Clinical Characteristics Of Eosinophilic Gastroenteritis

BACKGROND & AIMSEosinophilic Gastroenteritis(EG) is a rare gastrointestinal disorder. It was originally described by Kaijser in 1937. Klein et al. related the clinical manifestations to the area of maximal gastrointestinal involvement and the depth of the disease process and defined three patterns of it. They are predominant mucosal layer disease, predominant muscle layer disease and predominant subserosal disease. In 1990, Talley et al. established the diagnosis criterion of EG according to the classification established by Klein et al. The pathogenesis and etiology of the disease are not well understood, increasingly it is recognized as allergic response. It can present with various gastrointestinal symptoms, depending on the site of affected gastrointestinal tract and the layer of the gastrointestinal wall involved. Definitive diagnosis requires histological demonstrations of eosinophil infiltration in the gastrointestinal wall or high eosinophil count in ascitic fluid, absence of extra gastrointestinal eosinophilic infiltration and exclusion of other diseases that can present in similar fashion. EG is infrequent and its clinical symptoms are nonspecific, so it is difficult to diagnose EG and to distinguish it from other diseases. This study is to investigate diagnosis andtreatment of EG by analyzing the clinical data of 4 patients with EGMETHODSA total of 4 inpatients with EG according to the diagnosis criterion established by Talley were retrospectively investigated over a 2-year period from December, 2004 to January, 2007 in the First Affiliated Hospital of Zhejiang University. The data of 4 patients, including inducement, allergies, clinical manifestations, laboratorial results, imaging, endoscopy, pathology and the course of diagnosis and treatment were reviewed. Four cases have been followed up for 2 month to 2 years.RESULTSOne case has history of iodine allergy, one case has history of food sensitivity (salad oil). The chief symptoms included abdominal pain (4/4), nause and vomit (4/4), diarrhea (3/4), ascites(2/4), melena(2/4), mucous stool(1/4). The finding from physical examination included signs of ascites(2/4). Peripheral eosinophil evaluated before therapy (4/4). White Blood Cells evaluated (2/4), and fecal occult blood test was positive (2/4). All the examinations of the stool for ova or parasites were negative. IgG, IgA, IgM, IgE ,ESR and amylase were normal. Three cases took upright abdominal radiograph and all showed several air-fluid levels. Two underwent CT, one revealed ascites and enlarged mesenteric lymph nodes, the other showed edema small bowel walls, thickened gastric wall and ascites. One underwent small bowel enteroclysis and revealed irritation manifestation in postbulbar duodenal. Four cases took gastroscopy and three revealed chronic superficial gastritis (CSG), one case showed CSG and duodenal bulbaritis. Three cases underwent colonoscopy, one showed descending colonitis and two were negative. One patient took capsule endoscopy and enteroscopy, and both showed upper enteritis. Endoscopic biopsies showed eosinophilic infiltration of the gastrointestinal wall (3/4). After establishment diagnosis of EG, patients received corticosteroid therapy. Eosinophil reduced significantly and abdominal pain improved after three days. Abdominal pain and othergastrointestinal manifestations disappeared after one week. However one case had recurrence during following up.CONCLUSIONSEG is a rare disease of unknown pathogenesis and etiology. It can present with nonspecific gastrointestinal symptoms like abdominal pain, depending on the site and the layer of the gastrointestinal tract involved. Most patients present with peripheral eosinophilia, however, its endoscopy appearances and imagings do not have specific appearance. Histopathologic finding of eosinophilic infiltration is gold standard, also confirm the diagnosis due to the nonspecific clinical presentation. EG is sensitive to corticosteroid. However, the long-term prognosis of this disease is good. Eosinophil reduced obviously after taking prednisone three days and clinical manifestations improved after one week. It should be suspected in patients having gastrointestinal symptom along with peripheral eosinophilia and where standard examinations could not give the explanation. Multiple biopsies (6 at least) from both normal and abnormal appearing mucosa should be taken. Even multiple normal mucosal biopsies cannot exclude the diagnosis of EG. EG is highly suspected in clinic while normal mucosal biopsy, multiple biopsies should be done again.