence of mucosal edema on barium studies.
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| # Absent histological evidence of muscle infiltration.
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| # No evidence of gastrointestinal obstruction or eosinophilic ascites.
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| * '''Muscular eosinophilic gastroenteritis'''
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| # Documentation of complete/incomplete bowel obstruction, and/or infiltration of the tunica muscularis by eosinophils.
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| # No evidence of eosinophilic ascites.
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| * '''Subserosal eosinophilic gastroenteritis'''
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| # Eosinophilic infiltration of the gut
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| # Eosinophilic ascites is present
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| ==Risk Factors==
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| * Allergy: A study conducted in 40 patients with eosinophilic gastroenteritis demonstrated a history of allergy in half of the patients.<ref name="talley"/> Food intolerance or allergy is more commonly seen in mucosal eosinophilic gastroenteritis, affecting over 50% of patients with mucosal disease according to a study.<ref name="talley"/>
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| ==Pathophysiology==
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| ===Pathogenesis===
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| * Eosinophilic gastroenteritis is a rare disease with poorly understood pathophysiology.
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| * Eosinophils are normally seen in the entire GIT (except in the esophagus) of healthy individuals.<ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref>
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| * In patients with eosinophilic gastroenteritis, there is varying degrees of increased eosinophilic infiltration of the GIT (in the absence of other known causes of tissue eosinophilia).<ref name="pmid28299223">{{cite journal| author=Shetty V, Daniel KE, Kesavan A| title=Hematemesis as Initial Presentation in a 10-Week-Old Infant with Eosinophilic Gastroenteritis. | journal=Case Rep Pediatr | year= 2017 | volume= 2017 | issue= | pages= 2391417 | pmid=28299223 | doi=10.1155/2017/2391417 | pmc=5337357 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28299223 }} </ref><ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref>
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| * Any part of the GIT from the esophagus to the colon can be affected. Occasionally, eosinophilic gastroenteritis affects the entire gastrointestinal tract.<ref name="talley"/> The stomach and proximal small intestine are most commonly affected, while the colon is usually the least affected part of the GIT.<ref name="pmid28299223"/><ref name="talley"/><ref name="pmid26054822"/>
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| * The etiology of the excessive eosinophilic infiltration of the GIT is not clear. Destruction of the GIT epithelium caused by the release of eosinophilic basic protein and activated degranulating eosinophils has been proposed.<ref name="talley"/><ref name="pmid 11338074">{{cite journal| author=Tan AC, Kruimel JW, Naber TH| title=Eosinophilic gastroenteritis treated with non-enteric-coated budesonide tablets. | journal=Eur J Gastroenterol Hepatol | year= 2001 | volume= 13 | issue= 4 | pages= 425-7 | pmid= 11338074 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11338074 }} </ref>
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| * Inflammatory mediators such as Th-2 cytokines (IL-3, IL-5 and IL-13), eosinophils, and eosinophilic mediators such as eotaxin have been strongly implicated.<ref name="pmid28299223" /><ref name="pmid26054822"/><ref name="baig"/>
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| * The inflammatory mediators associated with the pathogenesis of eosinophilic gastroenteritis have well established roles in the pathogenesis of allergy and asthma. A significant number of patients with eosinophilic gastroenteritis have also been documented to have allergies/allergy-related disorders, suggesting a hypersensitivity reaction is involved in the pathogenesis of eosinophilic gastroenteritis.<ref name="pmid28299223" /><ref name="baig"/>
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| ==Causes==
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| The cause of eosinophilic gastroenteritis is unknown.<ref name="baig">{{cite journal| author=Baig MA, Qadir A, Rasheed J| title=A review of eosinophilic gastroenteritis. | journal=J Natl Med Assoc | year= 2006 | volume= 98 | issue= 10 | pages= 1616-9 | pmid=17052051 | doi= | pmc=2569760 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17052051 }} </ref>
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| ==Differentiating {{PAGENAME}} from Other Diseases==
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| Diseases with peripheral eosinophilia and gastrointestinal symptoms should be differentiated from eosinophilic gastroenteritis. It is also important to consider eosinophilic gastroenteritis in the differential diagnosis of unexplained gastrointestinal symptoms (even when peripheral eosinophilia is not present). Most diseases that can manifest with gastrointestinal symptoms and peripheral eosinophilia are easily differentiated from eosinophilic gastroenteritis via detailed history taking, laboratory investigations, and histologic examination of endoscopic biopsies.<ref name="baig"/><ref name="pmid26054822"/> Some of these diseases include:<ref name="baig"/><ref name="pmid26054822"/>
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| * Intestinal parasitic infections: Stool examination for ova and parasites can be utilized for diagnosis.
