Eosinophilic disorders of the gastrointestinal tract: clinical manifestations, diagnosis and treatment

Cover Page

Cite item

Abstract

Eosinophilic gastrointestinal disorders (EGID) are a kind of pathology which has not been well studied and has a trend to an increase during the last years that raises concern. They may have highly variable clinical manifestations; therefore, their differential diagnosis is not infrequently challenging. The article presents a review of scientific data on EGID and three clinical cases of various eosinophilic lesions of the stomach and gut in children. Clinical manifestations of EGID depend on their location and on the depth of the lesions. The first clinical case presented with repeated gastrointestinal bleedings in a child with hemorrhagic eosinophilic gastritis. The second clinical case was eosinophilic colitis with Crohnlike clinical and endoscopic manifestations, and the third one was eosinophilic ileocolitis with ascites. All these children had a background of sensitization to various food allergens. However, there were no high specific IgE in blood in any of the cases, although IgE were identified in the biopsy sample of intestinal mucosa and in duodenal aspirates. The results of the mast cell degranulation test with corresponding allergens correlated with the efficacy of their elimination. Elimination diet was recommended to all the patients; in two patients it was combined with a short course of glucocorticosteroids and in one case with subsequent montelucast treatment. All three patients achieved complete recovery, confirmed by their follow-up and repeated endoscopic and histological examinations.

About the authors

E. A. Kornienko

Saint-Petersburg State Pediatric Medical University

Author for correspondence.
Email: elenkornienk@yandex.ru

Elena A. Kornienko - MD, PhD, Professor, Head of the Chair of Gastroenterology, Faculty of Postgraduate and Additional Professional Education.

2 Litovskaya ul., Saint Petersburg, 194100.

Tel.: +7 (812) 778 06 61.

Russian Federation

Yu. A. Moiseenkova

St. Mary Magdalene Children's City Hospital No. 2

Email: fake@neicon.ru

Yuliya A. Moiseenkova - MD, Department of Gastroenterology.

47 2-ya liniya Vasil'evskogo ostrova, Saint Petersburg, 199053.

Russian Federation

N. L. Volkova

Saint-Petersburg State Pediatric Medical University

Email: fake@neicon.ru

Nataliya L. Volkova - MD, Head of the Department of Gastroenterology, Clinical Hospital.

2 Litovskaya ul., Saint Petersburg, 194100. 

 

Russian Federation

T. B. Loboda

Saint-Petersburg State Pediatric Medical University

Email: fake@neicon.ru

Tatiyana B. Loboda - MD, PhD, Associate Professor, Chair of Gastroenterology, Faculty of Postgraduate and Additional Professional Education.

2 Litovskaya ul., Saint Petersburg, 194100. 

 

