Eosinophilic gastroenteritis

Eosinophilic gastroenteritis Description, Causes and Risk Factors: Abbreviation: EG. Alternative Name: Eosinophilic gastritis. Eosinophilic gastroenteritis is a rare disease of unknown etiology characterized by patchy or diffuse eosinophilic infiltration of the gastrointestinal tract wall with various gastrointestinal manifestations. The disease is rare, and the incidence is difficult to estimate. However, >280 cases have been reported in medical literature. The majority of the cases of Eosinophilic gastroenteritis are reported in whites, with some cases occurring in Asians. A slight male preponderance has been reported. The majority of patients clinically present in the third-to-fifth decades, but the disease can affect any age group. The exact cause of Eosinophilic gastroenteritis is unknown, but parasites, immune disease and allergies to certain food items are all potential causes. The exact pathophysiology of the disease is unknown, but is associated with selective infiltration of eosinophils in parts of GI tract. The disorder is classified into primary or secondary subtypes. The primary subtypes include atopic, non-atopic and familiar variants. This are also called as allergic idiopathic eosinophilic gastritis. Eosinophilic involvement of the gut may be mucosal, muscularis and serosal causing variability in the presentation. Most patients have increased total Immunoglobulin E (IgE) and food specific IgE. In some patients, increased secretion of interleukin 4 (IL4) and interleukin 5 (IL5) from peripheral blood T cells home have been reported. Some foods can trigger the Eosinophilic gastroenteritis they may include milk, soy, wheat, eggs, nuts, shellfish, corn, rice, beef, pork, chicken, turkey. Symptoms:Eosinophilic gastroenteritis Symptom may include:
  • Abdominal pain, 77%.
  • Anorexia, Nausea, Vomiting, 48%.
  • Diarrhea, 42%.
  • Weight Loss, 17%.
  • Abdominal distension, 12%.
  • GI blood loss (occult/overt), 18%.
  • Ascites, 5%.
  • Protein malabsorption, 9%.
Diagnosis: Differential Diagnosis May Include:
  • Inflammatory bowel diseases.
  • Hypereosinophilic syndromes.
  • Connective tissue disease.
  • Lymphoma, vasculitis (Churg-Strauss syndrome, polyarteritis nodosa).
  • Celiac disease.
  • Parasitic infestations.
  • Malignancies.
Because there is no gold standard for this disease, a wide variety of diagnostic criteria is presented. Definitive diagnosis requires histological evidence of eosinophilic infiltration. As eosinophilic infiltrates can be diffused or patchy in distribution, multiple biopsies should be done to avoid missing the diagnosis. In patients with subserosal disease, abdominal paracentesis demonstrates a sterile fluid with a high eosinophil count. In cases where the disease is purely muscular, endoscopic biopsy may be non diagnostic and may require laparoscopic full thickness biopsy. Ultrasound and computed tomography scans may show thickened intestinal walls and, occasionally, localized lymphadenopathy. However, similar changes can also be found in other diseases such as Crohn's disease, lymphoma and granulomatous disease. Laboratory Tests May Include:
  • General History & Examination.
  • Complete blood count and differential.
  • Erythrocyte Sedimentation Rate (ESR).
  • Chemistry (serum bilirubin).
  • Total IgE
  • Fecal Protein.
Imaging Studies May Include:
  • Barium Studies.
  • Ultrasound.
  • CT Abdomen.
Others:
  • Endoscopy & biopsy of Upper & Lower GI tract
  • Ascitic fluid analysis.
  • Echocardiogram.
Treatment of Eosinophilic gastroenteritis: There have been no randomized prospective clinical trials regarding therapy. Thus, the treatment is empirical and based on the severity of the clinical manifestations. Patients with mild disease can be treated symptomatically. More symptomatic patients and those with evidence of malabsorption need more aggressive therapy. Corticosteroid therapy is the mainstay of treatment of Eosinophilic gastroenteritis both in adults as well as in children. The appropriate duration of steroid therapy is unknown. Signs may recur and medication is usually needed for life. A diet change to a hypoallergenic diet has been used with some success. If a diagnosis of Eosinophilic gastroenteritis is made, it is important to maintain your ferret on a strict diet, as treats and dietary changes can lead to a recurrence of clinical signs. NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.  

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