Eozinofilik Gastroenterit

Year 2022, Volume: 14 Issue: 3, 81 - 87, 31.12.2022

Selim Can Peker , Abdulbaki Erkovan , Mustafa Uğur Gunturk Ibrahim Kılıccalan

https://doi.org/10.35514/mtd.2022.79

Abstract

Eozinofilik gastroenteritis, mide ve ince bağırsakta yoğun eozinofili ile karakterize, Th2 aracılı alerjik bir hastalıktır. İlk olarak 1937 yılında tanımlanmasına rağmen patogenezi hala net olarak ortaya konamamıştır. Eozinofilik gastroenteritis, eozinofilik gastrointestinal bozuklar grubu içinde yer alır ve eozinofilik gastrit, eozinofilik enterit, eozinofilik kolit olmak üzere üç alt tipe ayrılır. Eozinofilik gastroenteritin en belirgin özelliği dokuda eozinofili tablosudur. Eozinofilik gastroenteriin klinik bulguları, gastrointestinal sistemdeki tutulum yerine ve bağırsak duvarında invazyon derinliğine göre farklılık gösterebilmektedir. Bununla birlikte en sık izlenen klinik belirtiler abdominal ağrı, bulantı, kusma, diare, kilo kaybı, gastrointestinal kanamadır. Tanısında anamnez, fizik muayene ve laboratuvar tetkikleri kullanılmaktadır. Eozinofilik gastroenteritis nadir izlenen bir hastalık olduğundan tanıda spesifik tanı kriterleri bulunmamaktadır. Ancak tanı sırasında dört ana kriterin varlığı önemlidir. Bu kriterler; gastroinsetinal semptomların bulunması, gastrointestinal sistemin eozinofilik infiltrasyonu, bağırsak eozinofilisinin diğer nedenlerinin (paraziter enfeksiyonlar, ilaçların yan etkileri, inflamatuar bağırsak hastalığı (IBD), bağ dokusu hastalıkları ve lenfoproliferatif maligniteler) dışlanması ve diğer sistemlerde tutulumun gözlenmemesi şeklindedir. Kesin tanı için klinik öykü, fizik muayene, laboratuar sonuçları, endoskopik ve radyolojik bulgular kullanılır. Eozinofilik gastroenterit tedavisinde diyet tedavisi, glukokortikoidler, immünsupresif ajanlar, mast hücresi stabilizatörleri, lökotrien antagonistleri, anti-IL5 antikoru, Anti-IgE antikoru gibi ajanlar kullanılmaktadır.

Keywords

Abdominal ağrı, eozinofili, eozinofilik gastroenterit, kortikosteroidler

Eosinophilic Gastroenteritis

Abstract

Eosinophilic gastroenteritis is a Th2 mediated allergic disease characterized by intense eosinophilia in the stomach and small intestine. Although it was first described in 1937, its pathogenesis is still not clearly established. Eosinophilic gastroenteritis is included in the group of eosinophilic gastrointestinal disorders and is divided into three subtypes: eosinophilic gastritis, eosinophilic enteritis, and eosinophilic colitis. The most prominent feature of eosinophilic gastroenteritis is tissue eosinophilia. Clinical manifestations of eosinophilic gastroenteritis may differ depending on the site of involvement in the gastrointestinal system and the depth of invasion in the intestinal wall. However, the most common clinical symptoms are abdominal pain, nausea, vomiting, diarrhea, weight loss, and gastrointestinal bleeding. Anamnesis, physical examination and laboratory tests are used in its diagnosis. Since eosinophilic gastroenteritis is a rare disease, there are no specific diagnostic criteria for diagnosis. However, the presence of four main criteria is important for diagnosis. These criteria are; Presence of gastroinsetinal symptoms, eosinophilic infiltration of the gastrointestinal tract, exclusion of other causes of intestinal eosinophilia (parasitic infections, side effects of drugs, inflammatory bowel disease (IBD), connective tissue diseases and lymphoproliferative malignancies) and absence of involvement in other systems. Clinical history, physical examination, laboratory results, endoscopic and radiological findings are used for definitive diagnosis. Agents such as diet therapy, glucocorticoids, immunosuppressive agents, mast cell stabilizers, leukotriene antagonists, anti-IL5 antibodies and anti-IgE antibodies are used in the treatment of eosinophilic gastroenteritis.

