Prevalence of Eosinophilic Gastroenteritis and Colitis in a Population-Based Study, From 2012 to 2017

Mansoor, Emad; Saleh, Mohannad Abou; Cooper, Gregory S.

doi:10.1016/j.cgh.2017.05.050

Cited by 165 publications

(166 citation statements)

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“…In this large database, 31 of 458 668 patients had elevated duodenal eosinophilia. This corresponds to a prevalence of 6.8/100 000, just above the 5.1/100 000 reported by Mansoor et al for eosinophilic gastroenteritis …”

Section: Discussionmentioning

confidence: 58%

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Quantification of the duodenal eosinophil content in adults: a necessary step for an evidence‐based diagnosis of duodenal eosinophilia

Genta

Sonnenberg

Turner

2018

Aliment Pharmacol Ther

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Summary Background The normal content of eosinophils in the adult duodenum remains undefined. Therefore, there is no foundation for evidence‐based criteria to diagnose eosinophilic duodenitis. Aim This study aimed at: (1) establishing the range of the eosinophil density in the mucosa of the duodenum of normal adults, and (2) determining the biopsy‐based prevalence of isolated eosinophilic duodenitis in a large population of adults. Methods We counted intact eosinophils in three separate high‐power fields (hpf area = 0.237 mm2 each) with the highest densities of eosinophils from the duodenal biopsy specimens of 370 consecutive adults (60% women) with no history of small intestinal disease and a normal duodenal histology. From a large database we also extracted patients with a diagnosis of elevated duodenal eosinophilia and reviewed their biopsies and clinical history. Results The mean eosinophil count for the 370 patients was 8.2 eos/hpf with a standard deviation of ± 6.3. Twenty‐seven of the 370 had eosinophil counts outside the 95% range, which was calculated as: mean + 1.96 × SD = 20.4 eos/hpf. In a database of 458 668 adult subjects, 31 patients (6.8/100 000) had elevated duodenal eosinophilia; 21 of these had other gastrointestinal organs involved by eosinophilia, suggesting eosinophilic gastroenteritis. No significant association between duodenal eosinophilia and any specific symptom was observed. Conclusions This study suggests that in this diverse US population, a cut‐off count of 20 eos/hpf would be useful to separate patients with normal from those with elevated duodenal eosinophilic infiltrations. The clinical implications of duodenal eosinophilia, particularly when it is not an expression of eosinophilic gastroenteritis, remain to be established.

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Section: Discussionmentioning

confidence: 58%

“…In panel B it can be noted that intraepithelial infiltration is limited and, in contrast with eosinophilic esophagitis, there is only minimal degranulation. Haematoxylin and eosin stain, original magnification 200X (A) and 400X (B) above the 5.1/100 000 reported by Mansoor et al for eosinophilic gastroenteritis 12.…”

mentioning

confidence: 68%

Quantification of the duodenal eosinophil content in adults: a necessary step for an evidence‐based diagnosis of duodenal eosinophilia

Genta

Sonnenberg

Turner

2018

Aliment Pharmacol Ther

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“…There are several factors that have hindered the understanding of non-esophageal EGIDs. Each is considered rare with an estimated prevalence from 2.1 to 8.2/100,000 7-8 . Current literature is predominately limited to case reports or single center retrospective studies with relatively small populations 9-16 .…”

Section: Introductionmentioning

confidence: 99%

Increasing Rates of Diagnosis, Substantial Co-occurrence, and Variable Treatment Patterns of Eosinophilic Gastritis, Gastroenteritis and Colitis Based on 10 Year Data Across a Multi-Center Consortium

