Eosinophilic Esophagitis and Gastroenteritis

Abstract

Eosinophilic gastrointestinal disease (EGID) can be classified as eosinophilic esophagitis (EoE) when the eosinophilia is limited to the esophagus or as eosinophilic gastritis (EG) if it is limited to the gastric tract, eosinophilic colitis (EC) if it is limited to the colon, and eosinophilic gastroenteritis (EGE) if the eosinophilia involves one or more parts of the gastrointestinal tract. EoE is by far the most common EGID. It is a well-defined chronic atopic disease due to a T helper type 2 (Th2) inflammation triggered often by food allergens. EoE diagnosis is done if an esophageal biopsy shows at least 15 eosinophils per high power field (eos/hpf). Globally accepted long-term therapies for EoE are the use of swallowed inhaled steroids or food antigen avoidance. The treatment of EoE is done not only to control symptoms but also to prevent complications such as esophageal stricture and food impaction. EGE cause non-specific gastrointestinal (GI) symptoms and are diagnosed if esophagogastroduodenoscopy (EGD)/colonoscopy show eosinophilia in one or more parts of the GI tract. They are rare diseases with an unclear pathogenesis, and they are poorly defined in terms of diagnostic criteria and treatment. Before initiating treatment of any EGE, it is imperative to conduct a differential diagnosis to exclude other causes of hypereosinophilia with GI localization. EGE are often poorly responsive to therapy and there is no commonly accepted long-term treatment. EG has many characteristics similar to EoE, including the fact that it is often due to a food allergen-driven Th2 inflammation; transcriptome analysis however shows that it is more a systemic disease and has a different gene signature than EoE. EC is a benign form of delayed food allergy in infant and is instead a difficult-to-treat severe inflammatory condition in older children and adults. EC in the latter groups can be a manifestation of drug allergy or autoimmune disease. Overall EGE, EC, and EG are rare and are a diagnosis of exclusion until more common causes of eosinophilia have been excluded.

Pathology of emphysematous reticulitis in cattle: report of two cases and comparative overview of similar or identical conditions

“…For stance, evidences indicate that eosinophilic gastrointestinal disorders are primarily polygenic allergic disorders in human medicine (Rothenberg 2004). Eosinophilic colitis in older children and adults is a difficult-to-treat severe inflammatory condition and can be a manifestation of drug allergy and autoimmune disease (Cianferoni and Spergel 2015). An association between a triad of chronic colonic inflammation, tissue eosinophilia, and type-1 hypersensitivity has been suggested in ulcerative colitis patients who show several markers of allergy, such as high level of serum total IgE and immediate-type hypersensitivity reaction confirmed by skin tests (D'Arienzo et al 2000;Daneshjoo and Talley 2002;Méndez-Sánchez et al 2007).…”

Assessment of eosinophils in gastrointestinal inflammatory disease of dogs

“…Eosinophilic gastrointestinal disease often is caused by food allergen‐driven Th2 inflammation that is likely to be responsible for the predominant infiltration of eosinophils 22. When activated, eosinophils can secrete various preformed inflammatory cytokines such as interleukin (IL)‐4, IL‐5, IL‐10, IL‐12, and IL‐13 as well as growth factors (eg, transforming growth factor [TGF]‐β), chemokines (regulated on activation, normal T cell expressed and secreted and eotaxin‐1), lipid mediators (platelet‐activating factor and leukotriene C4), and cytotoxic granule proteins 23.…”

Eosinophilic Gastrointestinal Diseases in Childhood

“…EoE is a chronic immune/antigen-mediated inflammatory disease of the esophagus characterized clinically by symptoms related to esophageal dysfunction and histologically by dense esophageal inflammation [2]. The incidence of EoE is 5.1/100,000 persons/year, while the prevalence is about 29.5 cases/100,000 inhabitants [3].…”