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| ==Overview==
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| Eosinophilic gastroenteritis (EG) is a rare disorder characterized by localized patchy or diffuse [[eosinophilic]] infiltration of the [[gastrointestinal]] (GI) tissue. The presentation may vary depending on the location, depth and extent of bowel wall involvement. It usually runs a chronic relapsing course.<ref name="klein">{{cite journal| author=Klein NC, Hargrove RL, Sleisenger MH, Jeffries GH| title=Eosinophilic gastroenteritis. | journal=Medicine (Baltimore) | year= 1970 | volume= 49 | issue= 4 | pages= 299-319 | pmid=5426746 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5426746 }} </ref><ref name="pmid17428742">{{cite journal| author=Treiber GG, Weidner S| title=Eosinophilic gastroenteritis. | journal=Clin Gastroenterol Hepatol | year= 2007 | volume= 5 | issue= 5 | pages= e16 | pmid=17428742 | doi=10.1016/j.cgh.2007.01.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17428742 }} </ref><ref name="pmid12185230">{{cite journal| author=Christopher V, Thompson MH, Hughes S| title=Eosinophilic gastroenteritis mimicking pancreatic cancer. | journal=Postgrad Med J | year= 2002 | volume= 78 | issue= 922 | pages= 498-9 | pmid=12185230 | doi= | pmc=1742453 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12185230 }} </ref><ref name="pmid12757181">{{cite journal| author=Jimenez-Saenz M, Villar-Rodriguez JL, Torres Y, Carmona I, Salas-Herrero E, Gonzalez-Vilches J et al.| title=Biliary tract disease: a rare manifestation of eosinophilic gastroenteritis. | journal=Dig Dis Sci | year= 2003 | volume= 48 | issue= 3 | pages= 624-7 | pmid=12757181 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12757181 }} </ref>
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| ==Historical Perspective==
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| The first description of eosinophilic gastroenteritis was by Kaijser et al. in 1937, and it was described as an allergic disease of the gut.<ref name="pmid15028974">{{cite journal| author=Whitaker IS, Gulati A, McDaid JO, Bugajska-Carr U, Arends MJ| title=Eosinophilic gastroenteritis presenting as obstructive jaundice. | journal=Eur J Gastroenterol Hepatol | year= 2004 | volume= 16 | issue= 4 | pages= 407-9 | pmid=15028974 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15028974 }} </ref><ref name="pmid28299223">{{cite journal| author=Shetty V, Daniel KE, Kesavan A| title=Hematemesis as Initial Presentation in a 10-Week-Old Infant with Eosinophilic Gastroenteritis. | journal=Case Rep Pediatr | year= 2017 | volume= 2017 | issue= | pages= 2391417 | pmid=28299223 | doi=10.1155/2017/2391417 | pmc=5337357 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28299223 }} </ref> Klein et al. subsequently classified it into three types (predominant mucosal, muscular, and subserosal layer disease) based on the depth of eosinophilic infiltration.<ref name="pmid5426746">{{cite journal| author=Klein NC, Hargrove RL, Sleisenger MH, Jeffries GH| title=Eosinophilic gastroenteritis. | journal=Medicine (Baltimore) | year= 1970 | volume= 49 | issue= 4 | pages= 299-319 | pmid=5426746 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5426746 }} </ref>
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| ==Classification==
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| Eosinophilic gastroenteritis can be subdivided into three groups according to the Klein classification:<ref name="talley">{{cite journal| author=Talley NJ, Shorter RG, Phillips SF, Zinsmeister AR| title=Eosinophilic gastroenteritis: a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues. | journal=Gut | year= 1990 | volume= 31 | issue= 1 | pages= 54-8 | pmid= 2318432 | doi= | pmc=1378340 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2318432 }} </ref><ref name="baig">{{cite journal| author=Baig MA, Qadir A, Rasheed J| title=A review of eosinophilic gastroenteritis. | journal=J Natl Med Assoc | year= 2006 | volume= 98 | issue= 10 | pages= 1616-9 | pmid=17052051 | doi= | pmc=2569760 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17052051 }} </ref><ref name="pmid8420276">{{cite journal| author=Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS et al.| title=Eosinophilic gastroenteritis: 10 years experience. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 1 | pages= 70-4 | pmid=8420276 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8420276 }} </ref>
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| * '''Mucosal eosinophilic gastroenteritis'''
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| # Most common subtype of eosinophilic gastroenteritis.
