Pediatr Gastroenterol Hepatol Nutr.  2015 Dec;18(4):253-260. 10.5223/pghn.2015.18.4.253.

Clinical Manifestations and Treatment Outcomes of Eosinophilic Gastroenteritis in Children

• Choi JS
• Choi SJ
• Lee KJ
• Kim A
• Yoo JK
• Yang HR
• Moon JS
• Chang JY
• Ko JS
• Kang GH

• KMID: 2383303
• DOI: http://doi.org/10.5223/pghn.2015.18.4.253

Abstract

PURPOSE
The aim of the present study was to investigate the clinical features and outcome of eosinophilic gastroenteritis (EGE) in children.
METHODS
Our study enrolled 24 children who were diagnosed with EGE from 1993 to 2014 at the Department of Pediatrics, Seoul National University Children's Hospital. The patients' clinical manifestations, treatments, and outcomes were reviewed from the medical records.
RESULTS
The mean age at diagnosis was 5.3 years. Most patients had gastrointestinal symptoms including diarrhea (54.2%) and abdominal pain (45.8%). Peripheral eosinophilia was present in 91.7% of the patients. Thirteen patients (54.2%) showed anemia, and 15 patients (62.5%) had hypoalbuminemia. EGE was classified as mucosal, subserosal, or muscular in 75.0%, 20.8%, and 4.2% of cases, respectively. Three patients showed gastroduodenal ulcers upon endoscopic analysis. A history of allergy was reported in 13 patients, including atopic dermatitis, allergic rhinitis, and asthma. Five patients (20.8%) improved with food restrictions. Among the 19 patients treated with steroids, 11 (57.9%) discontinued steroid treatment without subsequent relapse, 4 (21.1%) relapsed after ceasing steroid treatment, and 4 (21.1%) showed no response to steroids. Two patients who were resistant to steroids underwent therapeutic surgery. The presence of gastroduodenal ulcers was significantly associated with relapse and steroid resistance.
CONCLUSION
A high suspicion of EGE is warranted when children have nonspecific gastrointestinal symptoms and peripheral eosinophilia. Most patients improved with food restrictions or steroid treatment, although one-third of patients showed a relapse or steroid resistance.

Keyword

Eosinophils; Gastroenteritis; Ulcer; Steroids; Child

MeSH Terms

Abdominal Pain
Anemia
Asthma
Child*
Dermatitis, Atopic
Diagnosis
Diarrhea
Eosinophilia
Eosinophils*
Gastroenteritis*
Humans
Hypersensitivity
Hypoalbuminemia
Medical Records
Pediatrics
Peptic Ulcer
Recurrence
Rhinitis
Seoul
Steroids
Ulcer
Steroids

Figure

• 

  Fig. 1 Treatment outcome of 24 children.

Reference

1. Klein NC, Hargrove RL, Sleisenger MH, Jeffries GH. Eosinophilic gastroenteritis. Medicine (Baltimore). 1970; 49:299–319.

2. 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; 31:54–58.

3. Méndez-Sánchez N, Chávez-Tapia NC, Vazquez-Elizondo G, Uribe M. Eosinophilic gastroenteritis: a review. Dig Dis Sci. 2007; 52:2904–2911.

4. Chen MJ, Chu CH, Lin SC, Shih SC, Wang TE. Eosinophilic gastroenteritis: clinical experience with 15 patients. World J Gastroenterol. 2003; 9:2813–2816.

5. Kelly KJ. Eosinophilic gastroenteritis. J Pediatr Gastroenterol Nutr. 2000; 30 Suppl:S28–S35.

6. Lowichik A, Weinberg AG. A quantitative evaluation of mucosal eosinophils in the pediatric gastrointestinal tract. Mod Pathol. 1996; 9:110–114.

7. Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS, et al. Eosinophilic gastroenteritis: 10 years experience. Am J Gastroenterol. 1993; 88:70–74.

8. Whitington PF, Whitington GL. Eosinophilic gastroenteropathy in childhood. J Pediatr Gastroenterol Nutr. 1988; 7:379–385.

9. Cello JP. Eosinophilic gastroenteritis--a complex disease entity. Am J Med. 1979; 67:1097–1104.

10. Pineton de Chambrun G, Gonzalez F, Canva JY, Gonzalez S, Houssin L, Desreumaux P, et al. Natural history of eosinophilic gastroenteritis. Clin Gastroenterol Hepatol. 2011; 9:950–956.e1.

11. Lee MS, Yoo ES, Kim HS, Park EA, Seo JW, Lee SJ. Serum IgE standardized for age in Korean children and its diagnostic reliability in childhood asthma. J Korean Pediatr Soc. 1996; 39:397–403.

12. Tien FM, Wu JF, Jeng YM, Hsu HY, Ni YH, Chang MH, et al. Clinical features and treatment responses of children with eosinophilic gastroenteritis. Pediatr Neonatol. 2011; 52:272–278.

13. Redondo-Cerezo E, Cabello MJ, González Y, Gómez M, García-Montero M, de Teresa J. Eosinophilic gastroenteritis: our recent experience: one-year experience of atypical onset of an uncommon disease. Scand J Gastroenterol. 2001; 36:1358–1360.

14. Kalantar SJ, Marks R, Lambert JR, Badov D, Talley NJ. Dyspepsia due to eosinophilic gastroenteritis. Dig Dis Sci. 1997; 42:2327–2332.

15. Khan S. Eosinophilic gastroenteritis. Best Pract Res Clin Gastroenterol. 2005; 19:177–198.

16. Khan S, Orenstein SR. Eosinophilic gastroenteritis masquerading as pyloric stenosis. Clin Pediatr (Phila). 2000; 39:55–57.

17. Yun MY, Cho YU, Park IS, Choi SK, Kim SJ, Shin SH, et al. Eosinophilic gastroenteritis presenting as small bowel obstruction: a case report and review of the literature. World J Gastroenterol. 2007; 13:1758–1760.

18. Yamaguchi Y, Hayashi Y, Sugama Y, Miura Y, Kasahara T, Kitamura S, et al. Highly purified murine interleukin 5 (IL-5) stimulates eosinophil function and prolongs in vitro survival. IL-5 as an eosinophil chemotactic factor. J Exp Med. 1988; 167:1737–1742.

19. Yan BM, Shaffer EA. Primary eosinophilic disorders of the gastrointestinal tract. Gut. 2009; 58:721–732.

20. Pineton de Chambrun G, Desreumaux P, Cortot A. Eosinophilic enteritis. Dig Dis. 2015; 33:183–189.

21. DeBrosse CW, Rothenberg ME. Allergy and eosinophil-associated gastrointestinal disorders (EGID). Curr Opin Immunol. 2008; 20:703–708.

22. Yamada Y, Kato M, Isoda Y, Nishi A, Jinbo Y, Hayashi Y. Eosinophilic gastroenteritis treated with a multiple-food elimination diet. Allergol Int. 2014; 63:Suppl 1. 53–56.

23. 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.

24. 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.

25. Schwartz DA, Pardi DS, Murray JA. Use of montelukast as steroid-sparing agent for recurrent eosinophilic gastroenteritis. Dig Dis Sci. 2001; 46:1787–1790.