Eosinophilic Gastroenteritis

Eosinophilic gastroenteritis is relatively newly discovered disease

1. EOSINOPHILIC GASTROENTERITIS (EG) ESOPHAGITIS GASTRITIS ENTERITIS COLITIS

2. DIAGNOSTIC CRITERIA ABNORMAL GI SYMPTOMS (PAIN, DIARRHEA) EOSINOPHILIC INFILTRATION > 20 / hpf INFILTRATION LIMITED TO GIT ONLY NO KNOWN CAUSE OF EOSINOPHILIA 8 0 % PERIPHERAL EOSINOPHILIA 50 % ATOPY (ASTHMA,FOOD ALLERGY)

3. INCIDENCE M>F PEAK – 20 TO 50 YEARS MATHAN (1998 IJG)

4. EOSINOPHILS CYTOKINES (IL-3,IL-4,IL-13) LEUKOTRIENE (C4) CHEMOKINES

5. TYPES OF EG MUCOSAL FORM MUSCULAR FORM SEROSAL FORM OVERLAP POSSIBLE

6. MUCOSAL FORM ALLERGY MOST COMMON VOMITING, ABDOMINAL PAIN DIARRHEA, MALABSORPTION BLOOD IN STOOL FAILURE TO THRIVE DELAYED PUBERTY / AMENORRHEA (AEC – 2000 )

7. MUSCULAR FORM ALLERGY LEAST COMMON OBSTRUCTIVE SYMPTOMS PYLORIC STENOSIS INTESTINAL OBSTRUCTION (PROXIMAL) (AEC – 1000 )

8. SEROSAL FORM LEAST COMMON ASCITES – EXUDATIVE/EOSINOPHILIC LEAKAGE OF FLUID (STERILE) ENTIRE GI WALL INVOLVED (AEC – 8000 )

9. DIAGNOSIS CBC - E > 2000 (AEC) LOW IRON/ALBUMIN STOOL R/M IgE HIGH SKIN PRICK TEST

10. DIAGNOSIS BIOPSY 6 Bx FROM N/Abn AREA (PATCHY) > 20 E/hpf R/O VASCULITIS

11. LAPAROSCOPY FULL THICKNESS Bx IN OBSTRUCTIVE MASS LESION MIMICKING MALIGNANCY

12. DIFFERENTIAL DIAGNOSIS PARASITE INFECTION CELIAC DISEASE VASCULITIS IBD GERD MASTEOCYTOSIS HES NEOPLASM

13. TREATMENT ELIMINATION DIET MILK WHEAT(GLUTEN) SOY EGG/BEEF ELEMENTAL DIET ( VARIABLE EFFECT)

14. DRUGS STEROIDS PREDNISOLONE - 40 mg, 2-4Wk FLUTICASONE - 220mu puff/ bd BUDESONIDE CROMOLYN - 200 mg qid KETOTIFEN MONTILUKAST

15. SURGERY AVOIDED (PERSISTENT OBSTRUCTION) RECURRENCES

16. PROGNOSIS MORTALITY – RARE MORBIDITY – MALNUTRITION OBSTRUCTION PERFORATION WAXING AND WANING COURSE RISK OF CANCER IS NOT INCREASED