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| # Mucosal infiltration by eosinophils, and/or presence of mucosal edema on barium studies.
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| # Absent histological evidence of muscle infiltration.
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| # No evidence of gastrointestinal obstruction or eosinophilic ascites.
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| * '''Muscular eosinophilic gastroenteritis'''
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| # Documentation of complete/incomplete bowel obstruction, and/or infiltration of the tunica muscularis by eosinophils.
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| # No evidence of eosinophilic ascites.
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| * '''Subserosal eosinophilic gastroenteritis'''
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| # Eosinophilic infiltration of the gut
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| # Eosinophilic ascites is present
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| ==Risk Factors==
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| * Allergy: A study conducted in 40 patients with eosinophilic gastroenteritis demonstrated a history of allergy in half of the patients.<ref name="talley"/> Food intolerance or allergy is more commonly seen in mucosal eosinophilic gastroenteritis, affecting over 50% of patients with mucosal disease according to a study.<ref name="talley"/>
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| ==Pathophysiology==
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| ===Pathogenesis===
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| * Eosinophilic gastroenteritis is a rare disease with poorly understood pathophysiology.
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| * Eosinophils are normally seen in the entire GIT (except in the esophagus) of healthy individuals.<ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref>
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| * In patients with eosinophilic gastroenteritis, there is varying degrees of increased eosinophilic infiltration of the GIT (in the absence of other known causes of tissue eosinophilia).<ref name="pmid28299223">{{cite journal| author=Shetty V, Daniel KE, Kesavan A| title=Hematemesis as Initial Presentation in a 10-Week-Old Infant with Eosinophilic Gastroenteritis. | journal=Case Rep Pediatr | year= 2017 | volume= 2017 | issue= | pages= 2391417 | pmid=28299223 | doi=10.1155/2017/2391417 | pmc=5337357 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28299223 }} </ref><ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref>
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| * Any part of the GIT from the esophagus to the colon can be affected. Occasionally, eosinophilic gastroenteritis affects the entire gastrointestinal tract.<ref name="talley"/> The stomach and proximal small intestine are most commonly affected, while the colon is usually the least affected part of the GIT.<ref name="pmid28299223"/><ref name="talley"/><ref name="pmid26054822"/>
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| * The etiology of the excessive eosinophilic infiltration of the GIT is not clear. Destruction of the GIT epithelium caused by the release of eosinophilic basic protein and activated degranulating eosinophils has been proposed.<ref name="talley"/><ref name="pmid 11338074">{{cite journal| author=Tan AC, Kruimel JW, Naber TH| title=Eosinophilic gastroenteritis treated with non-enteric-coated budesonide tablets. | journal=Eur J Gastroenterol Hepatol | year= 2001 | volume= 13 | issue= 4 | pages= 425-7 | pmid= 11338074 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11338074 }} </ref>
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| * Inflammatory mediators such as Th-2 cytokines (IL-3, IL-5 and IL-13), eosinophils, and eosinophilic mediators such as eotaxin have been strongly implicated.<ref name="pmid28299223" /><ref name="pmid26054822"/><ref name="baig"/>
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| * The inflammatory mediators associated with the pathogenesis of eosinophilic gastroenteritis have well established roles in the pathogenesis of allergy and asthma. A significant number of patients with eosinophilic gastroenteritis have also been documented to have allergies/allergy-related disorders, suggesting a hypersensitivity reaction is involved in the pathogenesis of eosinophilic gastroenteritis.<ref name="pmid28299223" /><ref name="baig"/>