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| * Inflammatory bowel disease (IBD): Biopsy can easily ddistinguish IBD from eosinophilic gastroenteritis.
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| * Hypereosinophilic syndrome: It usually presents with markedly elevated peripheral eosinophilia (>1500 cells/μL) for more than six consecutive months. Eosinophilic gastroenteritis is observed in association with eosinophilic infiltration of other organ systems. The organs that are commonly affected in hypereosinophilic syndrome are the lungs, skin, GIT, kidneys, heart and brain.
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| * Helicobacter pylori infecton: This is not a common cause of tissue eosinophilia. Histology of gastric biopsies using silver staining can rule out Helicobacter pylori infection.
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| * Vasculitic disorders such as churg-Strauss syndrome and polyarteritis nodosa: Eosinophilic infiltration of small blood vessels in the GIT is seen. Autoantibodies are present and markers of inflammation are elevated.
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| * Connective tissue disorders such as scleroderma and dermatomyositis
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| * Celiac disease
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| * Drugs: Some medications have been documented to cause eosinophilic infiltration of the GIT. Examples of such medications include gold compounds, rifampicin, clofazimine, gemfibrozil, azathioprine, enalapril, naproxen and other NSAIDS, interferon, tacrolimus, etc.<ref name="pmid12118924">{{cite journal| author=Shakeer VK, Devi SR, Chettupuzha AP, Mustafa CP, Sandesh K, Kumar SK et al.| title=Carbamazepine-induced eosinophilic enteritis. | journal=Indian J Gastroenterol | year= 2002 | volume= 21 | issue= 3 | pages= 114-5 | pmid=12118924 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12118924 }} </ref><ref name="pmid7968003">{{cite journal| author=Lange P, Oun H, Fuller S, Turney JH| title=Eosinophilic colitis due to rifampicin. | journal=Lancet | year= 1994 | volume= 344 | issue= 8932 | pages= 1296-7 | pmid=7968003 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7968003 }} </ref><ref name="pmid16340639">{{cite journal| author=Jiménez-Sáenz M, González-Cámpora R, Linares-Santiago E, Herrerías-Gutiérrez JM| title=Bleeding colonic ulcer and eosinophilic colitis: a rare complication of nonsteroidal anti-inflammatory drugs. | journal=J Clin Gastroenterol | year= 2006 | volume= 40 | issue= 1 | pages= 84-5 | pmid=16340639 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16340639 }} </ref><ref name="pmid2220886">{{cite journal| author=Bridges AJ, Marshall JB, Diaz-Arias AA| title=Acute eosinophilic colitis and hypersensitivity reaction associated with naproxen therapy. | journal=Am J Med | year= 1990 | volume= 89 | issue= 4 | pages= 526-7 | pmid=2220886 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2220886 }} </ref><ref name="pmid10905364">{{cite journal| author=Kakumitsu S, Shijo H, Akiyoshi N, Seo M, Okada M| title=Eosinophilic enteritis observed during alpha-interferon therapy for chronic hepatitis C. | journal=J Gastroenterol | year= 2000 | volume= 35 | issue= 7 | pages= 548-51 | pmid=10905364 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10905364 }} </ref><ref name="pmid10963515">{{cite journal| author=Lee JY, Medellin MV, Tumpkin C| title=Allergic reaction to gemfibrozil manifesting as eosinophilic gastroenteritis. | journal=South Med J | year= 2000 | volume= 93 | issue= 8 | pages= 807-8 | pmid=10963515 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10963515 }} </ref><ref name="pmid8470652">{{cite journal| author=Ravi S, Holubka J, Veneri R, Youn K, Khatib R| title=Clofazimine-induced eosinophilic gastroenteritis in AIDS. