Racial differences in eosinophilic gastrointestinal disorders among Caucasian and Asian

Ito, Jun; Fujiwara, Takeo; Kojima, Reiji; Nomura, Ichiro

doi:10.1016/j.alit.2015.02.003

Cited by 32 publications

(24 citation statements)

References 116 publications

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“…EGID primarily involves eosinophilic esophagitis (EoE) and eosinophilic gastroenteritis (EGE). In Asian patients, EGE occurs more frequently than EoE compared with Caucasian patients[19]. …”

Section: Discussionmentioning

confidence: 99%

Diagnosis of eosinophilic gastroenteritis is easily missed

Abassa¹,

Lin²,

Xuan³

et al. 2017

WJG

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AIMTo analyze the clinical characteristics of eosinophilic gastroenteritis (EGE) and to investigate the situations of missed diagnosis of EGE.METHODSFirst, the clinical characteristics of 20 EGE patients who were treated at our hospital were retrospectively summarized. Second, 159 patients who underwent gastroscopy and 211 patients who underwent colonoscopy were enrolled. The pathological diagnosis showed only chronic inflammation in their medical records. The biopsy slides of these patients were reevaluated to determine the number of infiltrating eosinophils in order to assess the probability of a missed diagnosis of EGE. Finally, 122 patients who experienced refractory upper gastrointestinal symptoms for at least one month were recruited. At least 6 biopsy specimens were obtained by gastroscopy, and the number of eosinophils that had infiltrated was evaluated. Those who met the pathological diagnostic criteria of EGE underwent further examination to confirm the diagnosis of EGE. The probability of a missed diagnosis of EGE was prospectively investigated.RESULTSAmong the 20 patients with EGE, mucosal EGE was found in 15 patients, muscular EGE was found in 3 patients and serosal EGE was found in 2 patients. Abdominal pain was the most common symptom. The number of peripheral blood eosinophils was elevated in all 20 patients, all of whom were sensitive to corticosteroids. Second, among the 159 patients who underwent gastroscopy, 7 (4.40%) patients met the criteria for pathological EGE (eosinophil count ≥ 25/HPF). Among the 211 patients who underwent colonoscopy, 9 (4.27%) patients met the criteria for pathological EGE (eosinophil count ≥ 30/HPF). No patients with eosinophil infiltration were diagnosed with EGE in clinical practice before or after endoscopy. Although these patients did not undergo further examination to exclude other diseases that can also lead to gastrointestinal eosinophil infiltration, these might be the cases where the diagnosis of EGE was missed. Finally, among the 122 patients with refractory upper gastrointestinal symptoms, eosinophil infiltration was seen in 7 patients (5.74%). The diagnosis of EGE was confirmed in all 7 patients after the exclusion of other diseases that can also lead to gastrointestinal eosinophil infiltration. A positive correlation was observed between the duration of the symptoms and the risk of EGE (r = 0.18, P < 0.01). The patients whose symptoms persisted longer than 6 mo more readily developed EGE. None of the patients were considered to have EGE by their physicians before endoscopy.CONCLUSIONAlthough EGE is a rare inflammatory disorder, it is easily misdiagnosed. When a long history of abdominal symptoms fails to improve after conventional therapy, EGE should be considered.

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Section: Discussionmentioning

confidence: 99%

Diagnosis of eosinophilic gastroenteritis is easily missed

Abassa¹,

Lin²,

Xuan³

et al. 2017

WJG

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“…5 It has also been noted to be a disease most predominantly found in men as seen in our patient above. 6,7 A disparity between incidence rates has been noted among types of EGID with EoE described more frequently in Western countries and EGE more commonly in Asian countries. 6 Within EGE, most cases involve the stomach and proximal small bowel although, as in our case, jejunitis and ileitis are also described.…”

Section: Discussionmentioning

confidence: 99%

Eosinophilic Enteritis: A Delayed Diagnosis

Munjal

Al-Sabban

Bull-Henry

2017

Journal of Investigative Medicine High Impact Case Reports

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Eosinophilic gastrointestinal disorders are a rare and complex group of disorders that are characterized by eosinophilic infiltration of the gastrointestinal tract. Patients often present with a wide range of signs and symptoms as any length or layer of the GI tract can be involved such as mucosal, muscular, or serosal. As a part of the workup, patients frequently undergo computed tomography scans and multiple endoscopies before the diagnosis is finally made as was true in our case of a 59-year-old male patient presenting with 2 months of nausea, abdominal pain, and weight loss. He underwent esophagogastroduodenoscopies, colonoscopies, video capsule study, and balloon enteroscopy before the diagnosis was confirmed histologically. Endoscopic and radiographic findings can be variable and are usually unpredictable. The diagnosis is confirmed on histopathological examination of biopsies that must show >15-50 eosinophils/high-power field based on the location in the GI tract. In our patient, erythema, scalloping, whitish exudate, and patches of villous blunting were noted in the duodenum to proximal ileum endoscopically with >50 eosinophils/high-power field confirming the diagnosis of eosinophilic enteritis. This class of diseases is often found in patients with a history of allergic disorders suggestive of hypersensitivity in the etiology of the disease although our patient had no such known history. Elimination diets and steroids are the mainstay of therapy and often lead to complete resolution of symptoms as well as endoscopic and radiographic findings in up to 90% of patients as was seen in our patient, although some patients have a chronic remitting course.

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“…The prevalence of EoE is much higher in Western countries compared to Asia, including Japan. In contrast, EGE is relatively common in the Asian population compared to the Western population [10][11][12]. A recent systematic review by Arias et al [13] revealed that the population-based prevalence of EoE was estimated at 2.3-56.3/100,000, with a combined prevalence of 22.7/ 100,000 and 0.28% in North American and European populations.…”

Section: Epidemiologymentioning

confidence: 99%