Pesek

Reed²,

Muir

et al. 2018

Preprint

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Financial Support and AcknowledgementsSupport for this project was provided through a research training grant as part of the Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR) (U54 AI117804). CEGIR is part of the Rare Disease Clinical Research Network (RDCRN), an initiative of the Office of Rare Diseases Research (ORDR), NCATS, and is funded through collaboration between NIAID, NIDDK, and NCATS. CEGIR is also supported by patient advocacy groups including APFED CURED and EFC. This project also received support from NIH T32 DK007634 (CCR).Author DisclosersPatricia Fulkerson: Grant funding from the NIH; Consultant for Genentech, Inc; Research support from Knopp Biosciences, LLC.Gary Falk: Research support from Shire, Celgene, Adare, Regeneron. Consulting for ShireJonathan M. Spergel: Consultant for Regeneron, DBV Technology, Kaleo; Grant funding from DBV Technology, Aimmune Therapeutics, Food Allergy Research Education; Royalties from UpToDateNirmala Gonsalves: Royalties from UpToDate; Advisory board for AllakosSandeep K Gupta: Consultant for Alkalos, Abbott, QOL, Receptos; research support from ShireGlenn Furuta: Founder of EnteroTrack; Consultant for Shire; Royalties from UpToDateMarc E. Rothenberg: Consultant for Pulm One, Spoon Guru, ClostraBio, Celgene, Shire, Astra Zeneca, GlaxoSmithKline, Allakos, Adare, Regeneron and Novartis and has an equity interest in the first four listed and Immune Pharmaceuticals, and royalties from reslizumab (Teva Pharmaceuticals), PEESSv2 (Mapi Research Trust) and UpToDate. M.E.R. is an inventor of patents owned by Cincinnati Children’s.Evan Dellon: Consultant for Adare, Allakos, Alivio, Banner, Celgen/Receptos, Enumeral, GSK, Regeneron, Shire; Research funding from Adare, Celegene/Receptos, Miraca, Meritage, Nutricia, Regeneron, Shire, Educational grant from Banner, HoloclaraStudy HighlightsWhat is current knowledge?Eosinophilic gastrointestinal disorders (EGIDs) include eosinophilic esophagitis (EoE), eosinophilic gastritis (EG), gastroenteritis (EGE), and colitis (EC).Non-EoE EGIDs are rare with most studies limited to case reports or review of single center experiences.There are no widely established guidelines for the diagnosis of EG, EGE, or EC.What is new here?In this multicenter study, EG, EGE, and EC were all diagnosed with increasing frequency over the past decade.Presenting symptoms are non-specific and do not reliably distinguish between disorders.There was no male predominance and the majority of subjects had atopy.Co-occurrence of EG, EGE, and EC diagnoses is common, seen in 41% of patients.There is substantial variability between centers in initial treatment approaches.

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“…The prevalence of EC is estimated to be about 2.1 per 100,000 individuals [30], with no prominent differences related to age or gender [19, 30], although some authors claimed a predominance of males [53]. Associated atopy has been reported in 52.0% of pediatric patients and in 35.9% of adults with EC [19].…”

Section: Eosinophilic Colitismentioning

confidence: 99%

“…It has been proposed that > 50 eos/hpf are needed for the histological diagnosis of EGE (Table 2), but this number has to be confirmed by further studies in children. The prevalence of EGE is approximately 5.1 per 100,000 individuals [30]. EGE is more common among children of age < 5 years [19].…”

Section: Eosinophilic Gastroenteritismentioning

confidence: 99%

Eosinophilic Gastrointestinal Diseases in Childhood

Koutri

Papadopoulou

2018

Ann Nutr Metab

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Eosinophilic gastrointestinal diseases (EGIDs) comprise a group of chronic, inflammatory diseases of the gastrointestinal (GI) tract, that are characterized, clinically, by symptoms related to the dysfunction of the involved segment(s) of the GI tract, and histologically, by dense eosinophilic inflammation, in the absence of an identifiable secondary cause. The group of EGIDs comprises eosinophilic esophagitis (EoE), eosinophilic gastritis (EG), eosinophilic gastroenteritis (EGE), and eosinophilic colitis (EC). EoE is the most common and the best described EGID compared to EG, EGE, and EC. The clinical presentation of the EGIDs differs depending on the location and the extent of the eosinophilic infiltration in the GI tract, as well as its depth through the bowel wall. In the absence of biological markers, the diagnosis is based on the combination of clinical symptoms with the histological features of EGIDs, after the exclusion of secondary causes of eosinophilic inflammation of the GI tract. Treatment is individualized and includes elimination diets (mainly empiric or elemental) and/or drugs, according to the involved GI segment: proton pump inhibitors or local steroids in EoE; local or oral systemic steroids in EG/EGE limited to the duodenum; oral systemic steroids in EGE with lower small intestine and/or colon involvement. In patients with EoE, maintenance treatment with lower doses may be considered following histological remission with the means of drugs. In patients treated with elimination diets, disease food triggers identified during food reintroduction need to be further eliminated. Esophageal stenosis despite medical treatment requires endoscopic dilation, while the use of thiopurines or anti-TNF drugs may be considered in refractory or steroid-dependent EGID (other than EoE). The aim of this review is to provide the available evidence on each of the above disorders, to aid clinicians to interpret the clinical manifestations and the laboratory findings and choose the best available treatment option.

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Prevalence of Eosinophilic Gastroenteritis and Colitis in a Population-Based Study, From 2012 to 2017

Cited by 165 publications

References 28 publications

Quantification of the duodenal eosinophil content in adults: a necessary step for an evidence‐based diagnosis of duodenal eosinophilia

Quantification of the duodenal eosinophil content in adults: a necessary step for an evidence‐based diagnosis of duodenal eosinophilia

Increasing Rates of Diagnosis, Substantial Co-occurrence, and Variable Treatment Patterns of Eosinophilic Gastritis, Gastroenteritis and Colitis Based on 10 Year Data Across a Multi-Center Consortium

Eosinophilic Gastrointestinal Diseases in Childhood

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