Keywords

Eosinophilic gastroenteritis, Eosinophili, Abdominal Pain, Corticosteroids

References

• (1) Uppal V, Kreiger P, Kutsch E. Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. Clin Rev Allergy Immunol 2016;50:175–88. https://doi.org/10.1007/s12016-015-8489-4.
• (2) Rothenberg ME. Eosinophilic gastrointestinal disorders (EGID). J Allergy Clin Immunol 2004;113:11–28; quiz 29. https://doi.org/10.1016/j.jaci.2003.10.047.
• (3) Marichal T, Mesnil C, Bureau F. Homeostatic Eosinophils: Characteristics and Functions. Front Med 2017;4:101. https://doi.org/10.3389/fmed.2017.00101.
• (4) Kinoshita Y, Ishihara S. Eosinophilic gastroenteritis: epidemiology, diagnosis, and treatment. Curr Opin Allergy Clin Immunol 2020;20:311–5. https://doi.org/10.1097/ACI.0000000000000635.
• (5) Oh HE, Chetty R. Eosinophilic gastroenteritis: a review. J Gastroenterol 2008;43:741–50. https://doi.org/10.1007/s00535-008-2230-5.
• (6) Khan S. Eosinophilic gastroenteritis. Best Pract Res Clin Gastroenterol 2005;19:177–98. https://doi.org/10.1016/j.bpg.2005.01.009.
• (7) Spergel JM, Book WM, Mays E, Song L, Shah SS, Talley NJ, et al. Variation in prevalence, diagnostic criteria, and initial management options for eosinophilic gastrointestinal diseases in the United States. J Pediatr Gastroenterol Nutr 2011;52:300–6. https://doi.org/10.1097/MPG.0b013e3181eb5a9f.
• (8) Klein NC, Hargrove RL, Sleisenger MH, Jeffries GH. Eosinophilic gastroenteritis. Medicine (Baltimore) 1970;49:299–319. https://doi.org/10.1097/00005792-197007000-00003.
• (9) Amadori R, Stampini V, Rapetti R, Pirisi M, Vigone A, Surico D. Eosinophilic gastroenteritis in pregnancy: A review of the literature. Eur J Obstet Gynecol Reprod Biol 2020;248:102–5. https://doi.org/10.1016/j.ejogrb.2020.03.002.
• (10) Chang JY, Choung RS, Lee RM, Locke GR, Schleck CD, Zinsmeister AR, et al. A shift in the clinical spectrum of eosinophilic gastroenteritis toward the mucosal disease type. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 2010;8:669–75; quiz e88. https://doi.org/10.1016/j.cgh.2010.04.022.
• (11) Talley NJ, Shorter RG, Phillips SF, Zinsmeister AR. Eosinophilic gastroenteritis: a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues. Gut 1990;31:54–8. https://doi.org/10.1136/gut.31.1.54.
• (12) Sunkara T, Rawla P, Yarlagadda KS, Gaduputi V. <p>Eosinophilic gastroenteritis: diagnosis and clinical perspectives</p>. Clin Exp Gastroenterol 2019;12:239–53. https://doi.org/10.2147/CEG.S173130.
• (13) Hui CK, Hui NK. A Prospective Study on the Prevalence, Extent of Disease and Outcome of Eosinophilic Gastroenteritis in Patients Presenting with Lower Abdominal Symptoms. Gut Liver 2018;12:288–96. https://doi.org/10.5009/gnl17056.
• (14) Zhang M, Li Y. Eosinophilic gastroenteritis: A state-of-the-art review. J Gastroenterol Hepatol 2017;32:64–72. https://doi.org/10.1111/jgh.13463.
• (15) Pesek RD, Reed CC, Muir AB, Fulkerson PC, Menard-Katcher C, Falk GW, et al. 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;114:984–94. https://doi.org/10.14309/ajg.0000000000000228.
• (16) Mansoor E, Saleh MA, Cooper GS. Prevalence of Eosinophilic Gastroenteritis and Colitis in a Population-Based Study, From 2012 to 2017. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 2017;15:1733–41. https://doi.org/10.1016/j.cgh.2017.05.050.
• (17) Sevinç E. Eosinophilic Gastrointestinal Disorders. SDÜ Tıp Fakültesi Derg 2015;22:27–31.
