Eosinophilic gastroenteritis: Current aspects on etiology,pathogenesis, diagnosis and treatment

Abstract

SUMMARY
Idiopathic eosinophilic gastroenteritis is a rare inflammatory
disease of unknown origin, characterized by diffuse
eosinophilic infiltration of the gastrointestinal tract, accompanied
by varying abdominal symptoms related to the
location, severity and depth of invasion. Any part of the
gastrointestinal tract including the esophagus may be involved,
although the stomach and small bowel are the most
frequently affected areas. Other sites of involvement include
the pancreas, liver and biliary tree and tissues outside gastrointestinal
tract. Although the exact etiology is unknown,
an allergic disorder is present in almost � of the patients.
Increased production of Interleukin-5 and activated eosinophils
has been shown to be the rule in all cases. A large
proportion of patients demonstrates peripheral eosinophilia.
Eosinophil localization to the lamina propria at
baseline is critically regulated by eotaxin, a chemokine expressed
throughout the gastrointestinal tract. Diagnosis
may sometimes be difficult but it can be achieved with the
help of endoscopy plus mucosal biopsies, while peripheral
and tissue eosinophilia supported by the findings of radiology,
ultrasound and computed tomography can establish
the diagnosis in the majority of cases. Eosinophilic gastrenteritis
should be considered in the differential diagnosis
of patients with unexplained gastrointestinal symptoms
even in the absence of peripheral eosinophilia. Treatment
with corticosteroids and the newer ones such as budezonide
produces rapid relief of symptoms and clinical signs of the disease. Other valuable therapeutic modalities include
administration of immunosuppressives, chromoglycate
and dietary restrictions. Surgery is advocated only for
obstructing forms of the disease. The course of the disease
is characterized by frequent exacerbations and remissions.
The long-term prognosis is relatively benign. Patients suffering
from eosinophilic gastroenteritis require regular surveillance
and prompt treatment in order to avoid possible
complications.
Key words: Eosinophils, Gastroenteritis, Eosinophilic gastroenteritis,
Corticosteroids, Immunosupressives, Surgery,
Hypereosinophilic syndrome