PEDBASE.org - The Pediatric Database - Detailed information of EOSINOPHILIC GASTROENTERITIS

EOSINOPHILIC GASTROENTERITIS

DEFINITION:

An inflammatory disorder of the intestines characterized by infiltrates of eosinophils resulting in 3 clinical entities.

EPIDEMIOLOGY:

incidence: rare
age of onset:
- older children and adults
areas affected:
- major - stomach (gastric antrum) and upper small bowel
- minor - esophagus and distal small bowel
associated factors:
- food hypersensitivity
- atopy: rhinitis, asthma, dermatitis

PATHOGENESIS:

an allergic immunologic abnormality has been considered the most likely cause resulting in 3 clinical diseases:

1. Mucosal

biopsy - eosinophilic congestion of the lamina propria with patchy villous shortening, mucosal edema - patchy eosinophilic infiltration of the sub-mucosa as well in severe cases
elevated circulating eosinophils+/-elevated levels of IgE

2. Muscular

biopsy - massive and pervasive eosinophilic infiltration of the submucosa and muscularis externae
thickened and rigid gastic outlet and bowel wall

3. Serosal

biopsy - extensive eosinophilic infiltration of a thickened serosa
- may get granuloma formation

CLINICAL FEATURES:

1. Gastrointestinal Manifestations

abdominal pain
nausea and vomiting
intermittent diarrhea +/- bloody diarrhea
failure to thrive with poor growth and weight gain
complications:

1. Mucosal

protein-loosing enteropathy
iron deficiency anemia
malabsorption with steatorrhea
involvement of bladder and liver
cervical lymphadenopathy

2. Muscular

total gastric outlet obstruction
intestinal obstruction
protein-loosing enteropathy

3. Serosal

ascites - with eosinophilia in the fluid
pleural effusions - "

INVESTIGATIONS:

1. Endoscopy

gastric and duodenal lesions +/- esophageal & distal small bowel lesions
biopsy - see Pathology

2. Serum

elevated circulating eosinophilia
elevated levels of IgE
decreased serum protein and albumin
Malabsorption (check CBC, ferritin, albumin, folic acid)

3. Imaging Studies

barium enema may show bowel wall edema and rigidity
may show gastric outlet or intestinal obstruction

MANAGEMENT:

1. Supportive

doubtful role of elimination diets

2. Medications

1. Prednisone

1-2 mg/kg/d po q6-8h
may require high IV doses

2. Intal (disodium cromoglycate)

? role

Pediatric Database - EOSINOPHILIC GASTROENTERITIS

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