Eosinophilic pancreatitis versus pancreatitis associated with eosinophilic gastroenteritis – a systematic review regarding clinical features and diagnosis

Abstract

Background. Over the past years, eosinophil infiltration involving the gastrointestinal tract and pancreas leading to eosinophilic pancreatitis, eosinophilic gastroenteritis and hypereosinophilic syndrome has been reported in the literature. We aimed to analyze and compare the features involving patients with eosinophilic pancreatitis and pancreatitis associated with eosinophilic gastroenteritis and to determine if there is a connection between the two disorders or if they in fact meet the diagnostic criteria for hypereosinophilic syndrome. Material and methods. The following search was performed in March 2019 on PubMed (MEDLINE) database using the medical terms “pancreatitis”, “eosinophilic pancreatitis”, “eosinophilic gastroenteritis” and “hypereosinophilic syndrome”. Results. The search revealed 119 publications from 1970 onwards. A total of 83 papers were excluded, and the remaining 36 publications, consisting in case reports and case series, were analyzed. From 45 patients, 20 subjects with eosinophilic gastroenteritis developed pancreatitis, 20/45 had eosinophilic pancreatitis, and 5/45 hypereosinophilic syndrome involving the pancreas. There was no significant difference regarding clinical, laboratory and imaging features between the three groups, despite the multiple theories that explain the association of pancreatic and gastrointestinal eosinophilic infiltration. Although there was a strong resemblance between the three groups, histological evidence of eosinophilic gastrointestinal infiltration guided the treatment towards a less invasive way, while subjects with eosinophilic pancreatitis underwent pancreatic surgery to exclude potentially malignant lesions. Conclusion. Although there are various theories that explain pancreatitis development in patients with eosinophilic gastroenteritis, hypereosinophilia diagnostic work-up should be taken into account in all patients with high number of blood eosinophils, even in those with eosinophilic pancreatitis in order to establish the diagnosis using a minimally invasive approach and to apply an adequate treatment.

Eosinophilic duodenitis misdiagnosed as acute pancreatitis in a child: a case report

“…On this occasion, peripheral blood eosinophils and the serum levels of amylase and lipase could be used as indicators of non-EoE EGIDs. Allergic diseases, parasite infections, drug administration (especially immunosuppressants), in ammatory bowel diseases, and malignancy were also considered in the differential diagnosis when evaluating a patient with GI mucosal eosinophilia [3,11].…”

Eosinophilic gastroenteritis: Pathogenesis, diagnosis, and treatment

“…As is mentioned before, eosinophilic infiltration in the duodenum may lead to inflammation, edema, and fibrosis, sometimes involving the duodenal papilla, which may cause mechanical obstruction in the pancreatic duct. [ 76 ] In other circumstances, patients may present as acute bowel obstruction. In most cases, obstructions can be reversed by corticosteroid, avoiding unnecessary surgical treatment.…”

Idiopathisches Hypereosinophiles Syndrom mit Endorganschädigung und Erstmanifestation einer akut- auf chronischen Pankreatitis mit Fistelbildung

“…Einführung Das Hypereosinophile Syndrom ist definiert als persistierende Erhöhung der eosinophilen Granulozyten>1500 /µl über mindestens einen Monat mit assoziierter eosinophiler Gewebsinfiltration sowie einer Organdysfunktion oder -schädigung nach Ausschluss anderer Ursachen. Es ist ein sehr heterogenes Krankheitsbild, welches sich dermal, pulmonal, kardial, neuronal, als auch gastrointestinal manifestieren kann 1 2 .…”

“…Eine Beteiligung der Pankreas fällt häufig erst nach Pankreasresektion bei initialem Tumorverdacht auf. Bei persistierender Eosinophilie, insbesondere bei begleitender IgE- Erhöhung und eosinophiler Infiltration weiterer Organsystem sollte dieses seltene Krankheitsbild weiter abgeklärt werden und in die Differentialdiagnostik eingeschlossen werden 2 3 4 5 6 .…”