Russian Federation

References

  1. Платонова НБ. Аллергия к белкам коровьего молока. Педиатр. 2016;7(3):153-6. doi: 10.17816/PED73153-156.
  2. Jensen ET, Martin CF, Kappelman MD, Dellon ES. Prevalence of eosinophilic gastritis, gastroenteritis, and colitis: Estimates from a National Administrative Database. J Pediatr Gastroenterol Nutr. 2016;62(1):36-42. doi: 10.1097/MPG.0000000000000865.
  3. Collins MH. Histopathology associated with eosinophilic gastrointestinal diseases. Immunol Allergy Clin North Am. 2009;29(1):109-17, x-xi. doi: 10.1016/j.iac.2008.10.005.
  4. Choi JS, Choi SJ, Lee KJ, Kim A, Yoo JK, Yang HR, Moon JS, Chang JY, Ko JS, Kang GH. Clinical manifestations and treatment outcomes of eosinophilic gastroenteritis in children. Pediatr Gastroenterol Hepatol Nutr. 2015;18(4): 253-60. doi: 10.5223/pghn.2015.18.4.253.
  5. Naramore S, Gupta SK. Nonesophageal eosinophilic gastrointestinal disorders: clinical care and future directions. J Pediatr Gastroenterol Nutr. 2018;67(3):318-21. doi: 10.1097/MPG.0000000000002040.
  6. Clayton F, Fang JC, Gleich GJ, Lucendo AJ, Olalla JM, Vinson LA, Lowichik A, Chen X, Emerson L, Cox K, O'Gorman MA, Peterson KA. Eosinophilic esophagitis in adults is associated with IgG4 and not mediated by IgE. Gastroenterology. 2014;147(3):602-9. doi: 10.1053/j.gastro.2014.05.036.
  7. Klein NC, Hargrove RL, Sleisenger MH, Jeffries GH. Eosinophilic gastroenteritis. Medicine (Baltimore). 1970;49(4):299-319.
  8. Rothenberg ME. Eosinophilic gastrointestinal disorders (EGID). J Allergy Clin Immunol. 2004;113(1 ):11-28. doi: 10.1016/j.jaci.2003.10.047.
  9. Fleischer DM, Atkins D. Evaluation of the patient with suspected eosinophilic gastrointestinal disease. Immunol Allergy Clin North Am. 2009;29(1 ):53-63, ix. doi: 10.1016/j.iac.2008.09.002.
  10. Lucendo AJ, Arias A, De Rezende LC, Yague-Compadre JL, Mota-Huertas T, Gonzalez-Castillo S, Cuesta RA, Tenias JM, Bellon T. Subepithelial collagen deposition, profibrogenic cytokine gene expression, and changes after prolonged fluticasone propionate treatment in adult eosinophilic esophagitis: a prospective study. J Allergy Clin Immunol. 2011;128(5):1037-46. doi: 10.1016/j.jaci.2011.08.007.
  11. Straumann A, Conus S, Degen L, Felder S, Kummer M, Engel H, Bussmann C, Beglinger C, Schoepfer A, Simon HU. Budesonide is effective in adolescent and adult patients with active eosinophilic esophagitis. Gastroenterology. 2010;139(5):1526-37, 1537.e1. doi: 10.1053/j.gastro.2010.07.048.
  12. Aceves SS, Newbury RO, Chen D, Mueller J, Dohil R, Hoffman H, Bastian JF, Broide DH. Resolution of remodeling in eosinophilic esophagitis correlates with epithelial response to topical corticosteroids. Allergy. 2010;65(1):109-16. doi: 10.1111/j.1398-9995.2009.02142.x.
  13. Straumann A, Conus S, Degen L, Frei C, Bussmann C, Beglinger C, Schoepfer A, Simon HU. Long-term budesonide maintenance treatment is partially effective for patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2011;9(5):400-9.e1. doi: 10.1016/j.cgh.2011.01.017.
  14. Collins MH. Histopathologic features of eosinophilic esophagitis and eosinophilic gastrointestinal diseases. Gastroenterol Clin North Am. 2014;43(2):257-68. doi: 10.1016/j.gtc.2014.02.007.
  15. Jawairia M, Shahzad G, Mustacchia P. Eosinophilic gastrointestinal diseases: review and update. ISRN Gastroenterol. 2012;2012:463689. doi: 10.5402/2012/463689.
