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Chiou FK, Ng LQ, Loh W. Eosinophilic gastrointestinal disorders: a narrative review on clinical perspectives and research gaps in the Asian context. Transl Gastroenterol Hepatol 2024; 9:69. [PMID: 39503038 PMCID: PMC11535809 DOI: 10.21037/tgh-24-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 07/21/2024] [Indexed: 11/08/2024] Open
Abstract
Background and Objective Eosinophilic gastrointestinal disorders (EGID) are a heterogeneous group of conditions, comprising eosinophilic esophagitis (EoE) and non-EoE EGID which have gained considerable research interest. There are likely to be differences in disease characteristics between populations with distinct dietary, environmental and cultural backgrounds. However much of our understanding on EGID have come from studies from Europe and North America. The aim of this review is to summarize the recent developments and updates in EGID focusing on disease phenotype specifically in Asian patients, and identify opportunities for future research pertaining to disease profile in the Asian population. Methods Original studies, systematic reviews, meta-analyses and review articles up to March 2024 were systematically searched on PubMed, with specific focus on newer studies published in the past 10 years. Case reports, conference abstracts and articles that were not published in the English language were excluded. Key Content and Findings Prevalence and incidence of EoE and non-EoE EGID have reportedly increased globally over time, but population-based studies are lacking in Asia. Based on heterogeneous data from a limited number of studies from Asia, there are features in epidemiology, clinical phenotype, and treatment response that may be appreciably distinct in Asian patients with EoE and non-EoE EGID, as compared to the Western patient population. Moreover, the efficacy of novel biologic therapies such as dupilumab in the Asian population has not been well-defined. Conclusions There is a lack of robust data on many basic aspects of EGID in Asia. There is a pressing need to bridge this gap by building research networks and collaborations across wider regions in Asia, to gather high-quality, multicenter data using standardized and uniform criteria and build a more accurate understanding of EGID in Asian patients.
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Affiliation(s)
- Fang Kuan Chiou
- Gastroenterology, Hepatology & Nutrition Service, Paediatric Medicine, Kandang Kerbau Women’s and Children’s Hospital (KKH), Singapore, Singapore
| | - Lay Queen Ng
- Gastroenterology, Hepatology & Nutrition Service, Paediatric Medicine, Kandang Kerbau Women’s and Children’s Hospital (KKH), Singapore, Singapore
| | - Wenyin Loh
- Allergy Service, Paediatric Medicine, Kandang Kerbau Women’s and Children’s Hospital (KKH), Singapore, Singapore
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Tahir D, Ginnaram S, Ikonomi E. Eosinophilic Jejunitis Presenting as Intractable Vomiting, Persistent Leukocytosis, and Ascites in a Young Adult Patient. J Med Cases 2024; 15:102-105. [PMID: 38855296 PMCID: PMC11161182 DOI: 10.14740/jmc4196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/30/2024] [Indexed: 06/11/2024] Open
Abstract
Eosinophilic enteritis (EoN) poses a distinctive challenge, affecting individuals with various clinical presentations depending on the layer and extent of the bowel wall. We present a case of a 19-year-old female with abdominal pain, vomiting, and loose stools for 1 month. Labs were significant for persistent leukocytosis with peripheral eosinophilia. A computed tomography of the abdomen/pelvis demonstrated moderate abdominal ascites and moderately diffuse mucosal thickening of jejunal loops. A diagnostic paracentesis unveiled low serum ascites albumin gradient and 92% eosinophils. Push enteroscopy resulted in no significant biopsy findings, though a laparoscopic full-thickness jejunal biopsy exhibited increased eosinophils in the bowel wall. Intravenous steroid, proton pump inhibitor, and dietary changes resolved the symptoms and normalized the labs within a week. Our case report highlights a variable presentation of eosinophilic jejunitis uncommon in this disease population. EoN is an easily missed diagnosis and mandates frequent follow-up to prompt relevant investigations. Atopic clinical features are not prevalent in each case. While rare, EoN requires a strong clinical suspicion, even if endoscopic biopsies are unremarkable, prompting timely laparoscopic full-thickness biopsy. Per protocol, physicians must do the infectious and eosinophilia workup to rule out other etiologies. Our case also highlights that worsening clinical condition in EoN warrants early intravenous steroids with a favorable prognosis and considers a psychosocial aspect of the disease on the patient's health.
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Affiliation(s)
- Dawood Tahir
- Department of Internal Medicine, Jefferson Abington Hospital, Abington, PA, USA
| | - Shravya Ginnaram
- Department of Internal Medicine, Jefferson Abington Hospital, Abington, PA, USA
| | - Erkanda Ikonomi
- Department of Gastroenterology, Jefferson Abington Hospital, Abington, PA, USA
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Ghosh S, Hiwale KM. Challenges in Diagnosis and Management of Unusual Cases of Eosinophilic Enteritis in Rural Health Settings: A Comprehensive Review. Cureus 2024; 16:e55398. [PMID: 38562345 PMCID: PMC10982834 DOI: 10.7759/cureus.55398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
This comprehensive review delves into the challenges associated with diagnosing and managing unusual cases of eosinophilic enteritis in rural health settings. Eosinophilic enteritis, characterized by an abnormal accumulation of eosinophils in the gastrointestinal (GI) tract, poses distinct difficulties in diagnosis due to its varied presentations. In rural contexts, limited access to specialized diagnostic tools, a shortage of healthcare professionals, and geographical constraints compound these challenges. This abstract encapsulates the critical issues explored in the review, emphasizing the importance of addressing atypical cases and rural healthcare's unique hurdles. The conclusion is a rallying call for collaborative action, advocating for improved education, telemedicine solutions, and enhanced access to specialized care. The implications extend beyond eosinophilic enteritis, with the potential to instigate systemic improvements in rural healthcare globally. This review is a crucial contribution to understanding eosinophilic enteritis in rural settings and advocates for transformative measures to improve diagnosis, management, and overall healthcare outcomes.