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| The damage to the [[gastrointestinal tract]] wall is caused by eosinophilic [[Infiltration (medical)|infiltration]] and [[degranulation]].<ref name="pmid 11338074">{{cite journal| author=Tan AC, Kruimel JW, Naber TH| title=Eosinophilic gastroenteritis treated with non-enteric-coated budesonide tablets. | journal=Eur J Gastroenterol Hepatol | year= 2001 | volume= 13 | issue= 4 | pages= 425-7 | pmid= 11338074 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11338074 }} </ref> As a part of the[[Immune system|host defense]] mechanism, [[eosinophil]] is normally present in gastrointestinal [[mucosa]], though finding in deeper [[tissue]] is almost always [[Pathology (disambiguation)|pathologic]].<ref name="pmid 2869055">{{cite journal| author=Blackshaw AJ, Levison DA| title=Eosinophilic infiltrates of the gastrointestinal tract. | journal=J Clin Pathol | year= 1986 | volume= 39 | issue= 1 | pages= 1-7 | pmid= 2869055 | doi= | pmc=499605 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2869055 }} </ref> What triggers such dense infiltration in EG is not clear. It is possible that different [[pathogenesis|pathogenetic]] mechanisms of disease is involved in several subgroups of patients. Food [[allergy]] and variable [[IgE]] response to food substances has been observed in some patients which implies role of [[Hypersensitivity|hypersensitive]] response in pathogenesis. Many patients indeed have history of other [[atopy|atopic]] conditions like [[eczema]], [[asthma]] etc. Eosinophil recruitment into inflammatory tissue is a complex process, regulated by a number of [[inflammatory]] [[cytokines]]. In EG [[cytokines]] [[IL-3]], [[IL-5]] and granulocyte macrophage colony stimulating factor ([[GM-CSF]]) may be behind the recruitement and activation. They have been observed [[immunohistochemistry|immunohistochemically]] in diseased intestinal wall.<ref>{{cite journal |author=Desreumaux P, Bloget F, Seguy D, Capron M, Cortot A, Colombel J, Janin A |title=Interleukin 3, granulocyte-macrophage colony-stimulating factor, and interleukin 5 in eosinophilic gastroenteritis |journal=Gastroenterology |volume=110 |issue=3 |pages=768-74 |year=1996 |pmid=8608886}}</ref> In addition [[CCL11|eotaxin]] has been shown to have an integral role in regulating the homing of eosinophils into the [[lamina propria]] of stomach and small intestine.<ref>{{cite journal |author=Mishra A, Hogan S, Brandt E, Rothenberg M |title=An etiological role for aeroallergens and eosinophils in experimental esophagitis |journal=J. Clin. Invest. |volume=107 |issue=1 |pages=83-90 |year=2001 |pmid=11134183}}</ref> In the allergic subtype of disease, it is thought that food [[allergens]] cross the intestinal mucosa and trigger an inflammatory response that includes [[mast cell]] degranulation and recruitment of eosinophils.<ref>{{cite journal |author=Pérez-Millán A, Martín-Lorente J, López-Morante A, Yuguero L, Sáez-Royuela F |title=Subserosal eosinophilic gastroenteritis treated efficaciously with sodium cromoglycate |journal=Dig. Dis. Sci. |volume=42 |issue=2 |pages=342-4 |year=1997 |pmid=9052516}}</ref>
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| ==Causes==
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| The cause of eosinophilic gastroenteritis is unknown.<ref name="baig">{{cite journal| author=Baig MA, Qadir A, Rasheed J| title=A review of eosinophilic gastroenteritis. | journal=J Natl Med Assoc | year= 2006 | volume= 98 | issue= 10 | pages= 1616-9 | pmid=17052051 | doi= | pmc=2569760 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17052051 }} </ref>
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| ==Differentiating {{PAGENAME}} from Other Diseases==
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| Diseases with peripheral eosinophilia and gastrointestinal symptoms should be differentiated from eosinophilic gastroenteritis. It is also important to consider eosinophilic gastroenteritis in the differential diagnosis of unexplained gastrointestinal symptoms (even when peripheral eosinophilia is not present). Most diseases that can manifest with gastrointestinal symptoms and peripheral eosinophilia are easily differentiated from eosinophilic gastroenteritis via laboratory investigations and/or biopsies. Some of these diseases include:<ref name="baig">{{cite journal| author=Baig MA, Qadir A, Rasheed J| title=A review of eosinophilic gastroenteritis. | journal=J Natl Med Assoc | year= 2006 | volume= 98 | issue= 10 | pages= 1616-9 | pmid=17052051 | doi= | pmc=2569760 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17052051 }} </ref>
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| * Intestinal parasitic infections: Stool examination for ova and parasites can be utilized for diagnosis.
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| * Inflammatory bowel disease (IBD): Biopsy can easily ddistinguish IBD from eosinophilic gastroenteritis
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| * Hypereosinophilic syndrome: Markedly elevated peripheral eosinophilia (> 1,500 cells/μl) for more than six consecutive months is seen.
