eosinophilic gastroenteritis

DR. K. K. RAWALM.D. D.M.(GASTRO)

Consultant GastroenterologistMilestone Hospital Vidyanagar main roadRajkot (0281-2480843 / 44)

EOSINOPHILIC GASTROENTERITIS (EG)

ESOPHAGITIS GASTRITIS ENTERITIS COLITIS

DIAGNOSTIC CRITERIA

ABNORMAL GI SYMPTOMS (PAIN, DIARRHEA)

EOSINOPHILIC INFILTRATION > 20 / hpf INFILTRATION LIMITED TO GIT ONLYNO KNOWN CAUSE OF EOSINOPHILIA 80 % PERIPHERAL EOSINOPHILIA 50 % ATOPY (ASTHMA,FOOD

ALLERGY)

INCIDENCE

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

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

TYPES OF EG

MUCOSAL FORM MUSCULAR FORM SEROSAL FORM OVERLAP POSSIBLE

MUCOSAL FORM

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

MUSCULAR FORM ALLERGY LEAST COMMON

OBSTRUCTIVE SYMPTOMS PYLORIC STENOSIS INTESTINAL OBSTRUCTION

(PROXIMAL) (AEC – 1000)

SEROSAL FORM

LEAST COMMON ASCITES –

EXUDATIVE/EOSINOPHILIC LEAKAGE OF FLUID (STERILE) ENTIRE GI WALL INVOLVED (AEC – 8000)

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

DIAGNOSIS

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

LAPAROSCOPY

FULL THICKNESS Bx IN OBSTRUCTIVE MASS LESION MIMICKING MALIGNANCY

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

TREATMENT

ELIMINATION DIET MILK WHEAT(GLUTEN) SOY EGG/BEEF ELEMENTAL DIET ( VARIABLE

EFFECT)

DRUGS

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

SURGERY

AVOIDED (PERSISTENT OBSTRUCTION)

RECURRENCES

PROGNOSIS

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

INCREASED