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Affiliation(s)
- Shreya Ghosh
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - K M Hiwale
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Kim HR, Kim Y, Moon JS, Ko JS, Yang HR. Serum Eosinophilic Cationic Protein as a Useful Noninvasive Marker of Eosinophilic Gastrointestinal Disease in Children. Pediatr Gastroenterol Hepatol Nutr 2024; 27:79-87. [PMID: 38510583 PMCID: PMC10948968 DOI: 10.5223/pghn.2024.27.2.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 03/22/2024] Open
Abstract
Purpose Recently, the prevalence of eosinophilic gastrointestinal disease (EGID) has shown an increasing trend worldwide. As the diagnosis of EGID requires invasive endoscopy with biopsy, noninvasive markers for detecting EGID in suspected patients, particularly children, are urgently needed. Therefore, this study aimed to evaluate the diagnostic accuracy of serum eosinophil cationic protein (ECP) beyond peripheral eosinophil counts in pediatric patients with EGID. Methods Overall, 156 children diagnosed with EGID were enrolled and 150 children with functional abdominal pain disorder (FAPD) were recruited as controls. All participants underwent endoscopic biopsy in each segment of the gastrointestinal (GI) tract and serum ECP measurement, as well as peripheral eosinophil percent and absolute eosinophil count. Results Comparing EGID (n=156) with FAPD (n=150) patients, serum ECP levels were significantly higher in pediatric patients with EGID than in those with FAPD (25.8±28.6 µg/L vs. 19.5±21.0 µg/L, p=0.007), while there was no significant difference in peripheral eosinophil percent and absolute eosinophil counts between the two groups. Serum ECP levels were correlated with peripheral eosinophil percent (r=0.593, p<0.001) and the absolute eosinophil count (r=0.660, p<0.001). The optimal cutoff value of serum ECP for pediatric EGID was 10.5 µg/mL, with a sensitivity of 69.9% and a specificity of 43.4% with an area under the receiver operating characteristic curve of 0.562. Conclusion The combination of serum ECP levels and peripheral eosinophil counts, when employed with appropriated thresholds, could serve as a valuable noninvasive biomarker to distinguish between EGID and FAPD in pediatric patients manifesting GI symptoms.
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Affiliation(s)
- Hae Ryung Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Youie Kim
- Department of Pediatrics, Incheon St. Mary’s Hospital, Incheon, Korea
| | - Jin Soo Moon
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Sung Ko
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Dadkhah A, Mounesi Sohi AS, Rakhshankhah N, Mirsardoo A. A case report of eosinophilic jejunal enteritis with spared stomach presenting as abdominal pain. Radiol Case Rep 2024; 19:881-885. [PMID: 38188948 PMCID: PMC10770494 DOI: 10.1016/j.radcr.2023.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/20/2023] [Indexed: 01/09/2024] Open
Abstract
Eosinophilic gastroenteritis (EoGE) is a group of infrequent conditions that arise from the accumulation of eosinophils in the gastrointestinal (GI) tract without any secondary causes of eosinophilia. Most cases of EoGE cases show involvement of different parts of the GI tract. Herein, we report a case of EoGE with the sole involvement of Jejunum. A 57-year-old male patient presented to our center with a chief complaint of acute abdominal pain. The patient had experienced chronic abdominal pain and intermittent diarrhea for several years, but he presented to the emergency department with severe acute flank pain. The patient was first diagnosed with renal stone and treated accordingly. However, the computed tomography (CT) scan also showed other incidental findings related to his chronic abdominal pain from several years ago, including mesenteric infiltration which shows fluid appearance in some areas, mild wall thickening, and mucosal edema of the duodenum and jejunal loops with normal appearance of the ileum. Complete blood count (CBC) showed increased eosinophil (15.5%) and decreased lymphocytes (13.1%) percent. Pathological examination of enteroscopy samples of jejunum showed a mild increase in the number of eosinophils in lamina propria. Neither parasites nor granuloma was detected. However, no such changes were found in other parts of the GI tracts. Based on pathological examination, the patient was diagnosed with eosinophilic enteritis of the jejunum. EoGE does not typically involve a specific part of the GI and generally affects both the stomach and intestine. This study reported the first case of EoGE where only the jejunal part of the intestine was involved and other parts of the GI tract were spared.
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Affiliation(s)
- Adeleh Dadkhah
- Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Nima Rakhshankhah
- Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Mirsardoo
- Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Sasaki Y, Abe Y, Mizumoto N, Nomura E, Ueno Y. Small Bowel Endoscopic Features of Eosinophilic Gastroenteritis. Diagnostics (Basel) 2022; 13:113. [PMID: 36611405 PMCID: PMC9818497 DOI: 10.3390/diagnostics13010113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/24/2022] [Accepted: 12/29/2022] [Indexed: 12/31/2022] Open
Abstract
Eosinophilic gastroenteritis (EoGE) is a rare digestive disorder characterized by eosinophilic infiltration of the stomach and intestines. In the diagnosis of EoE, it is extremely important to recognize distinctive endoscopic findings and accurately detect increased eosinophilia in gastrointestinal tissues. However, endoscopic findings of EoGE in the small intestine remain poorly understood. Therefore, we conducted a literature review of 16 eligible papers. Redness or erythema was the most common endoscopic finding in the small bowel, followed by villous atrophy, erosion, ulceration, and edema. In some cases, stenosis due to circumferential ulceration was observed, which led to retention of the capsule during small bowel capsule endoscopy. Although many aspects of small bowel endoscopic findings in EoGE remain elusive, the findings presented in this review are expected to contribute to the further development of EoGE practice.
