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Eosinophilic gastroenteritis is a heterogeneous and uncommon disorder characterized by eosinophilic inflammation of the gastrointestinal tissues. The location and depth of infiltration determine its varied manifestations, and the latter is also the basis for the proposed classification into mucosal, muscular and serosal eosinophilic gastroenteritis. Abdominal pain, vomiting, and diarrhea are each present in nearly 50% of the patients, with some overlap. Peripheral eosinophilia is seen in approximately two-thirds of patients with eosinophilic gastroenteritis. It is now clear that eotaxin, a specific eosinophil chemoattractant, plays a pivotal role in the process of eosinophil production. The differential diagnosis of eosinophilic gastroenteritis in children includes parasitic infections, inflammatory bowel disease, connective tissue diseases, some malignancies and adverse effects of drugs. Eosinophilic gastroenteritis itself has been strongly associated with food allergies, and concomitant atopic diseases or a family history of allergies is elicited in about 70% of cases. The pediatric experience is unique with respect to recognition of distinctive entities such as allergic procto-colitis, almost exclusively seen in infants, and eosinophilic esophagitis being increasingly reported among children and young adults. The gold standard for diagnosis, usually demonstrated on endoscopic biopsies, is prominent tissue eosinophilia. However, the diagnosis may be obscured by the patchy nature of the disease, and muscular and serosal eosinophilic gastroenteritis subtypes. In the latter cases, full thickness biopsies would be indicated for a definitive diagnosis. There are many reports of successful treatment of eosinophilic gastroenteritis in children, using a variety of treatment regimens including elimination diets. Corticosteroids remain the most effective agents for controlling symptoms, but unfortunately the relapsing nature of the disease would mandate prolonged corticosteroid use. Reports of favorable responses to new leukotriene inhibitors in patients with eosinophilic gastroenteritis are encouraging; these responses should stimulate future research on the pathophysiology and management of eosinophilic gastroenteritis.
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PMID:Eosinophilic gastroenteritis: epidemiology, diagnosis and management. 1217 71

Eosinophilic gastroenteritis (EGE) is a rare inflammatory disease characterized by diffuse or scattered eosinophilic infiltration of the digestive tract and usually by peripheral blood eosinophilia. The most common presenting symptoms of EGE are abdominal pain, vomiting and diarrhea, but clinical features depend on which layers or location of gastrointestinal tract are involved. Treatment with corticosteroids results in clinical and histological remission in most patients and surgery can be avoided if a correct diagnosis is made. Previous history of allergy is a key to diagnosing EGE, but peripheral eosinophilia may be absent in some patients under concomitant treatment with corticosteroids. Radiological and endoscopic findings are also nonspecific and diagnosis must always be histologically confirmed. The gastrointestinal involvement is patchy in distribution, so more than one panendoscopic examination is often necessary to establish the diagnosis, and surgical or CT-guided full-thickness biopsy is needed in patients with muscular or serosal involvement. It emphasises the importance of a high index of clinical suspicion, which mainly depends on knowledge of natural history of the disease. We report here a case of EGE associated with transmural eosinophilic cholecystocholangitis, in a patient who presented with dyspeptic symptoms and recurrent cholestasis responsive to corticoesteroids. To our knowledge, this patient represents the second case, in the English literature, in which corticoid-responsive cholangitis was associated to histologically proven eosinophilic cholecystitis and gastrointestinal involvement, suggesting that EGE must always be considered in the differential diagnosis of biliary tract disease in patients with eosinophilia and/or atopic diseases.
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PMID:Biliary tract disease: a rare manifestation of eosinophilic gastroenteritis. 1275 81

