A Shift in the Clinical Spectrum of Eosinophilic Gastroenteritis Toward the Mucosal Disease Type

A Shift in the Clinical Spectrum of Eosinophilic Gastroenteritis Toward the Mucosal Disease TypeJoseph Y. Chang

Affiliations
Enteric NeuroScience Program, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
, Rok Seon Choung
AffiliationsEnteric NeuroScience Program, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
, Ru Min Lee
AffiliationsEnteric NeuroScience Program, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
, G. Richard Locke III
AffiliationsEnteric NeuroScience Program, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
, Cathy D. Schleck
AffiliationsDepartment of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota
, Alan R. Zinsmeister
AffiliationsDepartment of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota
, Thomas C. Smyrk
AffiliationsDivision of Anatomic Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota
, Nicholas J. Talley

Affiliations
Enteric NeuroScience Program, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MinnesotaDepartment of Internal Medicine, Mayo Clinic Florida, Jacksonville, FloridaReprint requests Address requests for reprints to: Nicholas J. Talley, MD, PhD, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, Minnesota 55905. fax: (507) 266-9081
published online 07 May 2010.

Abstract
Eosinophilic gastroenteritis (EG) is a rare disorder characterized by eosinophilic infiltration of the gastrointestinal (GI) tract. Despite the increasing prevalence of eosinophilic GI disorders, the epidemiology of EG has not been well studied. We evaluated the clinical spectrum of EG.

Methods
We reviewed data from patients diagnosed with EG, allergic gastroenteropathy, or eosinophilia and referred to gastroenterologists from 1987 to 2007 (n = 59; 52 with mucosal, 3 with muscularis, and 4 with subserosal disease). The study included subjects diagnosed with EG and those with a history that suggested EG, defined by GI symptoms; eosinophilic infiltration of the GI tract, eosinophilic ascites, or characteristic radiographic findings with eosinophilia; and no parasitic or extraintestinal disease. Findings were compared with those from patients with unexplained GI symptoms and peripheral eosinophilia (n = 11).

Results
Associations between clinical variables and EG subgroups did not differ between patients with EG and peripheral eosinophilia. Fifty percent of patients with EG who underwent food allergy testing had a positive test result; only 32% of those with EG who underwent radiographic imaging had positive test results. Patients with EG received steroid therapy; 75% with mucosal, 67% with muscle, and 100% with subserosal disease received prednisone. Eighty-eight percent of patients who received only steroids (mean follow-up period, 7 mo) and 94% of patients who received steroids in combination with another therapy (mean follow-up period, 4 mo) had improved or resolved disease.

Conclusions
Unlike eosinophilic esophagitis, EG is rare. Results from this large study suggest that EG disease type has shifted toward that of the mucosal layer.

Keywords: Eosinophilia, Gastroenteritis, Allergic Gastroenteropathy, Clinical Trial

Abbreviations used in this paper: EG, eosinophilic gastroenteritis, GI, gastrointestinal, HPF, high-power field, PEos, peripheral eosinophilia

Conflicts of interest The authors disclose no conflicts.

This article has an accompanying continuing medical education activity on page e88. Learning Objectives—At the end of this activity, the learner should be able to understand the clinical spectrum and clinical presentation of eosinophilic gastroenteritis and understand the imaging and pathological features of eosinophilic gastroenteritis.

PII: S1542-3565(10)00439-8

doi:10.1016/j.cgh.2010.04.022

© 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.

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A Shift in the Clinical Spectrum of Eosinophilic Gastroenteritis Toward the Mucosal Disease Type