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Affiliation(s)
- Yu Sasaki
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan
| | - Yasuhiko Abe
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan
- Division of Endoscopy, Yamagata University Hospital, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan
| | - Naoko Mizumoto
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan
| | - Eiki Nomura
- Department of Gastroenterology, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai 982-8502, Japan
| | - Yoshiyuki Ueno
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan
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Chehade M, Tan J, Gehman LT. Gastroenterology Practice Patterns Contribute to Missed Diagnoses of Eosinophilic Gastritis and Duodenitis. GASTRO HEP ADVANCES 2022; 2:334-342. [PMID: 39132645 PMCID: PMC11308756 DOI: 10.1016/j.gastha.2022.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/16/2022] [Indexed: 08/13/2024]
Abstract
Background and Aims Eosinophilic gastritis and eosinophilic duodenitis (EoG/EoD) are often misdiagnosed as functional gastrointestinal (GI) disorders. Consequently, patients with GI symptoms of EoG/EoD may not undergo the necessary steps for diagnosis. We studied gastroenterologists' evaluations of patients with chronic, unexplained, moderate-to-severe GI symptoms that were unresponsive to over-the-counter medications. Methods We performed a cross-sectional online survey of 202 board-certified gastroenterologists at office-based practices, community hospitals, or academic institutions. Respondents had been in active clinical practice for 3-35 years post-residency training, spent most of their time on direct patient care, managed ≥1 patient with irritable bowel syndrome and/or functional dyspepsia, and performed ≥1 endoscopy per month. Responses were analyzed to identify barriers to EoG/EoD diagnosis and management. Results Respondents managed a mean of 1880 patients per year; the most common diagnoses were functional dyspepsia (36%) and gastroesophageal reflux disease (19%). Mean proportions of patients who underwent upper endoscopy ranged from 42% to 84%. Biopsies were collected from >90% of patients with visible endoscopic mucosal abnormalities vs 42%-72% of patients with normal-appearing mucosae. Approximately 20% of respondents collected only 1-2 biopsies from each site of the GI tract. Only 30% routinely requested pathologists to count eosinophils, and nearly 40% had no histologic threshold for EoG/EoD diagnosis. Conclusion Gastroenterologists vary in their evaluation of patients with chronic, unexplained moderate-to-severe GI symptoms. Limited gastric and duodenal biopsy collection, particularly from normal-appearing mucosae, and failure to request tissue eosinophil counts might contribute to underdiagnosis of EoG/EoD. Availability and awareness of EoG/EoD diagnostic guidelines should improve detection in clinical practice.
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Affiliation(s)
- Mirna Chehade
- Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, New York
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Woolley M, Cook EE, Mu F, Betts KA, Billmyer E, Yim E, Chen J, Wu EQ. The Economic Burden of Eosinophilic Gastritis and Eosinophilic Enteritis in the United States. Adv Ther 2022; 39:3547-3559. [PMID: 35689161 PMCID: PMC9309124 DOI: 10.1007/s12325-022-02202-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/18/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Eosinophilic gastritis and eosinophilic enteritis (EoG/EoN) are associated with a substantial clinical burden. However, limited information is available regarding the economic burden of EoG/EoN. This study was conducted to compare healthcare resource use (HRU) and costs among patients with EoG/EoN versus without EoG/EoN in the USA. METHODS Administrative claims data from the IBM MarketScan® Commercial Claims and Encounters (CCAE) and Medicare Supplemental and Coordination of Benefits Databases (2009-2019) was used to identify two cohorts of patients. Patients without EoG/EoN were matched 3:1 to patients with EoG/EoN on sex, year of birth, and healthcare plan type. Study measures included demographic characteristics, select comorbidities, all-cause HRU, and costs. Comparisons were made over a 1-year period following EoG/EoN diagnosis for patients with EoG/EoN and an eligible date for patients without EoG/EoN. RESULTS A total of 2219 patients with EoG/EoN and 6657 patients without EoG/EoN were analyzed. Significantly higher proportions of patients with EoG/EoN versus without EoG/EoN had comorbid conditions. Rates of all-cause HRU were significantly higher among patients with EoG/EoN versus patients without EoG/EoN (adjusted rate ratio [95% confidence interval]: inpatient visits, 6.26 [5.26, 7.46]; outpatient visits, 1.17 [1.16, 1.19]; emergency department visits, 2.11 [1.98, 2.25]; all p < 0.001). Patients with EoG/EoN incurred significantly higher costs versus patients without EoG/EoN (adjusted mean cost difference $31,180; p < 0.001). Cost differences were largely due to outpatient (adjusted mean cost difference $14,018; p < 0.001) and inpatient (adjusted mean cost difference $11,224; p < 0.001) costs. CONCLUSION The economic burden associated with EoG/EoN is substantial, with patients with EoG/EoN having a higher rate of HRU and incurring $31,180 more than patients without EoG/EoN on average. Most of the cost difference was attributable to outpatient and inpatient costs. Cost-saving strategies to lower the burden of illness in this patient population are needed.
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Affiliation(s)
| | - Erin E Cook
- Analysis Group Inc., 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA
| | - Fan Mu
- Analysis Group Inc., 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA.
| | - Keith A Betts
- Analysis Group Inc., 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA
| | - Emma Billmyer
- Analysis Group Inc., 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA
| | - Erica Yim
- Analysis Group Inc., 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA
| | - Jingyi Chen
- Analysis Group Inc., 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA
| | - Eric Q Wu
- Analysis Group Inc., 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA
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Jackson DJ, Akuthota P, Andradas R, Bredenoord AJ, Cordell A, Gray S, Kullman J, Mathur SK, Pavord I, Roufosse F, Rubio C, Rusek IC, Simon D, Strobel MJ, Winders T. Improving Care in Eosinophil-Associated Diseases: A Charter. Adv Ther 2022; 39:2323-2341. [PMID: 35489014 PMCID: PMC9055373 DOI: 10.1007/s12325-022-02110-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/02/2022] [Indexed: 11/11/2022]
Abstract
Eosinophil-associated diseases (EADs) are a range of heterogeneous conditions in which eosinophils are believed to play a critical pathological role. EADs include common illnesses such as eosinophilic asthma and chronic rhinosinusitis and rare conditions such as hypereosinophilic syndromes (HES) and eosinophilic gastrointestinal disorders (EGIDs). EADs are associated with substantial burdens for the patient, including chronic, debilitating symptoms, increased financial burden, decreased health-related quality of life, and the need for repeated visits to multiple different healthcare professionals (HCPs), emergency departments, and/or hospitals. Poor EAD recognition by HCPs often contributes to delayed diagnoses, which further delays patient access to appropriate care and effective treatments, contributing to poor health outcomes. The objective of this charter is to outline key patient rights and expectations with respect to the management of their condition(s) and to set forth an ambitious action plan to improve health outcomes for patients with EADs: (1) people with EADs, their caretakers, HCPs, and the public must have greater awareness and education about EADs; (2) people with EADs must receive a timely, accurate diagnosis; (3) all people with EADs must have access to an appropriate multidisciplinary team, when necessary; and (4) people with EADs must have access to safe and effective treatment options without unnecessary regulatory delays. The principles described in this charter demonstrate the core elements of quality care that people with EADs must receive, and they represent clear steps by which to reduce patient and caregiver burden and improve patient outcomes. We urge HCPs, healthcare systems, and policymakers worldwide to swiftly adopt these principles to ensure patients with EADs have an accurate diagnosis in a timely manner and access to high-level care and treatment in an appropriate setting.