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 4 | pages= 612-3 | pmid=8470652 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8470652 }} </ref><ref name="pmid11468446">{{cite journal| author=Barak N, Hart J, Sitrin MD| title=Enalapril-induced eosinophilic gastroenteritis. | journal=J Clin Gastroenterol | year= 2001 | volume= 33 | issue= 2 | pages= 157-8 | pmid=11468446 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11468446 }} </ref><ref name="pmid16911498">{{cite journal| author=Saeed SA, Integlia MJ, Pleskow RG, Calenda KA, Rohrer RJ, Dayal Y et al.| title=Tacrolimus-associated eosinophilic gastroenterocolitis in pediatric liver transplant recipients: role of potential food allergies in pathogenesis. | journal=Pediatr Transplant | year= 2006 | volume= 10 | issue= 6 | pages= 730-5 | pmid=16911498 | doi=10.1111/j.1399-3046.2006.00538.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16911498 }} </ref>
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| ==Epidemiology and Demographics==
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| ===Incidence===
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| The estimated incidence of eosinophilic gastroenteritis is approximately 1-20 per 100,000 patients.<ref name="pmid28299223">{{cite journal| author=Shetty V, Daniel KE, Kesavan A| title=Hematemesis as Initial Presentation in a 10-Week-Old Infant with Eosinophilic Gastroenteritis. | journal=Case Rep Pediatr | year= 2017 | volume= 2017 | issue= | pages= 2391417 | pmid=28299223 | doi=10.1155/2017/2391417 | pmc=5337357 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28299223 }} </ref><ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref> It is a rare disease with approximately 300 reported cases in published literature.<ref name="baig"/>
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| ===Age===
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| EG can present at any age.<ref name="baig">{{cite journal| author=Baig MA, Qadir A, Rasheed J| title=A review of eosinophilic gastroenteritis. | journal=J Natl Med Assoc | year= 2006 | volume= 98 | issue= 10 | pages= 1616-9 | pmid=17052051 | doi= | pmc=2569760 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17052051 }} </ref> However, a higher incidence has been observed in the third to fifth decade of life.<ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref><ref name="klein"/> In pediatric patients with eosinophilic gastroenteritis, the esophagus is usually the involved organ (eosinophilic esophagitis).<ref name="pmid28299223"/> The youngest documented pediatric case of eosinophilic gastroenteritis occurred in a full-term 10month old infant.<ref name="pmid28299223"/>
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| ===Sex===
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| There is a higher incidence in adult males.<ref>{{cite book | last = Guandalini | first = Stefano | title = Essential Pediatric Gastroenterology and Nutrition | publisher = McGraw-Hill Professional | location = City | year = 2004 | isbn = 0071416307 }} Page 210.</ref><ref name="pmid28299223">{{cite journal| author=Shetty V, Daniel KE, Kesavan A| title=Hematemesis as Initial Presentation in a 10-Week-Old Infant with Eosinophilic Gastroenteritis. | journal=Case Rep Pediatr | year= 2017 | volume= 2017 | issue= | pages= 2391417 | pmid=28299223 | doi=10.1155/2017/2391417 | pmc=5337357 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28299223 }} </ref>
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| ===Race===
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| Eosinophilic gastroenteritis has been documented in all races.<ref>{{cite book | last = Guandalini | first = Stefano | title = Essential Pediatric Gastroenterology and Nutrition | publisher = McGraw-Hill Professional | location = City | year = 2004 | isbn = 0071416307 }} Page 210.</ref> However, most of the cases reported occurred in Caucasians.<ref name="baig"/>
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| ==Screening==
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| There is no screening guideline for eosinophilic gastroenteritis.