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| ==Epidemiology and Demographics==
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| ===Incidence===
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| The estimated incidence of eosinophilic gastroenteritis is approximately 1-20 per 100,000 patients.<ref name="pmid28299223">{{cite journal| author=Shetty V, Daniel KE, Kesavan A| title=Hematemesis as Initial Presentation in a 10-Week-Old Infant with Eosinophilic Gastroenteritis. | journal=Case Rep Pediatr | year= 2017 | volume= 2017 | issue= | pages= 2391417 | pmid=28299223 | doi=10.1155/2017/2391417 | pmc=5337357 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28299223 }} </ref><ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref> It is a rare disease with approximately 300 reported cases in published literature.<ref name="baig"/>
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| ===Age===
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| EG can present at any age.<ref name="baig">{{cite journal| author=Baig MA, Qadir A, Rasheed J| title=A review of eosinophilic gastroenteritis. | journal=J Natl Med Assoc | year= 2006 | volume= 98 | issue= 10 | pages= 1616-9 | pmid=17052051 | doi= | pmc=2569760 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17052051 }} </ref> However, a higher incidence has been observed in the third to fifth decade of life.<ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref><ref name="klein"/> In pediatric patients with eosinophilic gastroenteritis, the esophagus is usually the involved organ (eosinophilic esophagitis).<ref name="pmid28299223"/> The youngest documented pediatric case of eosinophilic gastroenteritis occurred in a full-term 10month old infant.<ref name="pmid28299223"/>
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| ===Sex===
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| There is a higher incidence in adult males.<ref>{{cite book | last = Guandalini | first = Stefano | title = Essential Pediatric Gastroenterology and Nutrition | publisher = McGraw-Hill Professional | location = City | year = 2004 | isbn = 0071416307 }} Page 210.</ref><ref name="pmid28299223">{{cite journal| author=Shetty V, Daniel KE, Kesavan A| title=Hematemesis as Initial Presentation in a 10-Week-Old Infant with Eosinophilic Gastroenteritis. | journal=Case Rep Pediatr | year= 2017 | volume= 2017 | issue= | pages= 2391417 | pmid=28299223 | doi=10.1155/2017/2391417 | pmc=5337357 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28299223 }} </ref>
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| ===Race===
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| Eosinophilic gastroenteritis has been documented in all races.<ref>{{cite book | last = Guandalini | first = Stefano | title = Essential Pediatric Gastroenterology and Nutrition | publisher = McGraw-Hill Professional | location = City | year = 2004 | isbn = 0071416307 }} Page 210.</ref> However, most of the cases reported occurred in Caucasians.<ref name="baig"/>
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| ==Screening==
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| There is no screening guideline for eosinophilic gastroenteritis.
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| ==Natural History, Complications, and Prognosis==
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| ===Natural History===
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| ===Complications===
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| Complications of eosinophilic gastroenteritis can include the following:<ref name="talley" /><ref name="pmid15028974">{{cite journal| author=Whitaker IS, Gulati A, McDaid JO, Bugajska-Carr U, Arends MJ| title=Eosinophilic gastroenteritis presenting as obstructive jaundice. | journal=Eur J Gastroenterol Hepatol | year= 2004 | volume= 16 | issue= 4 | pages= 407-9 | pmid=15028974 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15028974 }} </ref><ref name="pmid 12757181">{{cite journal| author=Jimenez-Saenz M, Villar-Rodriguez JL, Torres Y, Carmona I, Salas-Herrero E, Gonzalez-Vilches J et al.| title=Biliary tract disease: a rare manifestation of eosinophilic gastroenteritis. | journal=Dig Dis Sci | year= 2003 | volume= 48 | issue= 3 | pages= 624-7 | pmid= 12757181 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12757181 }} </ref><ref name="pmid8420276">{{cite journal| author=Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS et al.| title=Eosinophilic gastroenteritis: 10 years experience. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 1 | pages= 70-4 | pmid=8420276 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8420276 }} </ref><ref name="pmid26054822"/>
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| * Gastric outlet obstruction: Pyloric outlet obstruction has been documented in patients with muscular eosinophilic gastroenteritis, and surgical intervention is often required in severe cases.