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Scutaru TT, Kupcsulik P, Sahin P, Szücs Á. From eosinophilic esophagitis to esophagus perforation: clinical management strategies. Arch Clin Cases 2021; 6:37-47. [PMID: 34754907 PMCID: PMC8565702 DOI: 10.22551/2019.23.0602.10152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Eosinophilic esophagitis is a chronic, antigen-mediated inflammation of the esophagus. The disease is most common at young ages, with a male to female ratio of 3:1. Eosinophilic granulocyte infiltration induced by oral/aeroantigens in the esophagus, mucosal hyperplasia, and fibrosis of the subepithelial layers can lead to constriction, dysphagia, blockage and esophageal perforation. Case report: A 36-year-old male patient presented in June 2016 with dysphagia as the main complaint. Workup with plain chest radiography with a water soluble contrast swallow did not reveal any pathological lesions. The patient's swallowing difficulties persisted and one year later he was treated by esophageal food bolus impaction (EFBI) in another institution. A new plain chest radiography with a water soluble contrast swallow confirmed a 9 cm long stricture in the middle third with an EFBI. During gastroscopy, a clinical picture of eosinophilic esophagitis was noted, with partially destroyed foreign body at 25cm and iatrogenic perforation at the upper half of the esophagus. After preoperative intensive care unit valuation and preparation, transhiatal esophagectomy without thoracotomy and cervical esophagostomy was performed with pyloromyotomy and feeding jejunostomy. The postoperative period was uneventful. Histological examination confirmed the presence of strictures and perforation on the background of eosinophilic esophagitis. Elective esophageal reconstruction with cervical esophagogastric anastomosis was performed on January 2018. Control blood tests revealed persistent eosinophilia, while the plain chest radiography with a water soluble contrast swallow showed no contrast leakage. Per os nutrition was resumed and the patient was discharged in good general condition. Conclusions: Eosinophilic esophagitis is a rare and difficult to diagnose entity due to its non-specific clinical presentation. In order to avoid complications and undesired delay in diagnosis, one should take into consideration this entity in every clinical situation of a young male patient with swallowing complaints.
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Affiliation(s)
| | - Péter Kupcsulik
- Semmelweis University's First Department of Surgery, Budapest, Hungary
| | - Péter Sahin
- Jahn Ferenc South-Pest Hospital and Clinic, Budapest, Hungary
| | - Ákos Szücs
- Semmelweis University's First Department of Surgery, Budapest, Hungary
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Lucendo AJ, López-Sánchez P. Targeted Therapies for Eosinophilic Gastrointestinal Disorders. BioDrugs 2021; 34:477-493. [PMID: 32472465 DOI: 10.1007/s40259-020-00427-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The growing recognition of eosinophilic gastrointestinal disorders has revealed the limitations of current treatment (mainly based on dietary modification and corticosteroids), and include refractoriness, high recurrence rates, and the need for long-term therapy. Research efforts, mainly in eosinophilic esophagitis (EoE), have unveiled essential pathophysiological mechanisms leading to these disorders, which bear some similarities to those of atopic manifestations and are shared by eosinophilic gastroenteritis (EGE) and eosinophilic colitis (EC). Novel targeted therapies, some imported from bronchial asthma and atopic dermatitis, are currently being assessed in EoE. The most promising are monoclonal antibodies, including those targeting interleukin (IL)-13 (cendakimab) and IL-4 (dupilumab), with phase 3 trials currently ongoing. The potential of anti-integrin therapy (vedolizumab) and Siglec-8 blockers (antolimab) in EGE are also promising. Non-biological therapies for eosinophilic gut disorders, which include preventing the activation of Janus kinase (JAK)-signal transducer and activator of transcription (STAT) and chemoattractant receptor expressed on T helper 2 cells (CRTH2) signaling pathways, and other potential targets that deserve investigation in eosinophilic gut disorders, are reviewed.
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Affiliation(s)
- Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Vereda de Socuéllamos, s/n.,, 13700, Tomelloso, Ciudad Real, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain. .,Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.
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Li Q, He S, Liu T, He L, Jia Y, Wu H, Yan G. A case report of eosinophilic gastroenteritis misdiagnosed as cholelithiasis. Clin Case Rep 2020; 8:2843-2847. [PMID: 33363834 PMCID: PMC7752616 DOI: 10.1002/ccr3.3252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/15/2020] [Accepted: 07/19/2020] [Indexed: 11/11/2022] Open
Abstract
Eosinophilic gastroenteritis is not only easy to ignore in clinical practice, but also easy to miss in the process of pathological diagnosis. There is a need to consider it in the differential diagnosis of alimentary disease.