A 37-year-old man was admitted to our hospital complaining of severe abdominal pain and vomiting. His abdomen was distended, and there was diffuse tenderness and guarding in all four quadrants. Laboratory examinations revealed leukocytosis without eosinophilia. Abdominal radiograph revealed air-fluid levels in the small intestine. Computed tomography confirmed a dilatation of the small intestine and the presence of ascites. An emergency laparotomy was performed for a diagnosis of peritonitis due to intestinal obstruction. A large amount of yellow transudate was present in the abdominal cavity. An area of induration in the ileum was identified about 40 cm from the ileocecal valve. The ileum proximal to the induration was dilated, and the site of obstruction seemed to be the indurated segment. A partial iliectomy was performed. Histologically, dense infiltration of eosinophils was found transmurally, and eosinophilic enteritis was diagnosed. One year later, the patient was free of gastrointestinal symptoms. The relevant literature on eosinophilic gastroenteritis is discussed.
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PMID:Eosinophilic enteritis presenting as acute intestinal obstruction: a case report and review of the literature. 1280 99

Eosinophilic gastroenteritis is rare, seen in approximately 1 in 10,000 hospital admissions. The diagnosis is often retrospective and histopathological. Abdominal pain and obstructive symptoms associated with weight loss are the usual presenting complaints. We report a patient with symptoms of proximal bowel obstruction in whom diagnosis could not be made with conventional radiology and endoscopy. Laparoscopy showed that an intensely thickened proximal jejunum to be the cause of the obstruction. A laparotomy and resection anastomosis were done. The biopsy showed eosinophilic jejunitis. The patient did well post-operatively. The literature of this disease entity has been reviewed. Full-thickness laparoscopic biopsy and a course of steroids might avoid a laparotomy in these patients.
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PMID:Laparoscopy in eosinophilic jejunitis presenting as subacute bowel obstruction: a case report. 1460 34

Strongyloides stercoralis is the only parasite which can produce a chronic illness in humans, being through autoinfection. This nematode can also provoke death when patient's immunologic state deteriorates producing a massive hyper infection. The first patient with strongyloidiasis who has always lived in the Galician South area is described. The clinical picture consisted of unspecific cutaneous lesions and abdominal pain with severe peripheral eosinophilia (> 20,000/ml. The diagnosis was carried out observing the larvae in the fecal examination and was confirmed with a culture. Treatment with albendazole failed and the healing was reached with ivermectin. We must consider the possibility of strongyloidiasis because misdiagnosing these patients as eosinophilic gastroenteritis there would be a higher risk of hyperinfection if they are treated with corticosteroids.
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PMID:[Strongyloides stercoralis in the south of Galicia]. 1475 4

BACKGROUND: Eosinophilic gastritis is related to eosinophilic gastroenteritis, varying only in regards to the extent of disease and small bowel involvement. Common symptoms reported are similar to our patient's including: abdominal pain, epigastric pain, anorexia, bloating, weight loss, diarrhea, ankle edema, dysphagia, melaena and postprandial nausea and vomiting. Microscopic features of eosinophilic infiltration usually occur in the lamina propria or submucosa with perivascular aggregates. The disease is likely mediated by eosinophils activated by various cytokines and chemokines. Therapy centers around the use of immunosuppressive agents and dietary therapy if food allergy is a factor. CASE PRESENTATION: The patient is a 31 year old Caucasian female with a past medical history significant for ulcerative colitis. She presented with recurrent bouts of vomiting, abdominal pain and chest discomfort of 11 months duration. The bouts of vomiting had been reoccurring every 7-10 days, with each episode lasting for 1-3 days. This was associated with extreme weakness and cachexia. Gastric biopsies revealed intense eosinophilic infiltration. The patient responded to glucocorticoids and azathioprine. The differential diagnosis and molecular pathogenesis of eosinophilic gastritis as well as the molecular effects of glucocorticoids in eosinophilic disorders are discussed. CONCLUSIONS: The patient responded to a combination of glucocorticosteroids and azathioprine with decreased eosinophilia and symptoms. It is likely that eosinophil-active cytokines such as interleukin-3 (IL-3), granulocyte macrophage colony stimulating factor (GM-CSF) and IL-5 play pivotal roles in this disease. Chemokines such as eotaxin may be involved in eosinophil recruitment. These mediators are downregulated or inhibited by the use of immunosuppressive medications.
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PMID:Eosinophilia in a patient with cyclical vomiting: a case report. 1514 61

