From the Guidelines
Management of infiltrative disorders of the gastrointestinal tract requires a tailored approach based on the specific underlying condition, with a focus on accurate diagnosis, targeted therapy, and supportive care to improve morbidity, mortality, and quality of life. Treatment typically begins with accurate diagnosis through endoscopy with biopsies, followed by targeted therapy. For example, in the case of inflammatory bowel disease (IBD), which includes conditions such as Crohn's disease (CD) and ulcerative colitis (UC), treatment aims to achieve induction of remission, followed by maintenance therapy to prevent recurrent disease flares, as outlined in the WSES-AAST guidelines 1.
Some key considerations in managing infiltrative disorders of the GI tract include:
- The use of immunosuppressive therapies, such as azathioprine, 6-mercaptopurine, methotrexate, and 6-thioguanine, to control intestinal inflammation in IBD patients 1.
- The role of biologics, such as anti-TNF agents (e.g., infliximab, adalimumab, golimumab), anti-integrin agents (e.g., vedolizumab), and JAK inhibitors (e.g., tofacitinib), in the treatment of IBD patients who do not respond to conventional immunosuppressive therapies 1.
- The importance of dietary modifications and nutritional support in managing IBD patients, as highlighted in the AGA clinical practice update on diet and nutritional therapies in patients with IBD 1.
- The need for a multidisciplinary approach to care, involving gastroenterologists, surgeons, dietitians, and other specialists, to optimize outcomes for patients with IBD and other infiltrative disorders of the GI tract 1.
Overall, the management of infiltrative disorders of the GI tract requires a comprehensive and individualized approach, taking into account the specific underlying condition, disease severity, and patient preferences, with the goal of improving morbidity, mortality, and quality of life.
From the Research
Infiltrative Disorders of the GI Tract
Infiltrative disorders of the gastrointestinal (GI) tract refer to conditions characterized by the infiltration of various cells, such as eosinophils, into the GI wall. These disorders can affect different layers of the GI tract, including the mucosa, muscularis, and serosa.
Management Options
The management options for infiltrative disorders of the GI tract vary depending on the specific condition and its severity. Some of the management options include:
- Dietary approaches: Avoiding certain foods that may trigger or exacerbate symptoms 2, 3
- Pharmacological approaches:
- Corticosteroids: The mainstay of therapy for many infiltrative disorders, including eosinophilic gastroenteritis 2, 4
- Mast-cell stabilizers, leukotriene antagonists, antihistamines, immunomodulators, and biological agents: Alternative therapeutic options for patients who do not respond to corticosteroids or have refractory disease 2, 5
- Biologics: Targeted therapies that have shown promise in reducing eosinophil counts and improving symptoms in some patients with eosinophilic gastrointestinal diseases 5, 3
Specific Conditions
Some specific infiltrative disorders of the GI tract include:
- Eosinophilic gastroenteritis (EGE): A condition characterized by eosinophilic infiltration of the stomach and small intestine, which can be managed with dietary and pharmacological approaches 2, 4, 3
- Eosinophilic esophagitis (EoE): A condition characterized by eosinophilic infiltration of the esophagus, which can be managed with pharmacological approaches, including corticosteroids and biologics 6, 5
- Eosinophilic colitis: A condition characterized by eosinophilic infiltration of the colon, for which there are limited treatment options available 5