Effective Strategies for Managing Eosinophilic Gastroenteritis

Effective Strategies for Managing Eosinophilic Gastroenteritis

Eosinophilic gastroenteritis (EGE) is a rare and often underdiagnosed gastrointestinal disorder characterized by eosinophilic infiltration in the gastrointestinal tract, particularly affecting the stomach and intestines. The prevalence of EGE is estimated to be approximately 8.4 per 100,000 individuals, with symptoms that can mimic other gastrointestinal disorders, making diagnosis challenging (1). This article explores effective strategies for managing EGE, including clinical presentation, diagnostic approaches, treatment options, and the role of corticosteroids in management.

Clinical Presentation and Diagnosis of Eosinophilic Gastroenteritis

Patients with EGE commonly present with a variety of gastrointestinal symptoms, including abdominal pain, nausea, vomiting, diarrhea, and weight loss. These symptoms can range in severity and are often nonspecific, which can lead to misdiagnosis or delayed treatment (2). A thorough clinical history and physical examination are essential in identifying EGE, particularly when patients present with gastrointestinal obstructions or unusual abdominal complaints (3).

The diagnostic criteria for EGE, as proposed by Talley et al. (5), include:

1. Presence of gastrointestinal symptoms: Patients typically report symptoms like abdominal pain and diarrhea.
2. Eosinophilic infiltration: Biopsies must demonstrate eosinophilic infiltration (>50 eosinophils per high-power field) in the gastrointestinal tract.
3. Exclusion of other causes: It is crucial to rule out other conditions, such as parasitic infections or other eosinophilic disorders (6).

Endoscopy is often utilized for visualization and biopsy collection. At least six biopsy specimens should be obtained from both normal and abnormal areas to confirm the diagnosis accurately (7).

Treatment Approaches for Eosinophilic Gastroenteritis

The cornerstone of EGE management is pharmacological treatment, primarily using corticosteroids to reduce inflammation and eosinophilic infiltration. Corticosteroids have been shown to significantly improve symptoms and promote healing in EGE patients (8).

Table 1: Summary of Treatment Approaches

Corticosteroid therapy is typically initiated at high doses, followed by a gradual tapering to minimize side effects (9). The treatment duration may vary based on symptom resolution and eosinophil counts. In cases where corticosteroids are ineffective or contraindicated, alternative therapies such as immunosuppressants or biologics may be considered (10).

The Role of Corticosteroids in Eosinophilic Gastroenteritis Management

Corticosteroids play a pivotal role in the management of EGE due to their potent anti-inflammatory effects. The use of corticosteroids has been associated with significant clinical improvement in patients, often leading to rapid resolution of symptoms (11).

Dosage and Administration

The initial corticosteroid dosage typically ranges from 0.5 to 2 mg/kg/day of prednisone or its equivalent, depending on the severity of the condition. Once improvement is noted, the dosage can be tapered down slowly to prevent relapse (12).

Monitoring and Side Effects

While corticosteroids are effective, they are not without side effects, including potential for weight gain, osteoporosis, and increased susceptibility to infections. Regular monitoring of eosinophil counts and clinical symptoms is recommended to guide treatment adjustments and mitigate adverse effects (13).

Case Report: Surgical Intervention in Eosinophilic Gastroenteritis

In a notable case, a 50-year-old female presented with acute abdominal symptoms leading to an emergency laparotomy. Upon surgical exploration, significant eosinophilic infiltration was noted in the gastric wall, causing pyloric stenosis. This case exemplifies the importance of considering EGE in differential diagnoses for patients presenting with obstructive symptoms (14).

Table 2: Patient Presentation Overview

The patient underwent surgical resection of the affected segment and was subsequently started on corticosteroids, resulting in a favorable outcome with symptom resolution (15).

Conclusion

Eosinophilic gastroenteritis is a complex condition that requires a multifaceted approach for effective management. Early diagnosis, appropriate treatment with corticosteroids, and monitoring are crucial for improving patient outcomes. While surgery may be necessary in specific cases, the majority of patients respond well to pharmacological interventions. Increased awareness and understanding of EGE can lead to better diagnosis and management strategies, ultimately enhancing the quality of life for affected individuals.

FAQ

What are the main symptoms of eosinophilic gastroenteritis?
Common symptoms include abdominal pain, nausea, vomiting, diarrhea, and weight loss.

How is eosinophilic gastroenteritis diagnosed?
Diagnosis typically involves clinical evaluation, endoscopy, and biopsy showing eosinophilic infiltration.

What is the main treatment for eosinophilic gastroenteritis?
Corticosteroids are the first-line treatment, with dietary modifications and surgery considered in certain cases.

Are there any side effects of corticosteroid treatment?
Yes, potential side effects include weight gain, osteoporosis, and increased risk of infections.

Can eosinophilic gastroenteritis be managed without surgery?
Yes, most cases are managed successfully with medical therapy, and surgery is generally reserved for complications.

References

1. Environmental consequences of interacting effects of changes in stratospheric ozone, ultraviolet radiation, and climate: UNEP Environmental Effects Assessment Panel, Update 2024. https://doi.org/10.1007/s43630-025-00687-x

2. Acute Rheumatic Fever in an Adult Female Patient Presenting With Chest Pain: A Case Report. https://doi.org/10.7759/cureus.80133

3. Anti-Inflammatory Regulatory Role of Signal Transducer and Activator of Transcription 3 Phosphorylation in Regulating Hypersensitivity Responses to Echinococcus granulosus Hydatid Cyst Fluid. https://doi.org/10.2147/JIR.S509286

4. Once‐Weekly Insulin Versus Once‐Daily Insulin for Type 1 Diabetes Treatment: A Systematic Review and Meta‐Analysis of Randomised Controlled Trials. https://pubmed.ncbi.nlm.nih.gov/11971483/

5. The crosstalk of monocyte-neutrophil in hair follicles regulates neutrophil transepidermal migration in contact dermatitis. https://doi.org/10.1038/s42003-025-07960-w

6. Surgical Presentations of Eosinophilic Gastroenteritis: A Case Report. https://doi.org/10.7759/cureus.80144