• (18) 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;62:36–42. https://doi.org/10.1097/MPG.0000000000000865.
• (19) Kinoshita Y, Furuta K, Ishimaura N, Ishihara S, Sato S, Maruyama R, et al. Clinical characteristics of Japanese patients with eosinophilic esophagitis and eosinophilic gastroenteritis. J Gastroenterol 2013;48:333–9. https://doi.org/10.1007/s00535-012-0640-x.
• (20) Ito J, Fujiwara T, Kojima R, Nomura I. Racial differences in eosinophilic gastrointestinal disorders among Caucasian and Asian. Allergol Int Off J Jpn Soc Allergol 2015;64:253–9. https://doi.org/10.1016/j.alit.2015.02.003.
• (21) Khan S, Orenstein SR. Eosinophilic gastroenteritis: epidemiology, diagnosis and management. Paediatr Drugs 2002;4:563–70. https://doi.org/10.2165/00128072-200204090-00002.
• (22) Memon RJ, Savliwala MN. Eosinophilic Gastroenteritis. StatPearls, Treasure Island (FL): StatPearls Publishing; 2020.
• (23) Erdem L, Akbayir N. Eozinofilik Gastroenterit 2004:9.
• (24) Shih H-M, Bair M-J, Chen H-L, Lin I-T. Eosinophilic Gastroenteritis : Brief Review. Acta Gastro-Enterol Belg 2016;79:239–44.
• (25) Kinoshita Y, Oouchi S, Fujisawa T. Eosinophilic gastrointestinal diseases - Pathogenesis, diagnosis, and treatment. Allergol Int Off J Jpn Soc Allergol 2019;68:420–9. https://doi.org/10.1016/j.alit.2019.03.003.
• (26) Caldwell JM, Collins MH, Stucke EM, Putnam PE, Franciosi JP, Kushner JP, et al. Histologic eosinophilic gastritis is a systemic disorder associated with blood and extragastric eosinophilia, TH2 immunity, and a unique gastric transcriptome. J Allergy Clin Immunol 2014;134:1114–24. https://doi.org/10.1016/j.jaci.2014.07.026.
• (27) Hogan SP, Mishra A, Brandt EB, Royalty MP, Pope SM, Zimmermann N, et al. A pathological function for eotaxin and eosinophils in eosinophilic gastrointestinal inflammation. Nat Immunol 2001;2:353–60. https://doi.org/10.1038/86365.
• (28) Rothenberg ME. Eotaxin. An essential mediator of eosinophil trafficking into mucosal tissues. Am J Respir Cell Mol Biol 1999;21:291–5. https://doi.org/10.1165/ajrcmb.21.3.f160.
• (29) Ishihara S, Kinoshita Y, Schoepfer A. Eosinophilic Esophagitis, Eosinophilic Gastroenteritis, and Eosinophilic Colitis: Common Mechanisms and Differences between East and West. Inflamm Intest Dis 2016;1:63–9. https://doi.org/10.1159/000445131.
• (30) Kartal Ö, Çalışkaner AZ, Şener O. Eosinophilic Gastrointestinal Diseases. Asthma Allergy Immunol 2010;8:139–49.
• (31) Sherrill JD, Rothenberg ME. Genetic dissection of eosinophilic esophagitis provides insight into disease pathogenesis and treatment strategies. J Allergy Clin Immunol 2011;128:23–32; quiz 33–4. https://doi.org/10.1016/j.jaci.2011.03.046.
• (32) Kinoshita Y, Ishimura N, Oshima N, Mikami H, Okimoto E, Jiao DJ, et al. Recent Progress in the Research of Eosinophilic Esophagitis and Gastroenteritis. Digestion 2016;93:7–12. https://doi.org/10.1159/000441668.
• (33) de Vries JE, Carballido JM, Aversa G. Receptors and cytokines involved in allergic TH2 cell responses. J Allergy Clin Immunol 1999;103:S492-496. https://doi.org/10.1016/s0091-6749(99)70166-1.
• (34) Cello JP. Eosinophilic gastroenteritis—A complex disease entity. Am J Med 1979;67:1097–104. https://doi.org/10.1016/0002-9343(79)90652-1.
• (35) Reed C, Woosley JT, Dellon ES. Clinical characteristics, treatment outcomes, and resource utilization in children and adults with eosinophilic gastroenteritis. Dig Liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver 2015;47:197–201. https://doi.org/10.1016/j.dld.2014.11.009.
