Request PDF on ResearchGate | On Jan 5, , Amaia Campos Ruiz and others published Gastroenteritis eosinofílica: aportación de tres. Download Citation on ResearchGate | Gastroenteritis eosinofílica | Eosinophilic gastroenteritis represents a group of benign diseases that includes eosinophilic. Eosinophilic gastroenteritis and bowel obstruction. Can surgery be avoided? Gastroenteritis eosinofílica y obstrucción intestinal, ¿es la cirugía evitable?.
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We report a case of a year-old male patient with abdominal distension and diffuse stomach cramps associated with peripheral eosinophilia. Treatment for eosinophilic parasitosis was not effective. After a few weeks, the patient developed acute obstructive abdomen with ascites, which was atypically improved with the use of antispasmodics and analgesics.
Upper digestive endoscopy, colonoscopy and histopathologic examination of the gastric and intestinal mucosa did not show any significant changes. Video laparoscopic biopsy of the mesenteric lymph node and peritoneum revealed a nonspecific chronic inflammatory process with intense diffuse tissue eosinophilia. Complementary tests revealed right-sided pleural effusion and increased serum immunoglobulin E levels, with altered D-xylose absorption test results. The patient was treated with a hypoallergenic diet and an oral corticosteroid; the symptoms resolved and the laboratory test results improved.
Eosinophilic gastroenteritis is a rare inflammatory disease characterized by eosinophilic infiltration in the wall of the gastrointestinal tract. The clinical presentation varies according to the affected site and the depth and extent of digestive tract involvement.
This case report, which presents the rare simultaneous involvement of the mucosal, muscular and serosal layers, aims to describe and discuss the clinical and therapeutic aspects of eosinophilic gastroenteritis as well as its progression. Eosinophilic gastroenteritis is a rare inflammatory disease characterized by eosinophilic infiltration in the gastrointestinal tract affecting all age and ethnic groups [ 1 ].
In adults, the disease usually manifests between the third and fifth decades of life [ 2 ]. It can affect any part of the digestive tract from the esophagus to the rectum. The most commonly affected segments are the stomach, in particular the antrum, and the small intestine [ 3 ].
The clinical presentation depends on the site and depth of eosinophilic infiltration [ 2 ]. Kaijser described the first case of this disease inand since then, approximately cases have been reported in the literature [ 3 – 5 ]. A year-old male patient belonging to a mixed race presented with a complaint of postprandial bloating, abdominal distension and diffuse stomach cramps of moderate intensity since 2 weeks ago. He reported a history of allergic rhinitis, lactose intolerance, social drinking and smoking, the lattermost being discontinued since 10 years ago.
He was not consuming any medications. Erythrocyte and platelet counts, renal function, fasting glucose levels and lipid profile were normal. Three parasitology samples, coprology and stool culture yielded negative results. He presented with increased abdominal distension associated with intense pain, nausea, vomiting, and blocked stool and gas flow, which atypically was improved with analgesic, antispasmodic and antiemetic drugs.
No weight loss was observed.
Physical examination revealed a poor general condition with mild dyspnea, flushing and dehydration. He was afebrile, anicteric and acyanotic. His abdomen was swollen, tense, and diffusely painful on superficial and deep palpation, with a positive Blumberg sign, active bowel sounds and no visceromegaly. Lung auscultation revealed decreased vesicular murmurs at the right lung base, and cardiovascular examination showed no changes. The patient was hospitalized for investigations, and complementary tests were performed.
The serum potassium level was slightly decreased 3. The test for carcinoembryonic antigen CEA was negative 0. A urine culture tested negative. Abdominal ultrasound revealed grade III hepatic steatosis and a large amount of intraperitoneal free fluid Fig. Computed tomography and magnetic resonance imaging of the entire abdomen revealed diffuse thickening of the mesenterium with vessel ectasia, which was compatible with mesenteric panniculitis and was possibly associated with sclerosing mesenteritis, large-volume ascites, moderate right-sided pleural effusion mL and bilateral simple renal cysts measuring approximately 1 cm BOSNIAK 1.
Chest radiography revealed moderate right-sided pleural effusion without parenchymal changes Fig. Upper digestive endoscopy revealed a normal esophagus and duodenum, and mild enanthematous pangastritis. A urease test was negative. Video colonoscopy did not show any abnormalities. Gastric and intestinal biopsies revealed mild, nonspecific, chronic inflammation with normal eosinophil numbers in the mucosa. Paracentesis revealed an albumin level of 1.
Gastroenteritis eosinofílica y obstrucción intestinal: ¿es la cirugía evitable?
Culture yielded negative results. A diagnostic, video-assisted laparoscopy with biopsy was performed. There were no signs of malignancy. The D-xylose test was also performed; the results confirmed signs of malabsorption The patient was discharged after the symptoms were relieved, with a prescription of oral corticosteroid therapy that was to be tapered over a month.
The patient has been followed on an outpatient basis for a year and has been asymptomatic till date. Moreover, some studies reported eosinophilic gastroenteritis caused by medications such as gold salts, enalapril, azathioprine, co-trimoxazole, gemfibrozil and carbamazepine [ 348 – 10 ].
