Eosinophilic Gastritis/Gastroenteritis.

Phillip H Chen, Lorraine Anderson, Kuixing Zhang, Guy A Weiss

Journal: Current gastroenterology reports 2021;23(8):13

PMID: 34331146

Abstract

PURPOSE OF REVIEW

Eosinophilic gastritis/gastroenteritis (EG/EGE) are rare eosinophilic infiltrative disorders in children and adults that fall under the umbrella term eosinophilic gastrointestinal disorders (EGIDs). EGIDs also include eosinophilic esophagitis (EoE) and eosinophilic colitis. In this article, we present the current literature regarding the clinical presentation, diagnostic criteria, and management of EG/EGE.

RECENT FINDINGS

The underlying complex pathophysiology remains unknown, yet hypersensitivity response is a central component. Unlike EoE, standardized diagnostic criteria are lacking but, promising research employing tissue-based and blood-based methods of diagnosis have been reported. Non-EoE EGIDs are more challenging to treat than EoE. More than a third of patients may achieve spontaneous remission. Still, most will require dietary elimination and/or pharmaceutical interventions, mainly corticosteroids, but also biologics (monoclonal antibodies against IL-4, IL-5, TNFα, integrin α4β7, and IgE), mast-cell stabilizers, leukotriene (LT)-receptor antagonists, and antihistamines. Promising research suggests the role of AK002, an anti-siglec antibody, in clinical and histological improvement. Given the rarity and underdiagnosis of EG/EGE, different natural progression compared to EoE, heterogeneous clinical manifestations, and probable normal endoscopic appearance, it is vital to maintain a high suspicion index in atopic patients, obtain at least 5-6 random biopsies from each site for gastro/duodenal eosinophilic infiltrate with the subsequent exclusion of inflammatory, allergic and infectious differential diagnoses to increase the yield of an accurate diagnosis. Corticosteroids remain the mainstay of treatment, often requiring long-term use. Steroid-sparing agents remain experimental. Goals of therapy move beyond clinical remission but lack evidence to support histological remission.

Address: David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, suite 345, Los Angeles, CA, 90095, USA.; Department of Internal Medicine, University of California Los Angeles, Los Angeles, CA, USA.; Department of Allergy-Immunology, University of California Los Angeles, Los Angeles, CA, USA.; Department of Pathology, University of California Los Angeles, Los Angeles, CA, USA.; David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, suite 345, Los Angeles, CA, 90095, USA. [email protected].; Celiac Disease Program, Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, CA, USA. [email protected].

DOI: 10.1007/s11894-021-00809-2

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https://medlineplus.gov/eosinophilicesophagitis.ht...

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Full Text Sources:

https://dx.doi.org/10.1007/s11894-021-00809-2

MeSH Terms: Antibodies, Monoclonal, Humanized, Enteritis, Eosinophilia, Eosinophilic Esophagitis, Gastritis, Gastroenteritis, Humans