• (36) Choi BS, Hong SJ, Park SH, Kim HM, Choe B-H. Differences in Features and Course of Mucosal Type Eosinophilic Gastroenteritis between Korean Infants and Children. J Korean Med Sci 2015;30:1129–35. https://doi.org/10.3346/jkms.2015.30.8.1129.
• (37) Tien F-M, Wu J-F, Jeng Y-M, Hsu H-Y, Ni Y-H, Chang M-H, et al. Clinical Features and Treatment Responses of Children With Eosinophilic Gastroenteritis. Pediatr Neonatol 2011;52:272–8. https://doi.org/10.1016/j.pedneo.2011.06.006.
• (38) Zhang M, Li Y. Eosinophilic gastroenteritis: A state-of-the-art review: Eosinophilic gastroenteritis. J Gastroenterol Hepatol 2017;32:64–72. https://doi.org/10.1111/jgh.13463.
• (39) Zhang L, Duan L, Ding S, Lu J, Jin Z, Cui R, et al. Eosinophilic gastroenteritis: Clinical manifestations and morphological characteristics, a retrospective study of 42 patients. Scand J Gastroenterol 2011;46:1074–80. https://doi.org/10.3109/00365521.2011.579998.
• (40) Lecouffe-Desprets M, Groh M, Bour B, Le Jeunne C, Puéchal X. Eosinophilic gastrointestinal disorders associated with autoimmune connective tissue disease. Joint Bone Spine 2016;83:479–84. https://doi.org/10.1016/j.jbspin.2015.11.006.
• (41) Sheikh RA, Prindiville TP, Pecha RE, Ruebner BH. Unusual presentations of eosinophilic gastroenteritis: Case series and review of literature. World J Gastroenterol WJG 2009;15:2156–61. https://doi.org/10.3748/wjg.15.2156.
• (42) Eosinophilic Gastroenteritis: Background, Pathophysiology, Etiology 2020.
• (43) Khan S, Orenstein SR. Eosinophilic gastroenteritis. Gastroenterol Clin North Am 2008;37:333–48, v. https://doi.org/10.1016/j.gtc.2008.02.003.
• (44) Eosinophilic Gastroenteritis. NORD Natl Organ Rare Disord n.d. https://rarediseases.org/rare-diseases/eosinophilic-gastroenteritis/ (accessed January 12, 2021).
• (45) Méndez Sánchez IM, Rivera Irigoín R, Ubiña Aznar E, Vera Rivero FM, Fernández Pérez F, Navarro Jarabo JM, et al. [Distinct clinical presentations of a single medical entity: eosinophilic enteritis]. Gastroenterol Hepatol 2007;30:19–21. https://doi.org/10.1157/13097445.
• (46) Méndez-Sánchez N, Chávez-Tapia NC, Vazquez-Elizondo G, Uribe M. Eosinophilic gastroenteritis: a review. Dig Dis Sci 2007;52:2904–11. https://doi.org/10.1007/s10620-005-9011-2.
• (47) Karademir S, Akçayöz A, Bek K, Tanyel FC, Sungur M, Celik I, et al. Eosinophilic gastroenteritis presenting as protein--losing enteropathy (case report). Turk J Pediatr 1995;37:45–50.
• (48) Pierog AA, Mencin AA. A childhood case of eosinophilic gastritis and protein-losing enteropathy. Clin Pediatr (Phila) 2014;53:289–92. https://doi.org/10.1177/0009922813514849.
• (49) Shin WG, Park CH, Lee YS, Kim KO, Yoo K-S, Kim JH, et al. Eosinophilic Enteritis Presenting as Intussusception in Adult. Korean J Intern Med 2007;22:13–7. https://doi.org/10.3904/kjim.2007.22.1.13.
• (50) Hsu YQ, Lo CY. A case of eosinophilic gastroenteritis. Hong Kong Med J Xianggang Yi Xue Za Zhi 1998;4:226–8.
• (51) Uppal V, Kreiger P, Kutsch E. Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. Clin Rev Allergy Immunol 2016;50:175–88. https://doi.org/10.1007/s12016-015-8489-4.
• (52) Barabino AV, Castellano E, Gandullia P, Torrente F, Guida A, Magnano GM. Chronic eosinophilic ascites in a very young child. Eur J Pediatr 2003;162:666–8. https://doi.org/10.1007/s00431-003-1279-7.
