Eosinophilic gastroenteritis: clinical manifestations and morphological characteristics, a retrospective study of 42 patients.

OBJECTIVE: To evaluate the clinical manifestations, endoscopic, and radiological characteristics, histological features, and treatment of eosinophilic gastroenteritis in adult patients.

METHODS: The clinical records of 34 patients diagnosed as eosinophilic gastroenteritis and eight patients who had abdominal symptoms and unexplained peripheral eosinophilia but no evidence of tissue eosinophilic infiltration were reviewed and analyzed.

RESULTS: Thirteen patients had a history of asthma or allergic rhinitis, while 10 had an allergic history. Peripheral eosinophilia occurred in 83.3% of patients, IgE was elevated in half, and α2-macroglobulin was elevated in 92.8% of patients. The small intestine(82.4%)was the most common site involved. Erythema was the predominate feature seen on endoscopy. Radiographic study generally revealed thickening of the small intestinal wall. Eosinophilia generally involved the lamina propria of mucosa, but any layer of the gut could be affected, even in sites which had normal endoscopic or radiographic appearance. In all, 15.4% (6/39) of patients had Helicobacter pylori infection. Symptom remission within 1 week was found in 80% (20/25) of patients treated with steroids and in 58.8% (10/17) of patients treated with symptomatic treatment. In all, 85.7% (18/21) of patients had their eosinophil counts return to normal within 2 weeks in the steroid treatment group, but none (0/13) in the other group.

CONCLUSION: Eosinophilic gastroenteritis may be more common than previously recognized. Multiple biopsies obtained from the both normal and abnormal appearing areas in the second part of the duodenum are highly recommended. Steroids are effective in relieving symptoms and improving eosinophilia.