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Affiliation(s)
- QianLong Li
- The Fourth Department of the Digestive Disease CenterSuining Central HospitalSichuanChina
| | - SuYu He
- The Fourth Department of the Digestive Disease CenterSuining Central HospitalSichuanChina
| | - TianYu Liu
- The Fourth Department of the Digestive Disease CenterSuining Central HospitalSichuanChina
| | - Lianfen He
- The Fourth Department of the Digestive Disease CenterSuining Central HospitalSichuanChina
| | - Yingdong Jia
- The First Department of the Digestive Disease CenterSichuanChina
| | - Hang Wu
- The Department of UltrasonographySuining Central HospitalSichuanChina
| | - Gaowu Yan
- The Department of RadiologySuining Central HospitalSichuanChina
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13
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Torrijos EG, Gómez ARG, Ortega AME, Jimenez OG, Romo JBJ, Rodriguez RG. Eosinophilic esophagoduodenitis with unusual response to omeprazole in a teenager. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 44:132-133. [PMID: 32718846 DOI: 10.1016/j.gastrohep.2020.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/23/2020] [Accepted: 04/30/2020] [Indexed: 02/07/2023]
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Iacob SA, Olariu MC, Iacob DG. Eosinophilic Colitis and Clostridioides difficile Sepsis With Rapid Remission After Antimicrobial Treatment; A Rare Coincidence and Its Pathogenic Implications. Front Med (Lausanne) 2020; 7:328. [PMID: 32903297 PMCID: PMC7396602 DOI: 10.3389/fmed.2020.00328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 06/03/2020] [Indexed: 11/24/2022] Open
Abstract
Eosinophilic colitis is a rare inflammatory disorder of the digestive tract with chronic evolution and unknown pathophysiological mechanisms. The article describes the case of a 64-year old woman with a history of asthma and hypereosinophilia, who presented to a surgical department for persistent abdominal pain in the past 4 months, weight loss and malabsorption. She was diagnosed with eosinophilic colitis based on the colonoscopic result indicating extensive eosinophilic infiltration of the colonic mucosa correlated with the laboratory data and abdominal CT scan results. Following the colonoscopy, the patient developed fever, hypotension and diarrhea and was transferred to an Infectious Diseases Department with a presumptive diagnosis of abdominal sepsis. Treatment with ertapenem was immediately started. Metronidazole was also added due to a PCR positive stool test for Clostridioides difficile toxins encoding-genes. The patient displayed a rapid remission of the fever and of the intestinal complaints following antibiotic therapy and was discharged after 14 days. During a 3 months follow-up, the patient remained asymptomatic with normal values of laboratory parameters except for a persistent hypereosinophilia. The case outlines two distinguishing features: a histopathologic diagnosis of eosinophilic colitis, a rare diagnosis of a patient with chronic abdominal pain and an unexpected and rapid remission of the eosinophilic colitis following the antibiotic treatment and the restoration of the intestinal eubiosis.
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Affiliation(s)
- Simona Alexandra Iacob
- Infectious Diseases Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Infectious Diseases Department, The National Institute of Infectious Diseases "Matei Bals", Bucharest, Romania
| | - Mihaela Cristina Olariu
- Infectious Diseases Department, The National Institute of Infectious Diseases "Matei Bals", Bucharest, Romania.,Gastroenterology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Diana Gabriela Iacob
- Infectious Diseases Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Guo H, Ji X, Yang G, Jin Y. Abnormal thymic stromal lymphopoietin expression in the gastrointestinal mucosa of patients with eosinophilic gastroenteritis. J Pediatr (Rio J) 2020; 96:350-355. [PMID: 30763528 PMCID: PMC9432300 DOI: 10.1016/j.jped.2018.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 11/01/2018] [Accepted: 11/05/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To investigate the differential expression of the thymic stromal lymphopoietin isoforms, short and long, and discern their biological implications under eosinophilic gastroenteritis. METHODS The expression of thymic stromal lymphopoietin and its two isoforms in tissues was assessed by quantitative RT-PCR in healthy controls (n=24) and patients with eosinophilic gastroenteritis (n=17). RESULTS Thymic stromal lymphopoietin mRNA was significantly reduced in eosinophilic gastroenteritis when compared with healthy controls (p<0.0001). A significantly lower amount of short thymic stromal lymphopoietin mRNA was observed in eosinophilic gastroenteritis when compared with controls (p<0.05), while a significantly higher amount of long thymic stromal lymphopoietin mRNA was observed in eosinophilic gastroenteritis when compared with controls (p<0.05). Peak eosinophilic count is significantly positively correlated with the expression of long thymic stromal lymphopoietin mRNA in the gastrointestinal mucosal of patients with eosinophilic gastroenteritis (rs=0.623, p<0.005), while peak eosinophilic count is significantly negatively correlated with the expression of short thymic stromal lymphopoietin mRNA in the gastrointestinal mucosal of patients with eosinophilic gastroenteritis (rs=-0.4474, p<0.05). CONCLUSIONS Abnormal mucosal thymic stromal lymphopoietin expression may contribute to gastrointestinal mucosa damage in eosinophilic gastroenteritis.
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Affiliation(s)
- Hongmei Guo
- Children's Hospital Affiliated to Nanjing Medical University, Department of Gastroenterology, Nanjing, China
| | - Xiaolan Ji
- Children's Hospital Affiliated to Nanjing Medical University, Department of Gastroenterology, Nanjing, China
| | - Guang Yang
- Children's Hospital Affiliated to Nanjing Medical University, Department of Gastroenterology, Nanjing, China
| | - Yu Jin
- Children's Hospital Affiliated to Nanjing Medical University, Department of Gastroenterology, Nanjing, China.
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Guo H, Ji X, Yang G, Jin Y. Abnormal thymic stromal lymphopoietin expression in the gastrointestinal mucosa of patients with eosinophilic gastroenteritis. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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17
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Priyadarshni S, Surapaneni BK, Dave K, Kaplan S, Patel N. Upper Gastrointestinal Bleed in a Young Male- A Rare Presentation of Eosinophilic Gastroenteritis. Cureus 2020; 12:e7059. [PMID: 32219053 PMCID: PMC7086115 DOI: 10.7759/cureus.7059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Eosinophilic gastroenteritis (EGE) is a rare idiopathic disease affecting multiple organs (stomach and small intestine) of the digestive tract. It is characterized by eosinophilic infiltration of the bowel wall to a variable depth and symptoms associated with gastrointestinal tract disease. The prevalence of this condition is ranging from 8 and 28 per 100,000. We present a rare presentation of EGE manifesting as upper GI bleeding. A 28-year-old male with PMH of EGE, duodenal ulcers, and stricture presented to the hospital with the chief complaints of three episodes of dizziness and melena over one day. His home medications included prednisone, montelukast, and pantoprazole. On admission, he was found to be tachycardic (150) while other vital signs were stable. Physical examination revealed cold, pale and clammy skin but was otherwise normal on examination. Initial labs showed hemoglobin (hgb) of 9.3. His hospital course was complicated with 1 episode of large volume hematemesis >1.5 L and brief loss of consciousness for which a code rapid response was called. On day 2, the hgb dropped to 5.7 and the patient received a blood transfusion. Emergent endoscopy (EGD) revealed high-grade duodenal stenosis, severe pyloroduodenal deformity and a duodenal ulcer with the visible vessel. Two clips were deployed blindly. Epinephrine could not be injected due to hard and fibrotic tissue around duodenal stenosis. The Interventional Radiology team was consulted and emergent angiography was done which revealed active bleeding from a branch of the gastric artery. Embolization was done and hemostasis was achieved successfully. He needed 5 units of PRBC transfusion in total. He was treated with pantoprazole twice a day intravenously since admission. For his known duodenal stricture, the surgical team was consulted. No acute surgical intervention was recommended. On discharge, he was sent home with pantoprazole 40 mg twice a day, slow tapering of prednisone and close follow up with gastroenterology, surgery, and primary care doctor within 1 week. The purpose of this case report is to increase awareness about this clinical condition among medical professionals.