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| ==Natural History, Complications, and Prognosis==
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| ===Natural History===
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| Eosinophilic gastroenteritis is an idiopathic disease. A history of allergy/allergy-related disorders have been documented in a significant number of patients with the disease.<ref name="baig" />
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| ===Complications===
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| Complications of eosinophilic gastroenteritis can include the following:<ref name="talley" /><ref name="pmid15028974">{{cite journal| author=Whitaker IS, Gulati A, McDaid JO, Bugajska-Carr U, Arends MJ| title=Eosinophilic gastroenteritis presenting as obstructive jaundice. | journal=Eur J Gastroenterol Hepatol | year= 2004 | volume= 16 | issue= 4 | pages= 407-9 | pmid=15028974 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15028974 }} </ref><ref name="pmid 12757181">{{cite journal| author=Jimenez-Saenz M, Villar-Rodriguez JL, Torres Y, Carmona I, Salas-Herrero E, Gonzalez-Vilches J et al.| title=Biliary tract disease: a rare manifestation of eosinophilic gastroenteritis. | journal=Dig Dis Sci | year= 2003 | volume= 48 | issue= 3 | pages= 624-7 | pmid= 12757181 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12757181 }} </ref><ref name="pmid8420276">{{cite journal| author=Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS et al.| title=Eosinophilic gastroenteritis: 10 years experience. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 1 | pages= 70-4 | pmid=8420276 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8420276 }} </ref><ref name="pmid26054822"/><ref name="pmid16525206">{{cite journal| author=Lyngbaek S, Adamsen S, Aru A, Bergenfeldt M| title=Recurrent acute pancreatitis due to eosinophilic gastroenteritis. Case report and literature review. | journal=JOP | year= 2006 | volume= 7 | issue= 2 | pages= 211-7 | pmid=16525206 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16525206 }} </ref>
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| * Gastric outlet obstruction: Pyloric outlet obstruction has been documented in patients with muscular eosinophilic gastroenteritis, and surgical intervention is often required in severe cases.
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| * Esophageal narrowing/strictures: Seen when there is esophageal involvement.
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| * Biliary tract disease such as biliary tract fibrosis and obstruction.
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| * Intestinal perforation
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| * Intussusception
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| * Acute pancreatitis
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| ===Prognosis===
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| The prognosis is good with treatment but relapses are common, which may necessitate chronic low dose steroid therapy for maintenance of remission.<ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref><ref name="pmid8420276">{{cite journal| author=Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS et al.| title=Eosinophilic gastroenteritis: 10 years experience. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 1 | pages= 70-4 | pmid=8420276 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8420276 }} </ref> If eosinophilic gastroenteritis is left untreated, patients develop severe malabsorption and malnutrition. Spontaneous remission can also occur.<ref name="baig"/>
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| ==Diagnosis==
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| ===History and Symptoms===
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| ====History====
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| It is important to obtain the following history from the patient:<ref name="talley"/>
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| * Presenting symptoms
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| * Duration of symptoms
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| * History of allergy: A history of food allergy/intolerance, drug allergy, allergy-related conditions such as seasonal allergies, atopy, asthma, and nasal polyps should be obtained.
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| ====Symptoms====
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| Eosinophilic gastroenteritis can present with several nonspecific gastrointestinal symptoms. The manifestations often depend on the site affected in the GIT, and the involved layer of the gastrointestinal wall.<ref name="pmid26054822" /><ref name="baig">{{cite journal |author=Baig M, Qadir A, Rasheed J |title=A review of eosinophilic gastroenteritis |journal=Journal of the National Medical Association |volume=98 |issue=10 |pages=1616-9 |year=2006 |pmid=17052051}}</ref><ref>{{cite journal |author=Lee C, Changchien C, Chen P, Lin D, Sheen I, Wang C, Tai D, Sheen-Chen S, Chen W, Wu C |title=Eosinophilic gastroenteritis: 10 years experience |journal=Am. J. Gastroenterol. |volume=88 |issue=1 |pages=70-4 |year=1993 |pmid=8420276}}</ref> The following are the gastrointestinal symptoms seen in eosinophilic gastroenteritis:<ref name="talley"/><ref name="pmid 11338074"/><ref name="pmid28299223"/><ref name="baig" /><ref name="pmid8420276">{{cite journal| author=Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS et al.| title=Eosinophilic gastroenteritis: 10 years experience. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 1 | pages= 70-4 | pmid=8420276 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8420276 }} </ref><ref name="pmid22036223">{{cite journal| author=Tien FM, Wu JF, Jeng YM, Hsu HY, Ni YH, Chang MH et al.| title=Clinical features and treatment responses of children with eosinophilic gastroenteritis. | journal=Pediatr Neonatol | year= 2011 | volume= 52 | issue= 5 | pages= 272-8 | pmid=22036223 | doi=10.1016/j.pedneo.2011.06.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22036223 }} </ref><ref name="pmid15028974">{{cite journal| author=Whitaker IS, Gulati A, McDaid JO, Bugajska-Carr U, Arends MJ| title=Eosinophilic gastroenteritis presenting as obstructive jaundice. | journal=Eur J Gastroenterol Hepatol | year= 2004 | volume= 16 | issue= 4 | pages= 407-9 | pmid=15028974 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15028974 }} </ref>
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|
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| '''Common symptoms'''
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|
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| * Abdominal pain
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| * Nausea
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| * Vomiting
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| * Diarrhea
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| * Poor appetite
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| * Weight loss
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| * Steatorrhea
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| * Hematochezia
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| * Abdominal bloating: More often seen in patients with subserosal disease.
