Chapter 329 Eosinophilic Gastroenteritis

Eosinophilic gastroenteritis consists of a group of rare and poorly understood disorders that have in common gastric and small intestine infiltration with eosinophils and peripheral eosinophilia. The esophagus and large intestine may also be involved. Tissue eosinophilic infiltration can be seen in mucosa, muscularis, or serosa. Mucosal involvement can produce nausea, vomiting, diarrhea, abdominal pain, gastrointestinal bleeding, protein-losing enteropathy, or malabsorption. Involvement of the muscularis can produce obstruction (especially of the pylorus), whereas serosal activity produces eosinophilic ascites.

This condition clinically overlaps the dietary protein hypersensitivity disorders of the small bowel and colon. The differential diagnosis also includes celiac disease, chronic granulomatous disease, connective tissue disorders and vasculitides, multiple infections (particularly parasites), hypereosinophilic syndrome, early inflammatory bowel disease, and rarely malignancy. Allergies to multiple foods are often seen, and serum IgE is commonly elevated. Peripheral eosinophilia is present in ~75% of patients with this disorder. The mucosal form is most common and is diagnosed by identifying large numbers of eosinophils in biopsy specimens of gastric antrum or small bowel.

The presentation of eosinophilic gastroenteritis is nonspecific. The most common presenting symptoms include weight loss, diarrhea, growth failure, colicky abdominal pain, bloating, dysphagia, and vomiting. Presentation in infants can be similar to pyloric stenosis. Laboratory testing often reveals peripheral eosinophilia, elevated serum IgE levels, hypoalbuminemia, and anemia.

The disease usually runs a chronic, debilitating course with sporadic severe exacerbations. Although almost always effective for the treatment of isolated eosinophilic esophagitis, elemental diets are not always successful for the treatment of eosinophilic gastroenteritis. Orally administered cromolyn sodium and montelukast are sometimes successful. A majority of patients require treatment with systemic corticosteroids.