Leukotriene receptor antagonists as potential steroid sparing agents in a patient with serosal eosinophilic gastroenteritis

Aggarwal

Scandinavian Journal of Gastroenterology

et al. 2015

Eosinophilic gastroenteritis (EG) is a rare disorder characterized by eosinophilic infiltration of the gastrointestinal tract. No medication at present is approved by the Food and drug administration of United States for the treatment of EG. The rarity of the disease limits our experience with the different management options. It also limits the ability to conduct randomized controlled trials that could clearly delineate the efficacy of new therapeutic agents. This review assesses the various management options that have been tried on patients with EG.

Section: Montelukastmentioning

confidence: 98%

The management of eosinophilic gastroenteritis

Aggarwal

Scandinavian Journal of Gastroenterology

et al. 2015

“…Elevated IgE is reportedly present in about two-thirds of EGE cases[5] and a trend of increased erythrocyte sedimentation rate (ESR) values has been observed. Finally, some reports of EGE cases have demonstrated that peritoneal fluid analysis shows exudative fluid with a net eosinophilic predominance reaching about 90% of white blood cells (WBCs)[21]. …”

Section: Diagnosismentioning

confidence: 99%

Eosinophilic gastroenteritis: Approach to diagnosis and management

Rached

Hajj

2016

WJGPT

102

128

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.

“…Nevertheless, a low maintenance dose of oral steroids is usually required to maintain remission. Alternatively, anti-allergic agents, such as mast cell stabilisers, antihistamines, leukotriene receptor antagonists or immunosuppressant may act as steroid-sparing drugs 13. Elimination diets aim to identify and eliminate the offending food allergen from diet.…”

Section: Discussionmentioning

confidence: 99%

Eosinophilic ascites: a diagnostic challenge

Khalil

Joseph

2016

BMJ Case Reports

Eosinophilic ascites is a rare feature of eosinophilic gastroenteritis. We would like to highlight this increasingly recognised diagnosis in a case of unexplained ascites. We present a challenging case of a woman aged 25 years who presented with nausea, vomiting, diarrhoea, generalised abdominal pain and swelling 8-week following delivery of her first baby. Her symptoms were primarily aggravated by eating, and she had also noticed postprandial itching and self-limiting generalised rash. She had a strong history of atopy. Physical examination revealed abdominal tenderness and distension with shifting dullness. Urticarial skin rash was noted on the face, neck, chest and abdomen. Routine biochemistry was normal apart from peripheral eosinophilia. Imaging confirmed moderate ascites. Diagnostic paracentesis showed exudative ascites with numerous eosinophils. Histology of the upper and lower gastrointestinal tract showed infiltration of the oesophageogastroduodenal and rectosigmoid mucosa with eosinophils. The patient significantly improved following a course of steroids and six-food elimination diet.