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| * Ascites: Seen more often in patients with subserosal disease.
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| '''Uncommon symptoms'''
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| * Dysphagia: This has been documented in patients with esophageal involvement.
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| * Hematemesis
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| * Jaundice
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|
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| *Other documented features are [[Cholangitis]], [[pancreatitis]],<ref>{{cite journal |author=Lyngbaek S, Adamsen S, Aru A, Bergenfeldt M |title=Recurrent acute pancreatitis due to eosinophilic gastroenteritis. Case report and literature review |journal=JOP |volume=7 |issue=2 |pages=211-7 |year=2006 |pmid=16525206}}</ref> eosinophilic [[splenitis]], acute [[appendicitis]] and giant refractory [[duodenal ulcer]].
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| ===Physical Examination===
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| The physical examination findings in eosinophilic gastroenteritis are non-specific, and are mostly dependent on the site and depth of bowel involvement. The following are the common findings that may be present:<ref name="pmid26054822" /><ref name="pmid22036223">{{cite journal| author=Tien FM, Wu JF, Jeng YM, Hsu HY, Ni YH, Chang MH et al.| title=Clinical features and treatment responses of children with eosinophilic gastroenteritis. | journal=Pediatr Neonatol | year= 2011 | volume= 52 | issue= 5 | pages= 272-8 | pmid=22036223 | doi=10.1016/j.pedneo.2011.06.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22036223 }} </ref>
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| ====HEENT====
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| * Anemia
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| ====Gastrointestinal system====
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| * Abdominal tenderness
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| * Ascites
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| * Hematochezia on rectal exam
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| ====Skin====
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| Eczema may be seen in patients with atopy.
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| ===Laboratory Findings===
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| The following laboratory findings can be seen:<ref name="talley"/><ref name="pmid26054822"/>
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| * CBC: Peripheral blood [[eosinophilia]] is often seen, but it may be absent in >20% of affected patients. Patients with subserosal disease often have a higher eosinophil count. Anemia can also be present.
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| * Elevated [[serum]] [[IgE]] is a common finding.
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| * Elevated ESR: This can be moderately elevated in 25% of patients with eosinophilic gastroenteritis.
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| * Hypoalbuminuria: This can occur as a result of severe malabsorption and protein losing enteropathy.
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| * Fecal fat test: Mild-moderate steatorrhea is sometimes seen.
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| * Stool α-1 antitrypsin clearance: For assessment of fecal protein loss.
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| * Allergy testing: Tests such as skin-prick and RAST testing may be done when specific food and environmental allergies are strongly suspected as triggers for the disease.
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| ===Microscopic Findings===
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| Eosinophilic gastroenteritis is a diagnosis of exclusion. There are no well standardized pathologic criteria for making a diagnosis of eosinophilic gastroenteritis. Talley et al. proposed three diagnostic criteria:<ref name="pmid26054822" /><ref name="talley">{{cite journal |author=Talley N, Shorter R, Phillips S, Zinsmeister A |title=Eosinophilic gastroenteritis: a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues |journal=Gut |volume=31 |issue=1 |pages=54-8 |year=1990 |pmid=2318432}}</ref>
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| # Presence of gastrointestinal symptoms
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| # Biopsy demonstrating eosinophilic infiltration of one or more areas of the GIT (from the esophagus to colon)
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| # Exclusion of other causes of tissue eosinophilia.