• (53) Urek MC, Kujundžić M, Banić M, Urek R, Veić TŠ, Kardum D. Leukotriene receptor antagonists as potential steroid sparing agents in a patient with serosal eosinophilic gastroenteritis. Gut 2006;55:1363–4. https://doi.org/10.1136/gut.2006.099465.
• (54) Zhou H-B, Chen J-M, Du Q. Eosinophilic gastroenteritis with ascites and hepatic dysfunction. World J Gastroenterol WJG 2007;13:1303–5. https://doi.org/10.3748/wjg.v13.i8.1303.
• (55) Fenoglio LM, Benedetti V, Rossi C, Anania A, Wulhfard K, Trapani M, et al. Eosinophilic gastroenteritis with ascites: a case report and review of the literature. Dig Dis Sci 2003;48:1013–20. https://doi.org/10.1023/a:1023080419660.
• (56) Sunkara T, Rawla P, Yarlagadda KS, Gaduputi V. Eosinophilic gastroenteritis: diagnosis and clinical perspectives. Clin Exp Gastroenterol 2019;12:239–53. https://doi.org/10.2147/CEG.S173130.
• (57) Prussin C. Eosinophilic gastroenteritis and related eosinophilic disorders. Gastroenterol Clin North Am 2014;43:317–27. https://doi.org/10.1016/j.gtc.2014.02.013.
• (58) Kinoshita Y, Furuta K, Ishimaura N, Ishihara S, Sato S, Maruyama R, et al. Clinical characteristics of Japanese patients with eosinophilic esophagitis and eosinophilic gastroenteritis. J Gastroenterol 2013;48:333–9. https://doi.org/10.1007/s00535-012-0640-x.
• (59) Walker MM, Potter M, Talley NJ. Eosinophilic gastroenteritis and other eosinophilic gut diseases distal to the oesophagus. Lancet Gastroenterol Hepatol 2018;3:271–80. https://doi.org/10.1016/S2468-1253(18)30005-0.
• (60) Lee M, Hodges WG, Huggins TL, Lee EL. Eosinophilic gastroenteritis. South Med J 1996;89:189–94. https://doi.org/10.1097/00007611-199602000-00006.
• (61) Ingle SB, Hinge Ingle CR. Eosinophilic gastroenteritis: an unusual type of gastroenteritis. World J Gastroenterol 2013;19:5061–6. https://doi.org/10.3748/wjg.v19.i31.5061.
• (62) Caldwell JM, Collins MH, Stucke EM, Putnam PE, Franciosi JP, Kushner JP, et al. Histologic eosinophilic gastritis is a systemic disorder associated with blood and extragastric eosinophilia, TH2 immunity, and a unique gastric transcriptome. J Allergy Clin Immunol 2014;134:1114–24. https://doi.org/10.1016/j.jaci.2014.07.026.
• (63) Ingle SB, Patle YG, Murdeshwar HG, Pujari GP. A case of early eosinophilic gastroenteritis with dramatic response to steroids. J Crohns Colitis 2011;5:71–2. https://doi.org/10.1016/j.crohns.2010.10.002.
• (64) Kamal MF, Shaker K, Jaser N, Leimoon BA. Eosinophilic gastroenteritis with no peripheral eosinophilia. Ann Chir Gynaecol 1985;74:98–100.
• (65) Busoni VB, Lifschitz C, Christiansen S, G de Davila MT, Orsi M. [Eosinophilic gastroenteropathy: a pediatric series]. Arch Argent Pediatr 2011;109:68–73. https://doi.org/10.1590/S0325-00752011000100019.
• (66) Okimoto E, Ishimura N, Ishihara S. Clinical Characteristics and Treatment Outcomes of Patients with Eosinophilic Esophagitis and Eosinophilic Gastroenteritis. Digestion 2021;102:33–40. https://doi.org/10.1159/000511588.
• (67) Shahzad G, Moise D, Lipka S, Rizvon K, Mustacchia PJ. Eosinophilic enterocolitis diagnosed by means of upper endoscopy and colonoscopy with random biopsies treated with budenoside: a case report and review of the literature. ISRN Gastroenterol 2011;2011:608901. https://doi.org/10.5402/2011/608901.
