Treatment for Eosinophilic Gastroenteritis

Rare disease that mainly affects the distal and proximal areas of the digestive system. Characterized by the infiltration of eosinophils in the layers that make up the digestive tract, triggered by an allergen; without there being a probable cause to which it can be attributed, being a diagnosis that is reached by exclusion.

Epidemiology

It is rare, the registered cases do not exceed 300 in the world population. It usually appears in the third and fifth stages of life, slightly higher in men.

Causes of Eosinophilic Gastroenteritis

Gastroenteritis eosinofilica

Exposure of the gastric mucosa to an allergen present in some foods and drugs, triggering an immune process where the body’s defenses not only attack the allergen but also the tissue that is in contact with it.

Types

They are considered according to the infiltrated layer of the digestive tract.

  • Mucosa: It is the most frequent and can cause a malabsorption syndrome or ulcers.
  • Muscular: associated with intestinal obstructions and stenosis as a consequence of the thickening and stiffness of the muscularis mucosa in the affected section.
  • Serous: less frequent, predominantly in the colon and presents with exudative ascites.
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Symptoms of Eosinophilic Gastritis 

The symptoms will depend on the histological layer involved and the affected gastrointestinal segment. The ones that stand out:

  • Abdominal pain
  • Postprandial feeling of fullness – abdominal distention
  • Sickness
  • He retched
  • Diarrhea
  • Weightloss
  • Steatorrhea
  • Possible intestinal (mucosa) obstructions
  • Possible intestinal perforations (serosa)
  • Ascites associated with peripheral (serous) eosinophilia
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Diagnosis

This disease is a difficult entity to diagnose, due to the existence of similar entities in gastric symptoms, eosinophilic infiltration and the presence of peripheral esoinophilia . Between 70 to 80% of patients present with peripheral eosinophilia, because it is absent in the other percentage, this is not a conclusive characteristic for the diagnosis; only the histological study of a biopsy is conclusive (without the infiltration being attributed to other causes).

The anamnesis is of vital importance to investigate exhaustively if there are other causes of eosinophilia such as: recent trips to endemic areas of parasites, herbal supplements, drugs that can induce eosinophilia.

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Family history and episodes of food allergies, dust mites, rhinitis, or asthma should also be investigated.

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Endoscopy : to observe characteristics of the mucosa and take a biopsy. Generally from the stomach and duodenum (most affected regions).

Panendoscopy : As the disease is not usually continuous but rather patchy lesions, it is necessary to take multiple biopsies (minimum 6).

Colonoscopy : in patients with significant diarrhea.

There are multiple tests that must be done to rule out all the possibilities of differential diagnoses (blood smear, B12 levels, immunoglobulin series, serum tryptase, stool study, flow cytometry for lymphocyte subtypes). Remembering that the existence of eosinophilia in other organs rules out a possible diagnosis of eosinophilic gastroenteritis.

Differential diagnosis

It is extremely important that the doctor establish a differential diagnosis of eosinophilic gastroenteritis with entities that can cause peripheral eosinophilia, gastrointestinal symptoms, and even with entities in which there is eosinophilic infiltration of the digestive system, such as:

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-Inflammatory bowel disease

-Celiac Disease

-Intestinal lymphoma

-Systemic mastocytosis

-Parasitosis

-Pharmacological allergies (to gold salts, carbamazepine, chlormethiazole, azathioprine)

-Inflammatory fibroid polyps

-Rheumatic problems with intestinal conditions

-Poliarteritis nodosa

-Allergic rhinitis or eczema

-Idiopathic hyperosinophilic syndrome

-Carcinoma

-Crohn’s disease

-Chronic inflamation

-Granuloma eosinofilico

-Hodgkin lymphoma

– Churg-Strauss Syndrome

Proper treatment

This is based on dietary changes and steroid use:

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Dietary changes consist of eliminating potential allergenic foods, those that commonly cause hypersensitivity in the majority of the population (pollen, honey, soy, lactose, gluten, fish, shellfish, peanuts). If improvement occurs, less allergic foods should be added gradually until the allergen is identified.

The medication comprises prednisone 20-40 mg / day as the treatment of choice, administered in decreasing doses until improvement is observed after two weeks. In cases of recurrence, a low maintenance dose is established.

If the patient does not respond to oral prednisone, intravenous glucocorticoids should be indicated; bearing in mind that differential diagnoses should be ruled out.

When the lesion is located in the gastric antrum and the small intestine, budesonide dissolved in water has been successfully tested , which acts in the proximal digestive tract and not in the terminal ileum as occurs when taking the capsules normally. Immunosuppressants are occasionally used.

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