Eosinophilic gastrointestinal disorder: is it what it seems to be?

Abstract

Background:Eosinophilic gastroenteropathy is an uncommon condition whose causes can be numerous and non-specific. The aim of the study was to characterize the presence of gastrointestinal disorders in the adult Maltese population and assess the degree of association with atopic diseases.Methods:Adult patients with gastrointestinal eosinophilia in the gastrointestinal tract on histology were identified and their clinical case notes were reviewed. Patients were interviewed and asked questions regarding asthma, allergic rhinitis, and eczema.Results:Sixty-six patients (39 female) were recruited. The most common clinical symptoms were diarrhea (42.4%) and abdominal pain (33.3%). The sites involved were stomach (10.6%), colon (56.1%), small bowel (10.6%), small bowel and colon (18.2%), esophagus (1.5%), and esophagus and colon (1.5%). Forty percent had persistent lower gastrointestinal symptoms and a repeat ileocolonoscopy was performed within 12 months. These patients were diagnosed with ulcerative colitis (n=10; 47.6%), Crohn’s disease (n=6; 28.6%), indeterminate colitis (n=1; 4.8%) or microscopic colitis (n=4; 19%). Allergic rhinitis was present in 39.4% of the study group, eczema in 26.1%, and asthma in 19.7%. These findings were compared with local data for atopic conditions and the study group was found to have a significantly higher prevalence of allergic rhinitis (P=0.002), but not of asthma (P=0.62) or eczema (P=0.19).Conclusions:A high proportion of patients with eosinophilic gastrointestinal infiltration were subsequently diagnosed with inflammatory bowel disease. Patients persistently symptomatic or who do not respond to treatment should be reassessed to exclude inflammatory bowel disease, given its high prevalence in this group of patients.

Colitis eosinofílica: una entidad aparte

“…Aunque el pronóstico ha sido reportado como favorable, la progresión de la enfermedad con períodos alternantes de actividad inflamatoria y remisión han sido descritos 19 . Casos graves de hemorragia digestiva masiva, estenosis, vólvulo, invaginación y perforación han sido reportados [20][21][22][23] . Autores han mostrado que la CEo sería más agresiva en adolescentes y adultos, mientras que en la población pediátrica sería más leve resolviéndose a los días de realizar una restricción de los alimentos gatillantes 19 .…”

“…Por otra parte, la presencia de eosinofilia colónica no debe ser considerada un elemento exclusivo de la CEo. Estudios retrospectivos han mostrado que hasta un 25% de los pacientes inicialmente catalogados como CEo pueden desarrollar finalmente una enfermedad de Crohn o una colitis ulcerosa 11,20 . Ciertos criterios o hallazgos histológicos pueden apoyar el diagnóstico de CEo, destacando una menor intensidad del infiltrado inflamatorio, aumento en la degranulación de los mastocitos, presencia de depósitos de fibrina y un aumento de la IgE en áreas perineurales de la mucosa 43 .…”

Food protein-induced allergic proctocolitis in infants: Literature review and proposal of a management protocol

“…To date, several studies have demonstrated the importance of eosinophil (Eo) infiltrating the intestinal mucosa and lamina propria. 59 , 60 …”

The Regulation of Intestinal Inflammation and Cancer Development by Type 2 Immune Responses

“…This is revealed by a recent study reporting that patients with eosinophil-predominant inflammation have a lower risk of disease flares and hospitalization than those with a neutrophil-predominant inflammation [ 87 ]. It is worth noting that an increased number of eosinophils is a hallmark not only of IBD but also of a different disease, known as eosinophilic colitis (EC) [ 88 ]. This disorder is erroneously diagnosed as IBD in around 25% of the patients with EC.…”