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Affiliation(s)
| | - Balarama K Surapaneni
- Internal Medicine/ Graduate Medical Education, Aventura Hospital and Medical Center, Aventura, USA
| | - Kairavee Dave
- Graduate Medical Education, Aventura Hospital and Medical Center, Aventura, USA
| | - Steven Kaplan
- Gastroenterology, Aventura Hospital and Medical Center, Aventura, USA
| | - Nehal Patel
- Internal Medicine, Avnentura Hosptial and Medical Center, Aventura, USA
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18
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Lee M, Choi SY, Chung ML, Lee J, Sung M. A Rare Case of Eosinophilic Gastroenteritis in a Neonate with Fever. NEONATAL MEDICINE 2019. [DOI: 10.5385/nm.2019.26.4.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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19
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Kinoshita Y, Oouchi S, Fujisawa T. Eosinophilic gastrointestinal diseases - Pathogenesis, diagnosis, and treatment. Allergol Int 2019; 68:420-429. [PMID: 31000445 DOI: 10.1016/j.alit.2019.03.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/03/2019] [Accepted: 03/05/2019] [Indexed: 12/19/2022] Open
Abstract
Eosinophilic gastrointestinal diseases (EGIDs) are divided into eosinophilic esophagitis (EoE) and eosinophilic gastroenteritis (EGE), depending on the involved gastrointestinal tract, though both are considered to be chronic Th2-type allergic diseases caused by food or environmental allergens. In development of EoE, refluxed gastric acid may also have an important role. For diagnosis of EGIDs, the presence of symptoms possibly originating from the involved gastrointestinal tract and dense eosinophil infiltration are important factors. Imaging studies, including endoscopy and computed tomography, along with histopathological examinations of biopsy specimens are useful for diagnosis, whereas laboratory testing of blood, urine, and stool samples has limited value. Three useful options for treating EoE patients are acid inhibitors, swallowed topical corticosteroids, and an elimination diet, while systemic administration of glucocorticoids is the standard treatment of EGE, though information is limited. Since the prevalence of EGIDs is increasing in Western countries as well as Japan, development of effective treatments based on sufficient evidence is becoming an urgent need.
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Herrera Quiñones G, Scharrer SI, Jiménez Rodríguez AR, García Compean D, Borjas Almaguer OD, Martínez Segura JA, Jáquez Quintana JO, González González JA, Maldonado Garza HJ. Diagnosis of Eosinophilic Enteritis With Video Capsule Endoscopy and Double Balloon Enteroscopy With Favorable Response to Corticosteroids. ACG Case Rep J 2019; 6:e00127. [PMID: 31620526 PMCID: PMC6722375 DOI: 10.14309/crj.0000000000000127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 04/24/2019] [Indexed: 02/07/2023] Open
Abstract
Eosinophilic enteritis is a rare disease with nonspecific symptoms, often representing a diagnostic challenge. Video capsule endoscopy (VCE) has enabled examination of the full small bowel. However, capsule retention is an unfortunate complication. We present the case of a female patient admitted for abdominal pain. Appendectomy without resolution of symptoms was performed. A normal computed tomography and magnetic resonance imaging were obtained. The diagnosis was made by VCE and double balloon enteroscopy with biopsy. Asymptomatic capsule retention was resolved after corticosteroid therapy. The patient showed a favorable clinical and endoscopic response, confirmed through a second VCE after 3 months of treatment.
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Affiliation(s)
- Gilberto Herrera Quiñones
- Department of Gastroenterology and Endoscopy, University Hospital "Dr. José E. González", Monterrey, Mexico
| | - Susanna Isabel Scharrer
- Department of Gastroenterology and Endoscopy, University Hospital "Dr. José E. González", Monterrey, Mexico
| | | | - Diego García Compean
- Department of Gastroenterology and Endoscopy, University Hospital "Dr. José E. González", Monterrey, Mexico
| | - Omar David Borjas Almaguer
- Department of Gastroenterology and Endoscopy, University Hospital "Dr. José E. González", Monterrey, Mexico
| | | | - Joel Omar Jáquez Quintana
- Department of Gastroenterology and Endoscopy, University Hospital "Dr. José E. González", Monterrey, Mexico
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Increasing Rates of Diagnosis, Substantial Co-Occurrence, and Variable Treatment Patterns of Eosinophilic Gastritis, Gastroenteritis, and Colitis Based on 10-Year Data Across a Multicenter Consortium. Am J Gastroenterol 2019; 114:984-994. [PMID: 31008735 PMCID: PMC6554065 DOI: 10.14309/ajg.0000000000000228] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The literature related to eosinophilic gastritis (EG), gastroenteritis (EGE), and colitis (EC) is limited. We aimed to characterize rates of diagnosis, clinical features, and initial treatments for patients with EG, EGE, and EC. METHODS In this retrospective study, data were collected from 6 centers in the Consortium of Eosinophilic Gastrointestinal Researchers from 2005 to 2016. We analyzed demographics, time trends in diagnosis, medical history, presenting symptoms, disease overlap, and initial treatment patterns/responses. RESULTS Of 373 subjects (317 children and 56 adults), 38% had EG, 33% EGE, and 29% EC. Rates of diagnosis of all diseases increased over time. There was no male predominance, and the majority of subjects had atopy. Presenting symptoms were similar between diseases with nausea/vomiting and abdominal pain, the most common. One hundred fifty-four subjects (41%) had eosinophilic inflammation outside of their primary disease location with the esophagus the second most common gastrointestinal (GI) segment involved. Multisite inflammation was more common in children than in adults (68% vs 37%; P < 0.001). Initial treatment patterns varied highly between centers. One hundred-nine subjects (29%) had follow-up within 6 months, and the majority had clinical, endoscopic, and histologic improvements. CONCLUSIONS In this cohort, EG, EGE, and EC were diagnosed more frequently over time, and inflammation of GI segments outside the primary disease site co-occurrence of atopy was common with a lack of male predominance. Symptoms were similar between diseases, and initial treatment strategies were highly variable. Future investigation should assess the cause of the increased prevalence of eosinophilic GI disorders and prospectively assess outcomes to establish treatment algorithms.
