Eosinophilic gastroenteritis (EG) is an uncommon disease characterized by diffuse infiltration of any or all layers of gut wall by eosinophils.
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Epidemiology
Eosinophilic gastroenteritis is an uncommon but not rare disease with slight male predominance. It can affect any age group but usually patients present in their 3rd to 5th decades of life.
Clinical presentation
self-limiting disorder in the majority of cases
patients may present with dysphagia, food impaction, abdominal pain, nausea, vomiting, or diarrhea depending on the site of involvement
in severely affected children it may result in growth restriction
ascites and pleural effusions may be present
Pathology
chronic inflammatory disorder of GI wall of undetermined pathophysiology, although atopy-related genes, inflammatory cells, and mediators play a role in the pathogenesis of eosinophilic gastroenteritis
history of allergy, in particular food allergy, is present in approximately 50% of cases
more than 60% of cases show peripheral eosinophilia
on biopsy, there is evidence of mucosal edema and infiltration of the eosinophils, polymorphonuclear leukocytes (PMNs), and lymphocytes in different layers of the gut wall
Location
It can affect various segments of the bowel which include
esophagus: eosinophilic esophagitis
stomach: eosinophilic gastritis
duodenum: eosinophilic duodenitis
small bowel: eosinophilic enteritis
large bowel: eosinophilic colitis
Radiographic features
Fluoroscopy
eosinophilic esophagitis may show a "ringed esophagus" (series of ring-like strictures), and/or smooth long segment narrowing of the esophagus
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gastrointestinal involvement is more common
virtually always involves gastric antrum and proximal small intestine
non-specific mucosal fold thickening and nodularity particularly in the gastric antrum, without submucosal edema
when chronic, the antrum is narrowed with a nodular "cobblestone" mucosal appearance
CT
CT features are non-specific and may show gastro-intestinal wall thickening and submucosal edema
Treatment and prognosis
responds well to oral corticosteroids and dietary exclusion