An increase in immunoglobulin E levels may also be associated [ 41112 ]. The present report presents epidemiologic, clinical and laboratory aspects that are in line with those reported in the literature. Moreover, a personal history of atopy and elevated immunoglobulin E levels confirm the allergic nature gasgroenteritis the process [ 41112 ]. Although some studies indicate medications as the cause of the disease, there was no such history in our patients.
According to tastroenteritis findings, the eosinophilic infiltrate in the gastrointestinal tract is pathognomomic. The precise number of eosinophils, which is used as a criterion to define the disease, remains controversial [ 113 ]. In addition, false-negative results from biopsies of the gastric and intestinal mucosa may occur because the eosinophils may either be sparse or clustered in the deeper layers of the walls with affected mucosa.
There is a loss of integrity in the intestinal barrier in predisposed individuals. This allows antigens to cross the mucosa, thus inducing degranulation of mast cells, which release chemotactic factors that recruit eosinophils. The gastrointestinal tract is thus susceptible to direct damage by eosinophils via the release of toxic proteins major basic protein and eosinophil peroxidase as well as indirect damage via leukotrienes, release of histamine and cytokines IL-2, IL-3, IL-4, IL-5tumor necrosis factor alpha TNF-agranulocyte-macrophage colony-stimulating factor GM-CSF and transforming growth factor beta TGF-b [ 481114 ].
Eosinophilic gastroenteritis has been classified into mucosal, muscular and serosal types according to the predominantly affected layer as per histopathologic examination; these present specific differences in clinical manifestations [ 341415 ]. Symptoms include diarrhea, abdominal pain, nausea, gastrenteritis, weight loss and gastrointestinal bleeding.
In the more advanced stages, the malabsorption bastroenteritis may be observed, which can be confirmed by changes in the D-xylose test. Endoscopic examination may show thickening of the mucosal folds, polyps, luminal narrowing and ulcerations.
Pleural effusion or increased eosinophil counts may be revealed by biopsy of pleural specimens. Simultaneous affection of the three layers is not common [ 4 ].
The patient exhibited symptoms that were typical of concomitant mucosal, muscular and serosal involvement, with an emphasis on malabsorption associated with acute obstructive abdomen, large-volume ascites, pleural effusion and significant peripheral eosinophilia. The pharmacologic treatment of choice is the use of corticosteroids: Other drugs are also reported for use in corticosteroid-dependent or corticosteroid-resistant cases, with some showing discrepant results, such as azathioprine, cyclophosphamide, 6-mercaptopurine, cyclosporine A, hydroxyurea, omalizumab and mepolizumab [ 3111718 ].
Finally, diet management may lead to disease remission in rare cases where the mucosa is predominantly involved and a specific food intolerance or allergy has been identified [ 11 ]. It was very important for the patient to associate diet management with the use of prednisone, which facilitated relief from symptoms and normalization of the number of eosinophils in our patient.
There were no relapses after corticosteroid withdrawal. Complications such as obstruction, perforation, suspicion of cancer and refractoriness to drugs are an indication for surgical intervention [ 119 ].
The prognosis is benign in most cases. There are no reports of long-term sequelae, a higher probability of developing cancer, or decreased life expectancy [ 511 ]. We conclude that limited knowledge about the characteristics of eosinophilic gastroenteritis and the paucity of evidence may lead to misdiagnosis or inadequate therapy such as emergency surgeries, which increase the costs of patient study and management. We therefore emphasize on the need for additional studies with larger samples to establish diagnostic and therapeutic criteria that allow for the systematizing of patient care and treatment.
The aim is to improve the quality of life of affected individuals, considering that the incidence of eosinophilic gastroenteritis has increased over the last decade [ 11 ].
National Center for Biotechnology InformationU. Journal List Gastroenterology Res v. Published online Jan Author information Article notes Copyright and License information Disclaimer.
Accepted Dec CopyrightGomes de Matos Brasil et al. This is an open-access article distributed under the terms eosinofllica the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article has been cited by other articles in PMC. Abstract We report a case of a year-old male patient with abdominal distension and diffuse stomach cramps associated with peripheral eosinophilia. Eosinophilic gastroenteritis, Acute obstructive abdomen, Ascites, Pleural effusion, Immunoglobulin E, D-xylose absorption test. Introduction Eosinophilic gastroenteritis is a rare inflammatory disease characterized by eosinophilic infiltration in the gastrointestinal tract affecting all age and ethnic groups [ 1 ].
Case Report A year-old male patient belonging to a mixed race presented with a complaint of postprandial bloating, abdominal distension and diffuse stomach cramps of moderate intensity since 2 weeks ago.
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Open in a separate window. Abdominal ultrasound with a large volume of ascitic fluid in the peritoneal cavity. A chest X-ray showing moderate, right-sided pleural effusion. Eosinophilic gastroenteritis with ascites and hepatic dysfunction.
Khan S, Orenstein SR. Gastroenterol Clin North Am. Unusual presentations of eosinophilic gastroenteritis: Association of eosinophilic gastrointestinal disorders with other atopic disorders. Immunol Allergy Clin North Am. Sonography in diagnosis and follow-up of serosal eosinophilic gastroenteritis treated with corticosteroid. Allergic reaction to gemfibrozil manifesting as eosinophilic gastroenteritis. Adult eosinophilic gastroenteritis and hypereosinophilic syndromes.
Classification of eosinophilic gastrointestinal diseases.