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22
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Gonzalez-Canalizo V, Segues N, Medina A, Torrente S, Aguilar-Gama V, Ortega P, Bujanda L. Severe upper gastrointestinal bleeding due to eosinophilic gastritis. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 42:307-308. [PMID: 30017211 DOI: 10.1016/j.gastrohep.2018.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/15/2018] [Accepted: 05/24/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Valentín Gonzalez-Canalizo
- Hospital Universitario Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU) and Centro de Investigación en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Servicio de Aparato Digestivo, Spain; Hospital Universitario Donostia/Instituto Biodonostia, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), San Sebastián, Spain.
| | - Nerea Segues
- Hospital Universitario Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU) and Centro de Investigación en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Servicio de Aparato Digestivo, Spain; Hospital Universitario Donostia/Instituto Biodonostia, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), San Sebastián, Spain
| | - Andrea Medina
- Hospital Universitario Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU) and Centro de Investigación en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Servicio de Aparato Digestivo, Spain; Hospital Universitario Donostia/Instituto Biodonostia, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), San Sebastián, Spain
| | - Silvia Torrente
- Hospital Universitario Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU) and Centro de Investigación en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Servicio de Aparato Digestivo, Spain; Hospital Universitario Donostia/Instituto Biodonostia, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), San Sebastián, Spain
| | - Vanessa Aguilar-Gama
- Hospital Universitario Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU) and Centro de Investigación en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Servicio de Aparato Digestivo, Spain; Hospital Universitario Donostia/Instituto Biodonostia, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), San Sebastián, Spain
| | - Paula Ortega
- Hospital Universitario Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU) and Centro de Investigación en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Servicio de Aparato Digestivo, Spain; Hospital Universitario Donostia/Instituto Biodonostia, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), San Sebastián, Spain
| | - Luis Bujanda
- Hospital Universitario Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU) and Centro de Investigación en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Servicio de Aparato Digestivo, Spain; Hospital Universitario Donostia/Instituto Biodonostia, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), San Sebastián, Spain
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Gisasola P, Iriarte A, Larez MR, Casanova L, Bujanda L. Mediastinal abscess, an unusual way of presentation of eosinophilic esophagitis. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2019; 15:12. [PMID: 30858868 PMCID: PMC6396444 DOI: 10.1186/s13223-018-0313-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/20/2018] [Indexed: 11/11/2022]
Abstract
Eosinophilic esophagitis (EoE) is one of the most prevalent esophageal diseases and the leading cause of dysphagia and food impaction in children and young adults. EoE represents a chronic, local immune-mediated esophageal disease, characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. Mediastinal abscess is an uncommon condition that typically appears after esophageal perforations or thoracic surgeries, usually requiring treatment for surgical intervention due to its high morbidity-mortality. Mediastinal abscess, outside these two contexts, is extremely rare. We present the case of a mediastinal abscess secondary to EoE. It is important to think about this entity when there is a mediastinal abscess without trauma or previous surgery.
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Affiliation(s)
- Paul Gisasola
- Zumarraga Ospitalea, OSI Goierri-Urola Garaia, Department of Gastroenterology, Hospital Zumarraga, Argixao Auzoa, 20700 Zumarraga, Gipuzkoa, Basque Country Spain
| | - Ainara Iriarte
- Zumarraga Ospitalea, OSI Goierri-Urola Garaia, Department of Gastroenterology, Hospital Zumarraga, Argixao Auzoa, 20700 Zumarraga, Gipuzkoa, Basque Country Spain
| | - Martha Rosa Larez
- Zumarraga Ospitalea, OSI Goierri-Urola Garaia, Department of Gastroenterology, Hospital Zumarraga, Argixao Auzoa, 20700 Zumarraga, Gipuzkoa, Basque Country Spain
| | - Laura Casanova
- Zumarraga Ospitalea, OSI Goierri-Urola Garaia, Department of Gastroenterology, Hospital Zumarraga, Argixao Auzoa, 20700 Zumarraga, Gipuzkoa, Basque Country Spain
| | - Luis Bujanda
- Department of Gastroenterology, Instituto Biodonostia, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas Y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
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Clayton S, Cauble E, Kumar A, Patil N, Ledford D, Kolliputi N, Lopes-Virella MF, Castell D, Richter J. Plasma levels of TNF-α, IL-6, IFN-γ, IL-12, IL-17, IL-22, and IL-23 in achalasia, eosinophilic esophagitis (EoE), and gastroesophageal reflux disease (GERD). BMC Gastroenterol 2019; 19:28. [PMID: 30744559 PMCID: PMC6371504 DOI: 10.1186/s12876-019-0937-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/22/2019] [Indexed: 02/08/2023] Open
Abstract
An elevation of serum inflammatory biomarkers in achalasia patients compared with controls recently was demonstrated. It has not been determined whether the elevation of inflammatory cytokines is unique to achalasia or occurs with other diseases involving the esophagus. The primary aim of our study was to compare the differences in plasma immunological profiles (TNF- α receptor, IL-6, IFN-γ, IL-12, IL-17, IL-22, and IL-23) of patients with achalasia, eosinophilic esophagitis (EoE), and gastroesophageal reflux disease (GERD). A secondary aim of this study was to classify these same plasma cytokine profiles in the three achalasia subtypes. METHODS Plasma from 53 patients with achalasia, 22 with EoE, and 20 with GERD (symptoms plus esophagitis or + reflux study) were analyzed. EXCLUSION CRITERIA malignancy, autoimmune condition, immunodeficiency disorder, and treatment with steroids/immune modulating drugs. Cytokine levels were assayed via multiplex enzyme-linked immunosorbent assay (ELISA). RESULTS Our key finding revealed significant elevations in IL- 6 (p = 0.0158) in achalasia patients compared with EoE patients. Overall, plasma inflammatory biomarker patterns were not different in the three subtypes of achalasia. CONCLUSION There were no differences between the cytokine levels of any of the measured biomarkers between the achalasia and GERD groups suggesting that luminal stasis does increase biomarker levels for any of the cytokines examined in our study. While these results are an early first step towards clarifying some aspects of the pathogenesis of achalasia, they bring about many more questions that require further investigation and expansion. Further investigation with a larger cohort and a broader panel of biomarkers is needed.
