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Food allergies and eosinophilic gastrointestinal diseases
Published in Phillip D. Smith, Richard S. Blumberg, Thomas T. MacDonald, Principles of Mucosal Immunology, 2020
Cathryn Nagler, Glenn T. Furuta
Eosinophilic gastroenteritis is a rare disease that is characterized by a wide variety of vague intestinal symptoms and histological evidence of gastrointestinal eosinophilia. The diagnosis is based on the exclusion of other causes of intestinal eosinophilia. Since eosinophils reside in the normal gastrointestinal mucosa, the number of eosinophils that characterizes eosinophilic gastroenteritis has been difficult to determine. Eosinophilic gastroenteritis has three forms: mucosal, muscular, and serosal disease. Most patients with eosinophilic gastroenteritis have mucosal disease and symptoms related to epithelial dysfunction, including bleeding, pain and diarrhea. A smaller proportion of patients have muscular disease characterized by vomiting and bloating, suggestive of intestinal obstruction. An even smaller proportion have serosal disease that presents with abdominal bloating and ascites. Pathophysiologic mechanisms associated with eosinophilic gastroenteritis and the three phenotypes are not known. Treatment is based on either chronic topical or systemic steroid use or in some circumstances dietary elimination of suspected allergens.
Inflammatory bowel disease
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
Elizabeth Carty, Anne B Ballinger
There are no randomized controlled trials to guide the clinician in the treatment of patients with eosinophilic gastroenteritis. The response to dietary modification and food withdrawal is usually poor. Diarrhoea is treated symptomatically with loperamide. Patients with severe symptoms of malabsorption may respond to oral prednisolone (p. 91).
Pituitary Malfunction and Immune Abnormalities
Published in Istvan Berczi, Pituitary Function and Immunity, 2019
The cellular and humoral immune response in ten patients with various types of hypopituitarism has been evaluated. The immune function of patients was comparable to controls, except for a slight defect in phagocytic function.53 Cases of inflammatory bowel disease (Crohn’s disease) and eosinophilic gastroenteritis associated with hypopituitarism have been described. The case of eosinophilic gastroenteritis could be reversed completely by replacement therapy with cortisone.54,55 The association of hypothalamic hypopituitarism with rheumatologic symptoms has also been described.56 It is likely, that with our increasing understanding of the role of pituitary hormones in immune phenomena, the number of relevant clincial observations will increase substantially.
Utility of gastric and duodenal biopsy sampling in adult eosinophilic esophagitis patients to rule out other gastrointestinal disorders
Published in Scandinavian Journal of Gastroenterology, 2021
Willemijn E. de Rooij, Maria-Louise Haasnoot, Aaltje Lei, Marijn J. Warners, Aart Mookhoek, Albert J. Bredenoord
Routine sampling of biopsy specimens from the stomach and duodenum in the total study population (n = 93) showed histological changes in 28 (30%) patients, of which 23 (82%) patients were diagnosed with active/non-active (chronic) gastritis, 2 (7%) patients with active duodenitis, 2 (7%) patients with gastritis together with duodenitis and 1 (4%) patient met the histological criteria for a non-EoE EGID (Table 2). Of note, the diagnosis of eosinophilic gastroenteritis (EGE) in a single patient was suspected based on the presence of generalized GI eosinophilia, with a PEC ≥15 eos/hpf in the esophagus and ≥30 eos/hpf in at least 3 hpf in the duodenum [20,21]. In total, the yield of routine gastric and duodenal biopsy sampling for the proportion of patients with histological diagnosis such as gastritis was 30% (n/N = 28/93). However, only the single diagnosis of EGE was considered being a relevant other generalized or eosinophilic GI disorder within the context of a definitive diagnosis of EoE (diagnostic yield: 3.6% (95%CI 2.6–4.8%) (n/N = 1/93)) (Supplementary Table 1).
Immunohistochemical markers for eosinophilic esophagitis
Published in Scandinavian Journal of Gastroenterology, 2020
Katarzyna Zdanowicz, Magdalena Kucharska, Joanna Reszec, Dariusz Marek Lebensztejn, Urszula Daniluk
Eosinophilic esophagitis (EoE) has evolved from a rare case-reportable condition to one of the most common diseases of the upper gastrointestinal tract. Clinical features depend on age and include gastroesophageal reflux-like symptoms, vomiting, abdominal pain, dysphagia and food impaction, which can lead to poor quality of life. The current guidelines define EoE as an immune-mediated disease characterized by infiltration of eosinophils in the esophageal mucosa. According to histological criteria, the minimum number of eosinophils required to make a diagnosis is 15 per high power field (eos/hpf). In addition, other causes of local eosinophilia should be excluded, such as gastroesophageal reflux disease (GERD), eosinophilic gastroenteritis, celiac disease and Crohn’s disease [1]. GERD is the most common disorder in EoE differential diagnosis due to symptoms’ similarity and mucosal eosinophilia. Initially, EoE and GERD were considered mutually exclusive, now it is claimed that both entities may coexist.
Pharmacological treatments for eosinophilic esophagitis: current options and emerging therapies
Published in Expert Review of Clinical Immunology, 2020
Sialic acid-binding immunoglobulin-type lectins, or Siglecs, can be found on the membrane of eosinophils and other types of immune cells. An important role in eosinophil apoptosis and clearance has been recognized for Siglec-8, which also inhibits mediators release from mast cells and reverse tissue remodeling. The administration of anti-Siglec-8 monoclonal antibody to a murine model of eosinophilic gastroenteritis significantly reduced eosinophils and mast cells in the stomach, small intestine, and mesenteric lymph nodes and decreased levels of inflammatory mediators [129]. After this promising results, ongoing trials of two anti-Siglec-8 antibodies, AK001 and AK002, are being currently assessed in nasal polyposis, systemic mastocytosis, and keratoconjunctivitis (NCT02734849, NCT02808793, NCT03379311). An additional phase II, placebo-controlled RCT of AK002 is currently recruiting adult patients with eosinophilic gastritis and/or gastroenteritis (NCT03496571).