  16. Ziegler SF. The role of thymic stromal lymphopoietin (TSLP) in allergic disorders. Curr Opin Immunol. 2010;22(6):795-9. doi: 10.1016/j.coi.2010.10.020.
  17. Valent P, Klion AD, Rosenwasser LJ, Arock M, Bochner BS, Butterfield JH, Gotlib J, Haferlach T, Hellmann A, Horny HP, Leiferman KM, Metzgeroth G, Matsumoto K, Reiter A, Roufosse F, Rothenberg ME, Simon HU, Sotlar K, Vandenberghe P, Weller PF, Gleich GJ. ICON: eosinophil disorders. World Allergy Organ J. 2012;5(12):174-81. doi: 10.1097/WOX.0b013e31827f4192.
  18. Prasad GA, Alexander JA, Schleck CD, Zinsmeister AR, Smyrk TC, Elias RM, Locke GR 3rd, Talley NJ. Epidemiology of eosinophilic esophagitis over three decades in Olmsted County, Minnesota. Clin Gastroenterol Hepatol. 2009;7(10):1055-61. doi: 10.1016/j.cgh.2009.06.023.
  19. Коростовцев ДС, Корниенко ЕА, Галенко ЛА, Трусова ОВ, Камаев АВ, Макарова ИВ. Желудочно-кишечные проявления пищевой аллергии: патогенез, клинические формы, принципы терапии. Российский аллергологический журнал. 2014;(3):11-21.
  20. Hruz P, Straumann A, Bussmann C, Heer P, Simon HU, Zwahlen M, Beglinger C, Schoepfer AM; Swiss EoE study group. Escalating incidence of eosinophilic esophagitis: a 20-year prospective, population-based study in Olten County, Switzerland. J Allergy Clin Immunol. 2011;128(6):1349-50.e5. doi: 10.1016/j.jaci.2011.09.013.
  21. Roy-Ghanta S, Larosa DF, Katzka DA. Atopic characteristics of adult patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2008;6(5):531 -5. doi: 10.1016/j.cgh.2007.12.045.
  22. Erwin EA, James HR, Gutekunst HM, Russo JM, Kelleher KJ, Platts-Mills TA. Serum IgE measurement and detection of food allergy in pediatric patients with eosinophilic esophagitis. Ann Allergy Asthma Immunol. 2010;104(6): 496-502. doi: 10.1016/j.anai.2010.03.018.
  23. Almansa C, Krishna M, Buchner AM, Ghabril MS, Talley N, DeVault KR, Wolfsen H, Raimondo M, Guarderas JC, Achem SR. Seasonal distribution in newly diagnosed cases of eosinophilic esophagitis in adults. Am J Gastroenterol. 2009;104(4):828-33. doi: 10.1038/ajg.2008.169.
  24. Moawad FJ, Veerappan GR, Lake JM, Maydonovitch CL, Haymore BR, Kosisky SE, Wong RK. Correlation between eosinophilic oesophagitis and aeroallergens. Aliment Pharmacol Ther. 2010;31(4):509-15. doi: 10.1111/j.1365-2036.2009.04199.x.
  25. Wang FY, Gupta SK, Fitzgerald JF. Is there a seasonal variation in the incidence or intensity of allergic eosinophilic esophagitis in newly diagnosed children? J Clin Gastroenterol. 2007;41(5):451-3. doi: 10.1097/01.mcg.0000248019.16139.67.
  26. Spergel JM, Brown-Whitehorn TF, Beausoleil JL, Franciosi J, Shuker M, Verma R, Liacouras CA. 14 years of eosinophilic esophagitis: clinical features and prognosis. J Pediatr Gastroenterol Nutr. 2009;48(1):30-6. doi: 10.1097/MPG.0b013e3181788282.
  27. Lucendo AJ, Molina-Infante J, Arias A, von Arnim U, Bredenoord AJ, Bussmann C, Amil Dias J, Bove M, Gonzalez-Cervera J, Larsson H, Miehlke S, Papadopoulou A, Rodriguez-Sanchez J, Ravelli A, Ronkainen J, Santander C, Schoepfer AM, Storr MA, Terreehorst I, Straumann A, Attwood SE. Guidelines on eo-sinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J. 2017;5(3):335- 58. doi: 10.1177/2050640616689525.