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Affiliation(s)
- Steven Clayton
- Wake Forest Baptist Medical Center, Winston-Salem, NC USA
| | - Elliot Cauble
- University of South Florida, Division of Gastroenterology, Florida, USA
| | - Ambuj Kumar
- University of South Florida, Division of Gastroenterology, Florida, USA
| | - Nirav Patil
- Greenville Health System, Greenville, SC USA
| | - Dennis Ledford
- University of South Florida, Division of Allergy Immunology, Florida, USA
| | | | | | - Donald Castell
- Medical University of South Carolina, Division of Gastroenterology, Charleston, SC USA
| | - Joel Richter
- University of South Florida, Division of Gastroenterology, Florida, USA
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Eosinophil Counts in Mucosal Biopsies of the Ileum and Colon: Interobserver Variance Affects Diagnostic Accuracy. PATHOLOGY RESEARCH INTERNATIONAL 2018; 2018:2638258. [PMID: 30519390 PMCID: PMC6241360 DOI: 10.1155/2018/2638258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 10/18/2018] [Indexed: 12/26/2022]
Abstract
Primary eosinophilic gastroenteritis and colitis (EGE) is a rare entity with unspecific clinical and endoscopic findings. Validated histopathologic criteria for confirming the diagnosis are lacking, because numeric values for normal or elevated concentrations of eosinophils in mucosal biopsies are varying between observers. To quantify this interobserver variance, we had the same set of 30 slides of eosinophilic-rich mucosal biopsies from the ileum and colon systematically reviewed by a panel of six independent pathologists, each with more than a ten-year experience in the field. Using a highly standardized biopsy and slide preparation protocol, we ruled out any influence by the preparation, the patient, the endoscopist, the endoscopes and calipers used, the sampling site, the fixation and staining method, and the microscopic field sizes. Still, all numeric results differed between pathologists up to a factor greater than 30. Calculated positive or negative diagnosis of EGE differed up to a factor greater than 8. A theoretical incidence for EGE calculated from these numbers differed by a factor greater than 1500. We conclude that eosinophil counts in mucosal biopsies from the lower gastrointestinal tract are subject to a very high interobserver variance. Until further research provides objective and validated methods for standardization, all epidemiologic numbers derived from histopathologic findings may have to be questioned. When diagnosing individual patients with EGE, overall morphologic picture together with clinical and endoscopic findings is more important than numeric eosinophil count.
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Shi L, Jia QH, Liu FJ, Guan H, Jiang ZY. Massive hemorrhagic ascites: A rare presentation of eosinophilic gastroenteritis. World J Clin Cases 2018; 6:156-160. [PMID: 30079343 PMCID: PMC6068814 DOI: 10.12998/wjcc.v6.i7.156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/02/2018] [Accepted: 05/30/2018] [Indexed: 02/05/2023] Open
Abstract
According to Klein’s classification system, the symptomatology of eosinophilic gastroenteritis (EG), a rare disease, differs based on the affected tissue layer. Patients with subserosal EG often have peritoneal effusion. Hemorrhagic ascites due to EG is extremely rare and has not been reported in the literature. Here, we report a 57-year-old woman with EG and massive hemorrhagic ascites. Laboratory investigations showed elevated peripheral eosinophils with significant eosinophilia (65.6%). Ultrasonography showed massive abdominal ascites. Abdominal paracentesis revealed hemorrhagic peritoneal fluid and microscopy showed predominant eosinophils. Upper gastrointestinal endoscopy revealed erosions, exudates, and mucosal rings in the duodenal mucosa; histological examination indicated eosinophilic infiltration. EG presenting with hemorrhagic ascites was diagnosed by histologic examination of eosinophilic infiltration. She was empirically treated with ketotifen 1 mg bid po with rapid resolution of ascites and a remarkable decline in peripheral eosinophil counts. Clinicians should consider the differential diagnosis of unexplained hemorrhagic ascites.
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Affiliation(s)
- Lei Shi
- Department of Gastroenterology, the Eighth Affiliated Hospital of Guangxi Medical University, Guigang 537100, Guangxi Zhuang Autonomous Region, China
| | - Qiu-Hong Jia
- Department of Gastroenterology, the Eighth Affiliated Hospital of Guangxi Medical University, Guigang 537100, Guangxi Zhuang Autonomous Region, China
| | - Fu-Jian Liu
- Department of Gastroenterology, the Eighth Affiliated Hospital of Guangxi Medical University, Guigang 537100, Guangxi Zhuang Autonomous Region, China
| | - Hang Guan
- Department of Gastroenterology, the Eighth Affiliated Hospital of Guangxi Medical University, Guigang 537100, Guangxi Zhuang Autonomous Region, China
| | - Zhi-Yong Jiang
- Department of Gastroenterology, the Eighth Affiliated Hospital of Guangxi Medical University, Guigang 537100, Guangxi Zhuang Autonomous Region, China
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