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| * Esophageal narrowing/strictures: Seen when there is esophageal involvement.
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| * Biliary tract disease such as biliary tract fibrosis and obstruction.
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| * Intestinal perforation
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| * Intussusception
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| ===Prognosis===
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| The prognosis is good with treatment but relapses are common, which may necessitate chronic low dose steroid therapy for maintenance of remission.<ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref><ref name="pmid8420276">{{cite journal| author=Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS et al.| title=Eosinophilic gastroenteritis: 10 years experience. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 1 | pages= 70-4 | pmid=8420276 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8420276 }} </ref>
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| ==Diagnosis==
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| ===History and Symptoms===
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| ====History====
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| It is important to obtain the following history from the patient:<ref name="talley"/>
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| * Presenting symptoms
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| * Duration of symptoms
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| * History of allergy: A history of food allergy/intolerance, drug allergy, allergy-related conditions such as seasonal allergies, atopy, asthma, and nasal polyps should be obtained.
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| ====Symptoms====
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| Eosinophilic gastroenteritis can present with several nonspecific gastrointestinal symptoms. The manifestations often depend on the site affected in the GIT, and the involved layer of the gastrointestinal wall.<ref name="baig">{{cite journal |author=Baig M, Qadir A, Rasheed J |title=A review of eosinophilic gastroenteritis |journal=Journal of the National Medical Association |volume=98 |issue=10 |pages=1616-9 |year=2006 |pmid=17052051}}</ref><ref>{{cite journal |author=Lee C, Changchien C, Chen P, Lin D, Sheen I, Wang C, Tai D, Sheen-Chen S, Chen W, Wu C |title=Eosinophilic gastroenteritis: 10 years experience |journal=Am. J. Gastroenterol. |volume=88 |issue=1 |pages=70-4 |year=1993 |pmid=8420276}}</ref> The following are the gastrointestinal symptoms seen in eosinophilic gastroenteritis:<ref name="talley"/><ref name="pmid 11338074"/><ref name="pmid28299223"/><ref name="baig" /><ref name="pmid8420276">{{cite journal| author=Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS et al.| title=Eosinophilic gastroenteritis: 10 years experience. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 1 | pages= 70-4 | pmid=8420276 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8420276 }} </ref>
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| '''Common symptoms'''
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| * Abdominal pain
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| * Nausea
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| * Vomiting
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| * Diarrhea
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| * Poor appetite
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| * Weight loss
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| * Steatorrhea
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| * Abdominal bloating: More often seen in patients with subserosal disease.
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| * Ascites: Seen more often in patients with subserosal disease.
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| '''Uncommon symptoms'''
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| * Dysphagia: This has been documented in patients with esophageal involvement.
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| * Gastrointestinal bleeding: Hematemesis and fecal blood loss may occur.
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| EG typically presents with a combination of chronic nonspecific GI symptoms which include [[abdominal]] pain, [[nausea]], vomiting, [[diarrhea]], [[weight loss]], and abdominal distension. Approximately 80% have symptoms for several years.<ref>{{cite journal |author=Christopher V, Thompson M, Hughes S |title=Eosinophilic gastroenteritis mimicking pancreatic cancer |journal=Postgraduate medical journal |volume=78 |issue=922 |pages=498-9 |year=2002 |pmid=12185230}}</ref>; a high degree of clinical suspicion is often required to establish the diagnosis, as the disease is extremely rare. Occasionally, the disease may manifest itself as an acute abdomen or bowel obstruction.<ref>{{cite journal |author=Shweiki E, West J, Klena J, Kelley S, Colley A, Bross R, Tyler W |title=Eosinophilic gastroenteritis presenting as an obstructing cecal mass--a case report and review of the literature |journal=Am. J. Gastroenterol. |volume=94 |issue=12 |pages=3644-5 |year=1999 |pmid=10606337}}</ref><ref>{{cite journal |author=Tran D, Salloum L, Tshibaka C, Moser R |title=Eosinophilic gastroenteritis mimicking acute appendicitis |journal=The American surgeon |volume=66 |issue=10 |pages=990-2 |year=2000 |pmid=11261632}}</ref>
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| * '''[[Mucosal]] EG''' (25-100%) is the commonest variety.<ref name="baig">{{cite journal |author=Baig M, Qadir A, Rasheed J |title=A review of eosinophilic gastroenteritis |journal=Journal of the National Medical Association |volume=98 |issue=10 |pages=1616-9 |year=2006 |pmid=17052051}}</ref><ref>{{cite journal |author=Lee C, Changchien C, Chen P, Lin D, Sheen I, Wang C, Tai D, Sheen-Chen S, Chen W, Wu C |title=Eosinophilic gastroenteritis: 10 years experience |journal=Am. J. Gastroenterol. |volume=88 |issue=1 |pages=70-4 |year=1993 |pmid=8420276}}</ref> It presents with features of [[malabsorption]] and [[protein losing enteropathy]]. Failure to thrive and [[anaemia]] may also be present. [[Lower gastrointestinal bleeding]] may imply colonic involvement.
