From the Research
Eosinophilic enteritis, also known as eosinophilic gastroenteritis, is a rare primary eosinophilic gastrointestinal disorder characterized by the presence of an intense eosinophilic infiltrate on histopathology of the intestinal mucosa, and its diagnosis requires a high degree of clinical likelihood given the nonspecific presentation and physical examination findings. The term "Eosinophilic enteritis" appears to be a recognized medical condition in current medical literature, and it is characterized by a wide array of gastrointestinal symptoms such as abdominal pain, diarrhea, nausea, vomiting, bloating, or ascites 1. The diagnosis of eosinophilic enteritis requires a combination of clinical presentation, laboratory results, radiological findings, and endoscopy, with the cornerstone of the diagnosis being the histological examination of gastric and duodenal specimens for evidence of eosinophilic infiltration (>20 eosinophils per high-power field) 2.
Diagnosis
The diagnosis of eosinophilic enteritis is based on the following criteria:
- The presence of gastrointestinal symptoms
- Dense eosinophilic infiltration of the gastrointestinal mucosa
- Exclusion of other conditions leading to gastrointestinal eosinophilia 3 The Klein classification arbitrarily divided patients with eosinophilic enteritis into those with predominantly mucosal, muscle layer, or subserosal disease, relying on the concept that clinical presentation is dependent on the predominant involved layer of the gastrointestinal tract 1.
Treatment
The mainstay of therapy for eosinophilic enteritis is oral corticosteroids, which are highly effective in inducing remission. Other treatment options include antihistaminic drugs, sodium cromoglycate, mast-cell stabilizers, leukotriene antagonists, immunomodulators, and biological agents 4, 2, 1. In patients who are refractory to corticosteroids, the integrin blocker vedolizumab may be used, and it has been shown to induce a clinical and histological improvement in some patients 3.
Management
The management of eosinophilic enteritis includes both dietary and pharmacological approaches. Patients with mild disease can be treated symptomatically, while patients with more severe symptoms or malabsorption symptoms require more aggressive therapy 4. The subsequent course of the disease is quite variable, with some patients having no recurrences, while others experience recurrent symptoms during or immediately after corticosteroid interruption 1.
Key Points
- Eosinophilic enteritis is a rare primary eosinophilic gastrointestinal disorder
- The diagnosis requires a high degree of clinical likelihood and a combination of clinical presentation, laboratory results, radiological findings, and endoscopy
- The mainstay of therapy is oral corticosteroids
- Other treatment options include antihistaminic drugs, sodium cromoglycate, mast-cell stabilizers, leukotriene antagonists, immunomodulators, and biological agents
- The integrin blocker vedolizumab may be used in patients who are refractory to corticosteroids 4, 2, 1, 3