• (68) Gonsalves N. Eosinophilic Gastrointestinal Disorders. Clin Rev Allergy Immunol 2019;57:272–85. https://doi.org/10.1007/s12016-019-08732-1.
• (69) Cello JP. Eosinophilic gastroenteritis--a complex disease entity. Am J Med 1979;67:1097–104. https://doi.org/10.1016/0002-9343(79)90652-1.
• (70) Emerging questions regarding eosinophil’s role in the esopha... : Current Opinion in Gastroenterology n.d. https://journals.lww.com/co- gastroenterology/Abstract/2006/11000/Emerging_questions_regarding_eosinophil_s_role_in.13.aspx (accessed January 10, 2021).
• (71) Gülerman F, Güven B. Eozinofilik Gastroenteropatiler 2015:8.
• (72) Siewert E, Lammert F, Koppitz P, Schmidt T, Matern S. Eosinophilic gastroenteritis with severe protein-losing enteropathy: successful treatment with budesonide. Dig Liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver 2006;38:55–9. https://doi.org/10.1016/j.dld.2005.06.013.
• (73) Ishimura N, Furuta K, Sato S, Ishihara S, Kinoshita Y. Limited role of allergy testing in patients with eosinophilic gastrointestinal disorders. J Gastroenterol Hepatol 2013;28:1306–13. https://doi.org/10.1111/jgh.12197.
• (74) MacCarty RL, Talley NJ. Barium studies in diffuse eosinophilic gastroenteritis. Gastrointest Radiol 1990;15:183–7. https://doi.org/10.1007/BF01888770.
• (75) Vitellas KM, Bennett WF, Bova JG, Johnson JC, Greenson JK, Caldwell JH. Radiographic manifestations of eosinophilic gastroenteritis. Abdom Imaging 1995;20:406–13. https://doi.org/10.1007/BF01213260.
• (76) Horton KM, Corl FM, Fishman EK. CT of nonneoplastic diseases of the small bowel: spectrum of disease. J Comput Assist Tomogr 1999;23:417–28. https://doi.org/10.1097/00004728-199905000-00017.
• (77) Chen M-J, Chu C-H, Lin S-C, Shih S-C, Wang T-E. Eosinophilic gastroenteritis: clinical experience with 15 patients. World J Gastroenterol 2003;9:2813–6. https://doi.org/10.3748/wjg.v9.i12.2813.
• (78) Chehade M, Sicherer SH, Magid MS, Rosenberg HK, Morotti RA. Multiple exudative ulcers and pseudopolyps in allergic eosinophilic gastroenteritis that responded to dietary therapy. J Pediatr Gastroenterol Nutr 2007;45:354–7. https://doi.org/10.1097/MPG.0b013e31803219d5.
• (79) Jimenez-Rivera C, Ngan B, Jackson R, Ahmed N. Gastric pseudopolyps in eosinophilic gastroenteritis. J Pediatr Gastroenterol Nutr 2005;40:83–6. https://doi.org/10.1097/00005176-200501000-00015.
• (80) Urek MC, Kujundzić M, Banić M, Urek R, Veic TS, Kardum D. Leukotriene receptor antagonists as potential steroid sparing agents in a patient with serosal eosinophilic gastroenteritis. Gut 2006;55:1363–4. https://doi.org/10.1136/gut.2006.099465.
• (81) Solis-Herruzo JA, de Cuenca B, Muñoz-Yagüe MT. Laparoscopic findings in serosal eosinophilic gastroenteritis. Report of two cases. Endoscopy 1988;20:152–3. https://doi.org/10.1055/s-2007-1018162.
• (82) Matsushita T, Maruyama R, Ishikawa N, Harada Y, Araki A, Chen D, et al. The number and distribution of eosinophils in the adult human gastrointestinal tract: a study and comparison of racial and environmental factors. Am J Surg Pathol 2015;39:521–7. https://doi.org/10.1097/PAS.0000000000000370.
• (83) Kinoshita Y, Oouchi S, Fujisawa T. Eosinophilic gastrointestinal diseases – Pathogenesis, diagnosis, and treatment. Allergol Int 2019;68:420–9. https://doi.org/10.1016/j.alit.2019.03.003.
• (84) Ishihara S, Kinoshita Y, Schoepfer A. Eosinophilic Esophagitis, Eosinophilic Gastroenteritis, and Eosinophilic Colitis: Common Mechanisms and Differences between East and West. Inflamm Intest Dis 2016;1:63–9. https://doi.org/10.1159/000445131.