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| *'''Muscular EG''' (13-70%) presents with obstruction of gastric outlet or small intestine; sometimes as an obstructing [[Cecum|caecal]] mass or [[intussusception]].
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| *'''[[Serous membrane|Subserosal]]''' '''EG''' (4.5 % to 9 % in Japan and 13 % in the USA).<ref>{{cite journal |author=Miyamoto T, Shibata T, Matsuura S, Kagesawa M, Ishizawa Y, Tamiya K |title=Eosinophilic gastroenteritis with ileus and ascites |journal=Intern. Med. |volume=35 |issue=10 |pages=779-82 |year=1996 |pmid=8933185}})</ref> presents with ascites which is usually exudative in nature, abundant peripheral eosinophilia, and has favourable responses to [[corticosteroids]].
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| *Other documented features are [[Cholangitis]], [[pancreatitis]],<ref>{{cite journal |author=Lyngbaek S, Adamsen S, Aru A, Bergenfeldt M |title=Recurrent acute pancreatitis due to eosinophilic gastroenteritis. Case report and literature review |journal=JOP |volume=7 |issue=2 |pages=211-7 |year=2006 |pmid=16525206}}</ref> eosinophilic [[splenitis]], acute [[appendicitis]] and giant refractory [[duodenal ulcer]].
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| ===Physical Examination===
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| ===Laboratory Findings===
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| The following laboratory findings can be seen:<ref name="talley"/><ref name="pmid26054822"/>
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| * CBC: Peripheral blood [[eosinophilia]] is often seen, but it may be absent in >20% of affected patients. Patients with subserosal disease often have a higher eosinophil count. Anemia can also be present.
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| * Elevated [[serum]] [[IgE]] is a common finding.
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| * Elevated ESR: This can be moderately elevated in 25% of patients with eosinophilic gastroenteritis.
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| * Hypoalbuminuria: This can occur as a result of severe malabsorption and protein losing enteropathy.
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| * Fecal fat test: Mild-moderate steatorrhea is sometimes seen.
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|
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| ===Microscopic Findings===
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| Eosinophilic gastroenteritis is a diagnosis of exclusion. There are no well standardized pathologic criteria for making a diagnosis of eosinophilic gastroenteritis. Talley et al. proposed three diagnostic criteria:<ref name="talley">{{cite journal |author=Talley N, Shorter R, Phillips S, Zinsmeister A |title=Eosinophilic gastroenteritis: a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues |journal=Gut |volume=31 |issue=1 |pages=54-8 |year=1990 |pmid=2318432}}</ref>
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| # Presence of gastrointestinal symptoms
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| # Biopsy demonstrating eosinophilic infiltration of one or more areas of the GIT (from the esophagus to colon); OR characteristic radiological findings with peripheral eosinophilia.
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| # No evidence of parasitic or extraintestinal disease.
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| ====Biopsy====
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| * Biopsy is widely used for making a diagnosis. In the absence of other causes of tissue eosinophilia, eosinophilic infiltration of the GIT on biopsy and/or the presence of eosinophilic ascitic fluid in a patient with gastrointestinal symptoms is diagnostic for eosinophilic gastroenteritis.<ref name="pmid28299223"/>
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| * Eosinophilic infiltration of the gastrointestinal tract is seen on histology following endoscopic/surgical biopsies. Abnormal eosinophilic infiltration of the GIT can be defined as the presence of diffuse or multifocal eosinophils ≥20 per high power field.<ref name="talley"/>
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|
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| * The diagnosis can occasionally be missed, especially in patients with the localized patchy infiltration.