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| ====Biopsy====
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| * Biopsy is widely used for making a diagnosis. In the absence of other causes of tissue eosinophilia, eosinophilic infiltration of the GIT on biopsy and/or the presence of eosinophilic ascitic fluid in a patient with gastrointestinal symptoms is diagnostic for eosinophilic gastroenteritis.<ref name="pmid28299223"/>
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| * Eosinophilic infiltration of the gastrointestinal tract is seen on histology following endoscopic/surgical biopsies. Abnormal eosinophilic infiltration of the GIT can be defined as the presence of diffuse or multifocal eosinophils ≥20 per high power field.<ref name="talley"/><ref name="pmid26054822" />
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| * The diagnosis can occasionally be missed, especially in patients with the localized patchy infiltration. Multiple biopsy samples throughout the GIT (including visually normal areas) should be taken.<ref name="pmid26054822" />
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| ====Paracentesis====
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| * In cases of suspected eosinophilic ascites, it is important to perform a diagnostic paracentesis.<ref name="pmid26054822" />
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| [[File:Presentation1.jpg|center|Endoscopic biopsy of ileum showing distinct eosinophilic infiltration|700x700px]]
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| [[Hypereosinophilia]], the hallmark of allergic response, may be absent in up to 20% of patients, but [[hypoalbuminaemia]] and other abnormalities suggestive of malabsorption may be present.
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| When eosinophilic gastroenteritis is observed in association with eosinophilic infiltration of other organ systems, the diagnosis of [[idiopathic]] [[hypereosinophilic syndrome]] should be considered.<ref>{{cite journal |author=Matsushita M, Hajiro K, Morita Y, Takakuwa H, Suzaki T |title=Eosinophilic gastroenteritis involving the entire digestive tract |journal=Am. J. Gastroenterol. |volume=90 |issue=10 |pages=1868-70 |year=1995 |pmid=7572911}}</ref>
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| ===Imaging Findings===
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| Radiological studies are of limited diagnostic value in patients with eosinophilic gastroenteritis. The findings on imaging are often variable and non-specific. Imaging studies can reveal the following:<ref name="pmid28299223"/><ref name="chen">{{cite journal| author=Chen MJ, Chu CH, Lin SC, Shih SC, Wang TE| title=Eosinophilic gastroenteritis: clinical experience with 15 patients. | journal=World J Gastroenterol | year= 2003 | volume= 9 | issue= 12 | pages= 2813-6 | pmid=14669340 | doi= | pmc=4612059 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14669340 }} </ref><ref name="talley"/>
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| ====Ultrasonography====
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| * Presence of bowel thickening/folds, ascites and peritoneal nodules may be seen.
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| * Response to therapy
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| ====CT scan====
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| * May reveal prominent nodular, irregular folds/thickening of the stomach and intestines (similar findings can be seen in other diseases such as Crohn’s disease and lymphoma).
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| * Ascites may be seen
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| ====Barium studies====
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| * Presence of antral stenosis and mucosal irregularity of the stomach.
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| * Thickened mucosal folds of the small intestine due to edema may be seen.
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| ====Endoscopy====
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| * May show a normal appearance of the GIT.
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| * Gross findings such as gastric pseudopolyps are commonly seen.
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| * Other non-specific findings such as mucosal erythema, friability, and fine granularity in the stomach may be seen. Mucosal ulcerations/erosions, thickening of gastric mucosal folds and mucosal nodules or whitish specks are sometimes seen.
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| A few studies have reported the usefulness of Tc-99m hexamethylpropyleneamine oxime (HMPAO) scintigraphy scanning in detection of active eosinophilic inflammation, extent of disease, and assessment of the response to treatment [72, 73].
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| Endoscopy
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| The [[endoscopic]] appearance in eosinophilic gastroenteritis is nonspecific; it includes erythematous, friable, nodular, and occasional ulcerative changes. Sometimes diffuse inflammation results in complete loss of [[villi]], involvement of multiple layers, [[submucosal]] [[oedema]] and [[fibrosis]].<ref>{{cite journal |author=Johnstone J, Morson B |title=Eosinophilic gastroenteritis |journal=Histopathology |volume=2 |issue=5 |pages=335-48 |year=1978 |pmid=363591}}</ref><ref>{{cite journal |author=Katz A, Goldman H, Grand R |title=Gastric mucosal biopsy in eosinophilic (allergic) gastroenteritis |journal=Gastroenterology |volume=73 |issue=4 Pt 1 |pages=705-9 |year=1977 |pmid=892374}}</ref>
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| [[Radionuclide|Radio isotope]] scan using [[Tc-99m]] HMPAO-labeled [[leukocyte]] [[single photon emission computed tomography|SPECT]] may be useful in assessing the extent of disease and response to treatment but has little value in diagnosis, as the scan does not help differentiating EG from other causes of inflammation.<ref>{{cite journal |author=Lee K, Hahm K, Kim Y, Kim J, Cho S, Jie H, Park C, Yim H |title=The usefulness of Tc-99m HMPAO labeled WBC SPECT in eosinophilic gastroenteritis |journal=Clinical nuclear medicine |volume=22 |issue=8 |pages=536-41 |year=1997 |pmid=9262899}}</ref><ref>{{cite journal |author=Imai E, Kaminaga T, Kawasugi K, Yokokawa T, Furui S |title=The usefulness of 99mTc-hexamethylpropyleneamineoxime white blood cell scintigraphy in a patient with eosinophilic gastroenteritis |journal=Annals of nuclear medicine |volume=17 |issue=7 |pages=601-3 |year=2003 |pmid=14651361}}</ref>
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| ==Treatment==
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| There are no guidelines/definitive consensus for the management of eosinophilic gastroenteritis, and the treatment is usually based on the severity of the disease. Steroids are widely recognized as the mainstay of treatment for eosinophilic gastroenteritis.