Eosinophilic gastroenteritis is an inflammatory disorder of the gastrointestinal tract in which eosinophilic infiltration occurs in the gut layers. A case of subserosal eosinophilic gastroenteritis was diagnosed in a patient with abdominal pain, eosinophilic ascites, and pancreatitis. To our knowledge, this is the first case report of eosinophilic gastroenteritis associated with concurrent eosinophilic ascites and pancreatitis.
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PMID:Eosinophilic gastroenteritis, ascites, and pancreatitis: a case report and review of the literature. 1545 85

Eosinophilic gastroenteritis is an uncommon disease with an obscure etiology, although associations with allergy, the idiopathic hypereosinophilic syndrome, and connective tissue disease have been reported. We present the case of a 37-year-old woman with a history of idiopathic thrombocytopenic purpura who presented with refractory nausea, vomiting, and abdominal pain. Imaging studies were significant for bowel wall thickening and ascites, while laboratory studies revealed a positive antinuclear antibody (ANA), a positive anti-double stranded (DS) DNA antibody, low complement, and proteinuria. Exploratory laparotomy with gastric and small bowel biopsies established the diagnosis of eosinophilic gastroenteritis. In addition, the patient met clinical criteria for the diagnosis of systemic lupus erythematosus. Previous studies have described eosinophilic gastroenteritis in patients with scleroderma, polymyositis, or dermatomyositis. This is the first report to our knowledge of an individual with eosinophilic gastroenteritis and systemic lupus erythematosus.
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PMID:Eosinophilic gastroenteritis associated with systemic lupus erythematosus. 1614 55

An 18-year-old patient presented with abdominal pain, nausea, and low-grade fever. Sonography showed ascites in the region of the terminal ileum, and the presence of peritoneal nodules suggested peritoneal inflammation. Cytologic analysis of ascites revealed numerous eosinophils. Sonographic visualization of nodular peritoneal deposits associated with eosinophilic ascites permitted the diagnosis of the serosal form of eosinophilic gastroenteritis. The absence of mucosal and muscular involvement in the bowel wall was confirmed by endoscopy and CT. Two weeks of 20 mg/day oral prednisolone led to relief of the patient's symptoms, with normalization of laboratory parameters and sonographic findings.
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PMID:Sonography in diagnosis and follow-up of serosal eosinophilic gastroenteritis treated with corticosteroid. 1569 Apr 48

Eosinophilic gastroenteritis despite its uncommon occurrence is one of the most important primary eosinophilic gastrointestinal disorders, and most commonly presents with abdominal pain. The terminology is, however, misleading because all levels of the gastrointestinal tract from the esophagus to the rectum may be affected. A history of atopy and allergies is present in 25-75% cases. The heterogeneity in the clinical presentations of EG is determined by the site and depth of eosinophilic infiltration. Eosinophilic intestinal inflammation also occurs secondarily in the gastrointestinal tract in inflammatory bowel disease, autoimmune diseases, as reactions to medications, infections, hypereosinophilia syndrome, and after solid organ transplantation. Recent investigations providing an insight into the pathogenesis of eosinophilic gastroenteritis support a critical role for allergens, eosinophils, Th-2 type cytokines, and eotaxin in mediating eosinophilic inflammation. The diagnosis is confirmed by demonstrating prominent tissue eosinophilia on histopathology. Treatment recommendations based on data extrapolated from retrospective, uncontrolled studies, and expert opinion support the use of restricted diets, corticosteroids, leukotriene receptor antagonists, and mast cell stabilizers. Many unanswered questions remain with regard to the natural history, optimal duration of therapy, safer steroid-sparing long-term treatment agents, and the means of reliable and non-invasive follow-up.
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PMID:Eosinophilic gastroenteritis. 1583 87


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