• (85) Pineton de Chambrun G, Dufour G, Tassy B, Rivière B, Bouta N, Bismuth M, et al. Diagnosis, Natural History and Treatment of Eosinophilic Enteritis: a Review. Curr Gastroenterol Rep 2018;20:37. https://doi.org/10.1007/s11894-018-0645-6.
• (86) Okimoto E, Ishimura N, Okada M, Mikami H, Sonoyama H, Ishikawa N, et al. Successful Food-Elimination Diet in an Adult with Eosinophilic Gastroenteritis. ACG Case Rep J 2018;5:e38. https://doi.org/10.14309/crj.2018.38.
• (87) Kagalwalla AF, Sentongo TA, Ritz S, Hess T, Nelson SP, Emerick KM, et al. Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 2006;4:1097–102. https://doi.org/10.1016/j.cgh.2006.05.026.
• (88) Lucendo AJ, Serrano-Montalbán B, Arias Á, Redondo O, Tenias JM. Efficacy of Dietary Treatment for Inducing Disease Remission in Eosinophilic Gastroenteritis. J Pediatr Gastroenterol Nutr 2015;61:56–64. https://doi.org/10.1097/MPG.0000000000000766.
• (89) Alfadda AA, Storr MA, Shaffer EA. Eosinophilic colitis: epidemiology, clinical features, and current management. Ther Adv Gastroenterol 2011;4:301–9. https://doi.org/10.1177/1756283X10392443.
• (90) Sampson HA. Food allergy. Part 1: immunopathogenesis and clinical disorders. J Allergy Clin Immunol 1999;103:717–28. https://doi.org/10.1016/s0091-6749(99)70411-2.
• (91) Rothenberg ME. Eosinophilia. N Engl J Med 1998;338:1592–600. https://doi.org/10.1056/NEJM199805283382206.
• (92) Russel MG, Zeijen RN, Brummer RJ, de Bruine AP, van Kroonenburgh MJ, Stockbrügger RW. Eosinophilic enterocolitis diagnosed by means of technetium-99m albumin scintigraphy and treated with budesonide (CIR). Gut 1994;35:1490–2. https://doi.org/10.1136/gut.35.10.1490.
• (93) Elsing C, Placke J, Gross-Weege W. Budesonide for the treatment of obstructive eosinophilic jejunitis. Z Gastroenterol 2007;45:187–9. https://doi.org/10.1055/s-2006-927138.
• (94) Lombardi C, Salmi A, Passalacqua G. An adult case of eosinophilic pyloric stenosis maintained on remission with oral budesonide. Eur Ann Allergy Clin Immunol 2011;43:29–30.
• (95) Lombardi C, Salmi A, Savio A, Passalacqua G. Localized eosinophilic ileitis with mastocytosis successfully treated with oral budesonide. Allergy 2007;62:1343–5. https://doi.org/10.1111/j.1398-9995.2007.01461.x.
• (96) Tan AC, Kruimel JW, Naber TH. Eosinophilic gastroenteritis treated with non-enteric-coated budesonide tablets. Eur J Gastroenterol Hepatol 2001;13:425–7. https://doi.org/10.1097/00042737-200104000-00021.
• (97) Papadopoulou A, Koletzko S, Heuschkel R, Dias JA, Allen KJ, Murch SH, et al. Management guidelines of eosinophilic esophagitis in childhood. J Pediatr Gastroenterol Nutr 2014;58:107–18. https://doi.org/10.1097/MPG.0b013e3182a80be1.
• (98) Lucendo AJ. Eosinophilic diseases of the gastrointestinal tract. Scand J Gastroenterol 2010;45:1013–21. https://doi.org/10.3109/00365521003690251.
• (99) Netzer P, Gschossmann JM, Straumann A, Sendensky A, Weimann R, Schoepfer AM. Corticosteroid-dependent eosinophilic oesophagitis: azathioprine and 6- mercaptopurine can induce and maintain long-term remission: Eur J Gastroenterol Hepatol 2007;19:865–9. https://doi.org/10.1097/MEG.0b013e32825a6ab4.
