Eosinophilic disorders of the gastrointestinal tract: imaging features

Chandramohan, Anuradha; Mittal, Rohin; Yacob, Myla; Manipadam, M.T.; Kurian, Susy; Eapen, Anu

doi:10.4261/1305-3825.dir.4490-11.1

Cited by 24 publications

(31 citation statements)

References 19 publications

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“…Reports of imaging in EC describe unusual presentations, including a contrast enema demonstrating colocolonic intussusception [6], ileal wall thickening, mesenteric lymphadenopathy and a radiograph of cecal volvulus complicating EC [4]. Reported CT findings in adults include circumferential colonic wall thickening and ascites [11, 16], long-segment thickening from the ascending to the descending colon [17] and mucosal fold thickening and the “araneid-limb-like” sign in the ascending and transverse colon [12]. In addition, colonic inflammation has been noted as a feature of other eosinophilic gastrointestinal diseases.…”

Section: Discussionmentioning

confidence: 99%

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CT imaging features of eosinophilic colitis in children

et al. 2013

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Background Eosinophilic colitis (EC) is a gastrointestinal disease of undetermined etiology whose clinical features overlap with those of the inflammatory bowel diseases. To the best of our knowledge, the CT imaging features of EC have not been described in children. Objective To report and analyze the clinical, imaging and histological findings in seven children with EC. Materials and methods Children with EC were identified in a pediatric pathology database, and those with CT imaging within 2 months of diagnosis were included, totaling seven children. Clinical, imaging and pathological features were reviewed and analyzed. Results The most common presenting symptoms were abdominal pain, bloody diarrhea and rectal bleeding. EC was characterized as a dense and predominantly eosinophilic inflammatory infiltrate in the lamina propria or epithelium without granulomas. CT scans were abnormal in six children (86%), demonstrating colonic wall thickening, predominantly cecal, in five (71%), mild to moderate terminal ileal thickening in two (29%), and pneumatosis in one (14%). Right colonic involvement was greater than terminal ileal involvement. Conclusion CT imaging findings in children with EC include right colonic wall thickening of variable extent downstream and absent or mild involvement of the terminal ileum. EC should be considered in the differential diagnosis in children presenting with abdominal pain and bloody diarrhea.

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Section: Discussionmentioning

confidence: 99%

“…Treatment for EC is oral corticosteroids. Although a series of reports present detailed radiological findings of EC in adults, imaging findings in children have not been described [4–10, 12]. Our objective was to review the clinical, imaging and pathological features in children with EC.…”

Section: Introductionmentioning

confidence: 99%

CT imaging features of eosinophilic colitis in children

et al. 2013

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“…Computed tomography (CT) scan can detect diffuse thickening of mucosal folds, intestinal wall thickening, ascites and obstruction. Two other scanographic signs that may appear secondary to bowel wall layering are the “Halo sign” and the “araneid-limb-like sign”, both of which can aid in differentiating between an inflammatory and a neoplastic lesion[28,29] and in ruling out extra-intestinal pathologies. The imaging modality of Tc-99m hexamethylpropyleneamineoxime (HMPAO)-labeled WBC scintigraphy provides a topographic description of the disease and allows for monitoring of therapeutic response[30]; however, this technology is not widely available and is not yet established as a reliable diagnostic tool for EGE.…”

Section: Diagnosismentioning

confidence: 99%

Eosinophilic gastroenteritis: Approach to diagnosis and management

Rached

Hajj

2016

WJGPT

102

128

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Eosinophilic gastroenteritis (EGE) is a rare and benign inflammatory disorder that predominantly affects the stomach and the small intestine. The disease is divided into three subtypes (mucosal, muscular and serosal) according to klein’s classification, and its manifestations are protean, depending on the involved intestinal segments and layers. Hence, accurate diagnosis of EGE poses a significant challenge to clinicians, with evidence of the following three criteria required: Suspicious clinical symptoms, histologic evidence of eosinophilic infiltration in the bowel and exclusion of other pathologies with similar findings. In this review, we designed and applied an algorithm to clarify the steps to follow for diagnosis of EGE in clinical practice. The management of EGE represents another area of debate. Prednisone remains the mainstay of treatment; however the disease is recognized as a chronic disorder and one that most frequently follows a relapsing course that requires maintenance therapy. Since prolonged steroid treatment carries of risk of serious adverse effects, other options with better safety profiles have been proposed; these include budesonide, dietary restrictions and steroid-sparing agents, such as leukotriene inhibitors, azathioprine, anti-histamines and mast-cell stabilizers. Single cases or small case series have been reported in the literature for all of these options, and we provide in this review a summary of these various therapeutic modalities, placing them within the context of our novel algorithm for EGE management according to disease severity upon presentation.

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“…1,2 Se consideran enfermedades poco frecuentes y de presentación más común en niños, adolescentes y adultos jóvenes, en el sexo masculino y en sujetos caucásicos. 3,4,5,6 La incidencia y prevalencia varían entre seis y 13 casos/100 000 habitantes y entre 28 y 90 casos/100 000 habitantes, respectivamente, según la población evaluada, con un incremento mundial en los últimos años.…”

Section: Antecedentesunclassified

Caracterización epidemiológica, clínica y diagnóstica de niños con gastroenteropatía eosinofílica. Estudio retrospectivo de tres instituciones de salud de alta complejidad

Holguín

Gallego-Yepes

Toro

et al. 2018

RAM

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Antecedentes: Los desórdenes gastrointestinales eosinofílicos son poco frecuentes. En Colombia no hay estudios en población pediátrica.Objetivo: Describir características epidemiológicas, clínicas y diagnósticas de una población pediátrica con desórdenes gastrointestinales eosinofílicos.Métodos: Estudio observacional, retrospectivo en niños entre 0 y 12 años evaluados en tres hospitales de alta complejidad de Medellín, Colombia, entre 2010 y 2015.Resultados: De 151 niños, 74 (49 %) padecían esofagitis eosinofílica, 35 (23.2 %) gastritis eosinofílica, 20 (13.2 %) duodenitis eosinofílica y 65 (43 %) ileítis o colitis eosinofílica; 60.9 % era del sexo masculino, la mediana de edad fue de cinco años, 66.9 % tenía antecedente de enfermedad alérgica y 78.8 %, afectación de un solo segmento del tracto gastrointestinal. Los principales síntomas fueron dolor abdominal y vómito. El conteo máximo de eosinófilos por campo de alto poder en esófago, estómago, duodeno, íleon y colon fue de 34, 21, 42, 45 y 60, respectivamente. La eosinofilia periférica fue más frecuente en pacientes con afectación de esófago y estómago. Los alimentos más sensibilizantes fueron huevo, leche, camarón, trigo y pollo. Se utilizaron inhibidores de bomba de protones, esteroides o inmunosupresores y dietas de exclusión de alimentos.Conclusiones: Los desórdenes gastrointestinales eosinofílicos pueden afectar múltiples segmentos y sus síntomas son inespecíficos, por lo que se requiere manejo multidisciplinario.

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Eosinophilic disorders of the gastrointestinal tract: imaging features

Cited by 24 publications

References 19 publications

CT imaging features of eosinophilic colitis in children

CT imaging features of eosinophilic colitis in children

Eosinophilic gastroenteritis: Approach to diagnosis and management

Caracterización epidemiológica, clínica y diagnóstica de niños con gastroenteropatía eosinofílica. Estudio retrospectivo de tres instituciones de salud de alta complejidad

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