Eosinophilic gastrointestinal diseases K29.5

Kaijser, 1937

Rare, chronic inflammatory, immune-mediated, enteral eosinophilic mucositis with gastric dysfunction and eosinophilic mucosal infiltration. Eosinophilic gastroenteritis is seen as a partial symptom (or subgroup) of eosinophilic diseases of the gastrointestinal tract or a generalized atopic diathesis.

Remark. According to a more recent classification, the term "eosinophilic gastroenteritis" is preferred by the term: eosinophilic gastrointestinal diseases/EGID as a generic term for eosinophilic inflammation of the gastrointestinal (GI) tract in the absence of secondary causes (Dellon ES et al. 2022). The affected segments of the gastrointestinal tract are specifically named and abbreviated as "Eo":

Eosinophilic gastritis (EoG)

Eosinophilic enteritis (EoN)

Eosinophilic colitis (EoC).

Unexplained; food allergies can often be detected. In about half of those affected there are indications of atopic diathesis or manifest atopy (more frequent in children than in adults). In patients with milk or soya allergy, there were frequent indications of eosinophilic gastroenteritis (Verdaguer J et al 1993).

The role of previous viral infections (CMV; parainfluenza infections) is not yet clear.

The pathogenetic role of Th2 cells, of eotaxin-1 and interleukin-5 is discussed.

Varying degrees of symptoms such as pain (62%), nausea (71%), vomiting, diarrhea, anemia and weight loss.

Intestinal obstruction may occur if the muscular layer of the intestine is infiltrated. Possible eosinophilic infiltration of the subserosa of the intestine can lead to eosinophilic ascites.

Furthermore, an enteral protein loss syndrome is possible.

Further eosinophilic organ manifestations are possible. In a larger study of 24 Korean children, 13 patients (54.2 %) were found to have a history of allergies, including atopic dermatitis, allergic rhinitis and asthma. Five patients (20.8%) improved when they restricted their diet.

Other organ manifestations: esophageal involvement(eosinophilic esophagitis - 30%), colonic involvement(eosinophilic proctocolitis 28%); lung involvement(eosinophilic pneumonia), urinary bladder involvement(eosinophilic cystitis), skin involvement(atopic dermatitis/Choi JS et al. 2015).

Possible eosinophilia, increased IgE.

Mucosal or transmural eosinophilic infiltration of the gastrointestinal wall. In rare cases also eosinophilic infiltration of the serosa.

Clinical symptoms; hematoeosinophilia, increased total IgE, endoscopy of the intestinal tract with bioptic clarification (detection of >20 eosinophilic granulocytes per HPF (High Power Field = visual field per 400-fold magnification).

In case of detection of a food allergy, strict allergenicity.

Chromoglycinic acid, antihistamines and montelukast are used. The therapeutic effects are often unsatisfactory.

In case of resistance to therapy, systemic therapy with glucocorticoids (high response rate).

The long-term prognosis is good, especially in childhood. Spontaneous remissions are possible. In adults, the transition to a chronic disease is often unavoidable.

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