• (100) Paganelli R, Levinsky RJ, Brostoff J, Wraith DG. IMMUNE COMPLEXES CONTAINING FOOD PROTEINS IN NORMAL AND ATOPIC SUBJECTS AFTER ORAL CHALLENGE AND EFFECT OF SODIUM CROMOGLYCATE ON ANTIGEN ABSORPTION. The Lancet 1979;313:1270–2. https://doi.org/10.1016/S0140-6736(79)92230-X.
• (101) Melamed I, Feanny SJ, Sherman PM, Roifman CM. Benefit of ketotifen in patients with eosinophilic gastroenteritis. Am J Med 1991;90:310–4.
• (102) Suzuki J, Kawasaki Y, Nozawa R, Isome M, Suzuki S, Takahashi A, et al. Oral disodium cromoglycate and ketotifen for a patient with eosinophilic gastroenteritis, food allergy and protein-losing enteropathy. Asian Pac J Allergy Immunol 2003;21:193–7.
• (103) Freeman HJ. Longstanding eosinophilic gastroenteritis of more than 20 years. Can J Gastroenterol J Can Gastroenterol 2009;23:632–4. https://doi.org/10.1155/2009/565293.
• (104) Molkhou P, Dupont C. Ketotifen in prevention and therapy of food allergy. Ann Allergy 1987;59:187–93.
• (105) De Maeyer N, Kochuyt A-M, Van Moerkercke W, Hiele M. Montelukast as a treatment modality for eosinophilic gastroenteritis. Acta Gastro-Enterol Belg 2011;74:570–5.
• (106) Quack I, Sellin L, Buchner NJ, Theegarten D, Rump LC, Henning BF. Eosinophilic gastroenteritis in a young girl--long term remission under Montelukast. BMC Gastroenterol 2005;5:24. https://doi.org/10.1186/1471-230X-5-24.
• (107) Shih H-M, Bair M-J, Chen H-L, Lin I-T. Eosinophilic Gastroenteritis : Brief Review. Acta Gastro-Enterol Belg 2016;79:239–44.
• (108) Wan D, Liu X, Li G. The effects of montelukast on eosinophilic gastroenteritis in a mouse model. Immunopharmacol Immunotoxicol 2013;35:292–5. https://doi.org/10.3109/08923973.2012.745871.
• (109) Shirai T, Hashimoto D, Suzuki K, Osawa S, Aonahata M, Chida K, et al. Successful treatment of eosinophilic gastroenteritis with suplatast tosilate. J Allergy Clin Immunol 2001;107:924–5. https://doi.org/10.1067/mai.2001.114705.
• (110) To M, Suzuki N, Fueta M, Yamada H, Ogawa C, Sano Y. [A case of eosinophilic gastroenteritis: observation of serum IL-5 and sIL-2R levels before and after remission]. Arerugi Allergy 2004;53:443–7.
• (111) Ishido K, Tanabe S, Higuchi K, Sasaki T, Katada C, Azuma M, et al. Eosinophilic Gastroenteritis Associated with Giant Folds. Dig Endosc 2010;22:312–5. https://doi.org/10.1111/j.1443-1661.2010.01012.x.
• (112) 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:S275. https://doi.org/10.1016/S0091-6749(03)80986-7.
• (113) Spergel JM, Rothenberg ME, Collins MH, Furuta GT, Markowitz JE, Fuchs G, et al. Reslizumab in children and adolescents with eosinophilic esophagitis: Results of a double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol 2012;129:456-463.e3. https://doi.org/10.1016/j.jaci.2011.11.044.
• (114) Roman S, Savarino E, Savarino V, Mion F. Eosinophilic oesophagitis: From physiopathology to treatment. Dig Liver Dis 2013;45:871–8. https://doi.org/10.1016/j.dld.2013.02.015.
• (115) Dobbins JW, Sheahan DG, Behar J. Eosinophilic gastroenteritis with esophageal involvement. Gastroenterology 1977;72:1312–6.
• (116) Oyaizu N, Uemura Y, Izumi H, Morii S, Nishi M, Hioki K. Eosinophilic gastroenteritis. Immunohistochemical evidence for IgE mast cell-mediated allergy. Acta Pathol Jpn 1985;35:759–66.
• (117) Rothenberg ME, Mishra A, Brandt EB, Hogan SP. Gastrointestinal Eosinophils in Health and Disease. Adv. Immunol., vol. 78, Elsevier; 2001, p. 291–328. https://doi.org/10.1016/S0065-2776(01)78007-8.