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| *
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| *
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| *
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| *Definitive diagnosis involves [[histology|histological]] evidence of eosinophilic infiltration in biopsy slides. [[Microscopy]] reveals >20 eosinophils per [[High Power Field|high power field]].<ref name="talley" /><ref name="baig" /> Infiltration is often patchy , can be missed and [[laparoscopy|laparoscopic]] full thickness biopsy may be required.
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| [[File:Eosinophilic gastroenteritis.jpg|center|thumb|Endoscopic biopsy of ileum showing distinct eosinophilic infiltration]]
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| [[Hypereosinophilia]], the hallmark of allergic response, may be absent in up to 20% of patients, but [[hypoalbuminaemia]] and other abnormalities suggestive of malabsorption may be present.
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| When eosinophilic gastroenteritis is observed in association with eosinophilic infiltration of other organ systems, the diagnosis of [[idiopathic]] [[hypereosinophilic syndrome]] should be considered.<ref>{{cite journal |author=Matsushita M, Hajiro K, Morita Y, Takakuwa H, Suzaki T |title=Eosinophilic gastroenteritis involving the entire digestive tract |journal=Am. J. Gastroenterol. |volume=90 |issue=10 |pages=1868-70 |year=1995 |pmid=7572911}}</ref>
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| ===Imaging Findings===
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| There are no guidelines for the diagnosis of eosinophilic gastroenteritis.
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| ====Endoscopy====
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| There are no specific endoscopic findings for eosinophilic gastroenteritis. Gross findings such as gastric pseudopolyps are commonly seen. Other non-specific findings seen in the GIT include erythema, erosions, and lymphonodular hyperplasia occurring in the gastric antrum, fundus, and pyloric regions of the stomach.<ref name="pmid28299223"/>
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| ====CT scan====
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| Imaging studies such as a CT scan is essential, especially when biopsy studies are not diagnostic.<ref name="talley"/> Radiological changes seen in the gastrointestinal tract are non-specific findings such as very prominent bowel folds,
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| [[Image:CT gastroent.jpg|Spiral CT showing ascites and concentric thickening of colon and ileum in eosinophilic gastroenteritis|center|600x500px]]
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| [[CT scan]] may show nodular and irregular thickening of the folds in the distal stomach and proximal small bowel, but these findings can also be present in other conditions like [[Crohn's disease]] and [[lymphoma]].
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| The [[endoscopic]] appearance in eosinophilic gastroenteritis is nonspecific; it includes erythematous, friable, nodular, and occasional ulcerative changes.<ref name="chen">{{cite journal| author=Chen MJ, Chu CH, Lin SC, Shih SC, Wang TE| title=Eosinophilic gastroenteritis: clinical experience with 15 patients. | journal=World J Gastroenterol | year= 2003 | volume= 9 | issue= 12 | pages= 2813-6 | pmid=14669340 | doi= | pmc=4612059 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14669340 }} </ref> Sometimes diffuse inflammation results in complete loss of [[villi]], involvement of multiple layers, [[submucosal]] [[oedema]] and [[fibrosis]].<ref>{{cite journal |author=Johnstone J, Morson B |title=Eosinophilic gastroenteritis |journal=Histopathology |volume=2 |issue=5 |pages=335-48 |year=1978 |pmid=363591}}</ref><ref>{{cite journal |author=Katz A, Goldman H, Grand R |title=Gastric mucosal biopsy in eosinophilic (allergic) gastroenteritis |journal=Gastroenterology |volume=73 |issue=4 Pt 1 |pages=705-9 |year=1977 |pmid=892374}}</ref>
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| [[Radionuclide|Radio isotope]] scan using [[Tc-99m]] HMPAO-labeled [[leukocyte]] [[single photon emission computed tomography|SPECT]] may be useful in assessing the extent of disease and response to treatment but has little value in diagnosis, as the scan does not help differentiating EG from other causes of inflammation.<ref>{{cite journal |author=Lee K, Hahm K, Kim Y, Kim J, Cho S, Jie H, Park C, Yim H |title=The usefulness of Tc-99m HMPAO labeled WBC SPECT in eosinophilic gastroenteritis |journal=Clinical nuclear medicine |volume=22 |issue=8 |pages=536-41 |year=1997 |pmid=9262899}}</ref><ref>{{cite journal |author=Imai E, Kaminaga T, Kawasugi K, Yokokawa T, Furui S |title=The usefulness of 99mTc-hexamethylpropyleneamineoxime white blood cell scintigraphy in a patient with eosinophilic gastroenteritis |journal=Annals of nuclear medicine |volume=17 |issue=7 |pages=601-3 |year=2003 |pmid=14651361}}</ref>