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| ===Medical Therapy===
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| The medical management of eosinophilic gastroenteritis entails the following:<ref name="talley"/><ref name="pmid15492606">{{cite journal| author=Barbie DA, Mangi AA, Lauwers GY| title=Eosinophilic gastroenteritis associated with systemic lupus erythematosus. | journal=J Clin Gastroenterol | year= 2004 | volume= 38 | issue= 10 | pages= 883-6 | pmid=15492606 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15492606 }} </ref>:<ref name="pmid26054822" /><ref name="pmid15492606">{{cite journal| author=Barbie DA, Mangi AA, Lauwers GY| title=Eosinophilic gastroenteritis associated with systemic lupus erythematosus. | journal=J Clin Gastroenterol | year= 2004 | volume= 38 | issue= 10 | pages= 883-6 | pmid=15492606 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15492606 }} </ref><ref name="pmid6547462">{{cite journal| author=Katz AJ, Twarog FJ, Zeiger RS, Falchuk ZM| title=Milk-sensitive and eosinophilic gastroenteropathy: similar clinical features with contrasting mechanisms and clinical course. | journal=J Allergy Clin Immunol | year= 1984 | volume= 74 | issue= 1 | pages= 72-8 | pmid=6547462 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6547462 }} </ref><ref name="chen"/><ref name="pmid28299223" /><ref name="pmid28279648">{{cite journal| author=Yanagimoto Y, Taniuchi S, Ishizaki Y, Nakano K, Hosaka N, Kaneko K| title=Eosinophilic gastroenteritis caused by eating hens' eggs: A case report. | journal=Allergol Int | year= 2017 | volume= | issue= | pages= | pmid=28279648 | doi=10.1016/j.alit.2017.02.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28279648 }} </ref>
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| '''Preferred therapy'''
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| * Corticosteroids: This is the mainstay of therapy for eosinophilic gastroenteritis. A dramatic response to corticosteroid therapy is commonly seen in patients with subserosal disease. A 90% response rate to corticosteroid therapy has been documented in some studies.
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| * Dietary modification
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| # Elimination of identified food allergies from the diet.
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| # Introduction of elemental diets.
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| '''Alternate therapy'''
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| These can be used alone or in combination with steroid therapy for treatment and/or maintenance therapy.
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| * Ketotifen
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| * Cromolyn sodium
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| * Montelukast: Either used alone or in combination with steroids as a steroid-sparing agent. Some patients treated with montelukast alone did not have a relapse.<ref name="pmid22036223">{{cite journal| author=Tien FM, Wu JF, Jeng YM, Hsu HY, Ni YH, Chang MH et al.| title=Clinical features and treatment responses of children with eosinophilic gastroenteritis. | journal=Pediatr Neonatol | year= 2011 | volume= 52 | issue= 5 | pages= 272-8 | pmid=22036223 | doi=10.1016/j.pedneo.2011.06.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22036223 }} </ref>
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| * Suplatast
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| * Biologic medications such as omalizumab, reslizumab and mepolizumab.
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| ===Surgery===
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| ===Prevention===
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| ==References==
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| {{reflist|2}}
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| {{Allergic conditions}}
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| [[Category:Gastroenterology]]
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| {{WH}}
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| {{WS}}
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