  28. Walsh SV, Antonioli DA, Goldman H, Fox VL, Bousvaros A, Leichtner AM, Furuta GT. Allergic esophagitis in children: a clinicopathological entity. Am J Surg Pathol. 1999;23(4):390-6.
  29. Fox VL. Pediatric endoscopy. Gastrointest Endosc Clin N Am. 2000;10(1):175-94, viii.
  30. Spechler SJ, Genta RM, Souza RF. Thoughts on the complex relationship between gastroesophageal reflux disease and eosinophilic esophagitis. Am J Gastroenterol. 2007;102(6):1301-6. doi: 10.1111/j.1572-0241.2007.01179.x.
  31. Rothenberg ME, Mishra A, Collins MH, Putnam PE. Pathogenesis and clinical features of eosinophilic esophagitis. J Allergy Clin Immunol. 2001 ;108(6):891 -4. doi: 10.1067/mai.2001.120095.
  32. Kelly KJ. Eosinophilic gastroenteritis. J Pediatr Gastroenterol Nutr. 2000;30 Suppl:S28-35.
  33. Pasha SF, Leighton JA, Williams JW, De Petris G, Harold K, Shiff AA. Capsule retention in a patient with eosinophilic gastroenteritis mimicking diaphragm disease of the small bowel. Endoscopy. 2009;41 Suppl 2:E290-1. doi: 10.1055/s-0029-1215125.
  34. Lemale J, Dainese L, Tounian P. Eosinophilic gastroenteritis and colitis in pediatric patients: Increasingly frequent diseases. Arch Pediatr. 2015;22(7):769-77. doi: 10.1016/j.arcped.2015.04.005.
  35. Iacono G, Cavataio F, Montalto G, Florena A, Tumminello M, Soresi M, Notarbartolo A, Carroccio A. Intolerance of cow's milk and chronic constipation in children. N Engl J Med. 1998;339(16):1100-4. doi: 10.1056/NEJM199810153391602.
  36. Zukerberg L, Mahadevan K, Selig M, Deshpande V. Oesophageal intrasquamous IgG4 deposits: an adjunctive marker to distinguish eosinophilic oesophagitis from reflux oesophagitis. Histopathology. 2016;68(7): 968-76. doi: 10.1111/his.12892.
  37. Kuang FL, Klion AD. Biologic agents for the treatment of hypereosinophilic syndromes. J Allergy Clin Immunol Pract. 2017;5(6):1502- 9. doi: 10.1016/j.jaip.2017.08.001.
  38. Prussin C. Eosinophilic gastroenteritis and related eosinophilic disorders. Gastroenterol Clin North Am. 2014;43(2):317-27. doi: 10.1016/j.gtc.2014.02.013.
  39. Pineton de Chambrun G, Gonzalez F, Canva JY, Gonzalez S, Houssin L, Desreumaux P, Cortot A, Colombel JF. Natural history of eosinophilic gastroenteritis. Clin Gastroenterol Hepatol. 2011;9(11):950-6.e1. doi: 10.1016/j.cgh.2011.07.017.
  40. Suzuki J, Kawasaki Y, Nozawa R, Isome M, Suzuki S, Takahashi A, Suzuki H. Oral disodium cromoglycate and ketotifen for a patient with eosinophilic gastroenteritis, food allergy and protein-losing enteropathy. Asian Pac J Allergy Immunol. 2003;21(3):193-7.
  41. De Maeyer N, Kochuyt AM, Van Moerkercke W, Hiele M. Montelukast as a treatment modality for eosinophilic gastroenteritis. Acta Gastroenterol Belg. 2011;74(4):570-5.
  42. Prussin C, James SP, Huber MM, Klion AD, Metcalfe DD. Pilot study of anti-IL-5 in eosinophilic gastroenteritis. J Allergy Clin Immunol. 2003;111(2 Suppl 3):S275. doi: 10.1016/S0091-6749(03)80986-7.
  43. Kim YJ, Prussin C, Martin B, Law MA, Haverty TP, Nutman TB, Klion D. Rebound eosinophilia after treatment of hypereosinophilic syndrome and eosinophilic gastroenteritis with monoclonal anti-IL-5 antibody SCH55700. J Allergy Clin Immunol. 2004;114(6):1449-55. doi: 10.1016/j.jaci.2004.08.027.

Supplementary files

There are no supplementary files to display.


Copyright (c) 2018 Kornienko E.A., Moiseenkova Y.A., Volkova N.L., Loboda T.B.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies