Eosinophilic Gastroenteritis Complicated with &lt;i&gt;Helicobacter pylori&lt;/i&gt; Infection Unresponsive to Eradication Therapy

Nakamura, Akira; Iwaya, Yugo; Iwaya, Mai; Okamura, Takuma; Kobayashi, Satoshi; Daikuhara, Seiichi; Nozawa, Yuichi; Fukuzawa, Shinya; Nakamura, Shinichiro; Okuhara, Sadahisa; Yamada, Shigenori; Yokosawa, Shuichi; Suga, Tomoaki; Arakura, Norikazu; Tanaka, Eiji

doi:10.2169/internalmedicine.53.2111

Cited by 5 publications

(6 citation statements)

References 18 publications

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“…Discoloration and white granular elevations may represent eosinophil accumulations like white exudates in EoE. A few studies have reported cracked mucosa in patients with EGE [26,28]. Magnifying narrow-band image endoscopy showed that cracks were defects of surface mucosal epithelium.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic findings of gastric lesions in patients with eosinophilic gastrointestinal disorders

et al. 2020

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Background and study aims Eosinophilic gastrointestinal disorders are classified into eosinophilic esophagitis, eosinophilic gastritis, eosinophilic gastroenteritis, and eosinophilic colitis according to the site of eosinophilic infiltration. Although well established in eosinophilic esophagitis, endoscopic findings in eosinophilic gastritis and eosinophilic gastroenteritis with regard to gastric lesions have not been clearly described. The aim of this study was to identify endoscopic findings of gastric lesions associated with eosinophilic gastrointestinal disorders. Patients and methods Out of 278 patients with eosinophilic gastrointestinal disorders, 18 had eosinophilic gastritis or eosinophilic gastroenteritis confirmed by biopsy; their endoscopic images were analyzed retrospectively. The association between endoscopic findings and number of eosinophils in the gastric mucosa was investigated. Results Erythema was most frequently observed (72 %), followed by ulcers (39 %), discoloration (33 %), erosions (28 %), nodularity (28 %), and polyps (28 %). There were several unique endoscopic findings such as submucosal tumor-like deep large ulcers in three patients, antral Penthorum-like appearances (small nodules radially lined toward the pyloric ring) in three patients, “muskmelon-like appearances” (discolored mucosa-composed mesh pattern) in three patients, multiple white granular elevations in two patients, cracks (appearance of furrows similar to those in eosinophilic esophagitis) in five patients, and antral rings in one patient. No significant association was observed between endoscopic findings and number of gastric eosinophils. Conclusions Several unique endoscopic findings of gastric lesions were observed in patients with eosinophilic gastritis or eosinophilic gastroenteritis. Submucosal tumor-like ulcers, antral Penthorum-like appearances, muskmelon-like appearances, and cracks might be associated with eosinophilic gastrointestinal disorders.

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Section: Discussionmentioning

confidence: 99%

Endoscopic findings of gastric lesions in patients with eosinophilic gastrointestinal disorders

et al. 2020

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“…There are few reports regarding EGIDs complicated by H. pylori infection (Papadopoulos et al 2005;Nakamura et al 2014). H. pylori eradication may or may not be effective for EGIDs, and effectiveness is not consistent.…”

Section: Discussionmentioning

confidence: 99%

Eosinophilic Duodenal Ulcer Exacerbation after <i>Helicobacter pylori</i> Eradication in a 14-Year-Old Boy

Fujita

Tominaga

Tanaka

et al. 2022

Tohoku J. Exp. Med.

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Eosinophilic gastrointestinal disorders (EGIDs) cause various gastrointestinal symptoms due to infiltration of eosinophils into the gastrointestinal tract. Helicobacter pylori (H. pylori) is a microorganism that is associated with various diseases such as autoimmune diseases. In recent years, H. pylori is considered protective in inflammatory bowel diseases and gastrointestinal autoimmune disorders but is not known to be protective in EGIDs. A 14-year-old boy presented with epigastric pain and nausea, without diarrhea. His symptoms were not associated with meals. Blood examination showed an eosinophil count of 1,666 cells/µL (17.0%) and an interleukin-5 (IL-5) level of less than 3.9 pg/mL. Esophagogastroduodenoscopy showed chronic gastritis and duodenal ulcers. Capsule endoscopy and colonoscopy showed no abnormal findings. The patient was diagnosed with chronic gastritis due to H. pylori infection and eosinophilic duodenal ulcers. H. pylori eradication was performed. However, the abdominal pain worsened with elevated peripheral eosinophil count [2,314/µL (26%)] and serum IL-5 level (8.0 pg/mL). Montelukast administration improved the symptoms and laboratory findings [peripheral eosinophil count, 330/µL (5.9%); IL-5, < 3.9 pg/mL]. EGIDs should be considered as a cause of duodenal ulcers. H. pylori may be protective in EGIDs. Montelukast monotherapy may be considered as a first line treatment for eosinophilic duodenal lesions.

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“…In fact, when the mucosa is in the primary inflammatory location, stomach ache, diarrhoea and/or weight loss are often noted. If the muscular layer is involved, nausea, vomiting and/or stomach ache may be the symptoms 1. EA is common when the serosa is involved, and is probably the most unusual and rare presentation of EG 4 7…”

Section: Discussionmentioning

confidence: 99%

“…Several studies suggest a role of various cytokines, such as interleukin 3 and 4, granulocyte macrophage colony-stimulating factor and eotaxin, which are produced by eosinophils. Some studies also advocate that food allergens may play a role in local recruitment of eosinophils 1 4…”

Section: Discussionmentioning

confidence: 99%

A 22-year-old male patient with ascites

et al. 2015

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A 22-year-old male patient presented with a 3-day history of abdominal pain, diarrhoea, nausea and vomiting. He reported abdominal distention of a couple of weeks' duration. He had been hospitalised 7 months earlier, owing to the same symptoms, however, the cause was never clarified. Initial examination showed abdominal distention and blood tests indicated eosinophilia. An abdominal CT scan showed mild ascites and a diffuse thickening of the small intestinal loops, and a cystic formation 3 cm in diameter on the liver. The differential diagnosis included parasite infection and eosinophilic gastroenteritis. Liver MRI revealed a simple biliary cyst. Microbiological tests, stool and blood cultures as well as stool examination for parasites were negative. The diagnostic paracentesis revealed eosinophilic ascites. An endoscopy was performed and histopathology revealed presence of moderate to marked lymphoplasmacytic infiltrate containing eosinophils, compatible with eosinophilic gastroenteritis. The patient responded well to the initiation of corticosteroids.

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Eosinophilic Gastroenteritis Complicated with <i>Helicobacter pylori</i> Infection Unresponsive to Eradication Therapy

Cited by 5 publications

References 18 publications

Endoscopic findings of gastric lesions in patients with eosinophilic gastrointestinal disorders

Endoscopic findings of gastric lesions in patients with eosinophilic gastrointestinal disorders

Eosinophilic Duodenal Ulcer Exacerbation after <i>Helicobacter pylori</i> Eradication in a 14-Year-Old Boy

A 22-year-old male patient with ascites

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