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| ==Treatment==
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| ===Medical Therapy===
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| * Steroids are the mainstay of therapy for eosinophilic gastroenteritis. A dramatic response to corticosteroid therapy is commonly seen in patients with subserosal disease.<ref name="talley"/> A 90% response rate to corticosteroid therapy has been documented in some studies.<ref name="pmid15492606">{{cite journal| author=Barbie DA, Mangi AA, Lauwers GY| title=Eosinophilic gastroenteritis associated with systemic lupus erythematosus. | journal=J Clin Gastroenterol | year= 2004 | volume= 38 | issue= 10 | pages= 883-6 | pmid=15492606 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15492606 }} </ref>
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| * Other treatment modalities include:<ref name="pmid15492606">{{cite journal| author=Barbie DA, Mangi AA, Lauwers GY| title=Eosinophilic gastroenteritis associated with systemic lupus erythematosus. | journal=J Clin Gastroenterol | year= 2004 | volume= 38 | issue= 10 | pages= 883-6 | pmid=15492606 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15492606 }} </ref><ref name="pmid6547462">{{cite journal| author=Katz AJ, Twarog FJ, Zeiger RS, Falchuk ZM| title=Milk-sensitive and eosinophilic gastroenteropathy: similar clinical features with contrasting mechanisms and clinical course. | journal=J Allergy Clin Immunol | year= 1984 | volume= 74 | issue= 1 | pages= 72-8 | pmid=6547462 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6547462 }} </ref><ref name="chen"/>
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| # Elimination of identified food allergy.
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| #
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| * Corticosteroids are the mainstay of therapy with a 90% response rate in some studies. Appropriate duration of steroid treatment is unknown and relapse often necessitates long term treatment. Various steroid sparing agents e.g. [[sodium cromoglycate]] (a stabilizer of mast cell [[cell membrane|membranes]]), [[ketotifen]] (an [[antihistamine]]), and [[montelukast]] (a selective, competitive [[Leukotriene antagonist|leukotriene receptor antagonist]]) have been proposed, centering around an allergic hypothesis, with mixed results.<ref name="pmid15492606">{{cite journal| author=Barbie DA, Mangi AA, Lauwers GY| title=Eosinophilic gastroenteritis associated with systemic lupus erythematosus. | journal=J Clin Gastroenterol | year= 2004 | volume= 38 | issue= 10 | pages= 883-6 | pmid=15492606 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15492606 }} </ref> An elimination diet may be successful if a limited number of food allergies are identified.<ref name="pmid6547462">{{cite journal| author=Katz AJ, Twarog FJ, Zeiger RS, Falchuk ZM| title=Milk-sensitive and eosinophilic gastroenteropathy: similar clinical features with contrasting mechanisms and clinical course. | journal=J Allergy Clin Immunol | year= 1984 | volume= 74 | issue= 1 | pages= 72-8 | pmid=6547462 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6547462 }} </ref><ref name="chen"/>
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| ===Surgery===
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| ===Prevention===
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| == Other gastrointestinal conditions associated with allergy ==
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|
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| *[[Eosinophilic esophagitis]]
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| *Eosinophilic [[ascites]]
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| *[[Coeliac disease]]
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| *[[Protein losing enteropathy]] from intolerance to cow's milk protein
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| *Infantile formula protein intolerance
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|
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| == See also ==
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| [[Allergy]]<br />
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| [[Gastroenteritis]]<br />
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| [[Malabsorption]]
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| ==References==
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| {{reflist|2}}
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| {{Allergic conditions}}
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| [[Category:Gastroenterology]]
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| {{WH}}
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| {{WS}}
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| * Eosinophilic gastroenteritis caused by eating hens' eggs: A case report.PMID: 28279648
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| * Eosinophilic Gastroenteritis Presenting with Red Streaking.PMID: 28250308
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