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    Eosinophilic Gastroenteritis

    Definition

    • Marked infiltration of stomach and/or small intestine by eosinophils

    Diagnostic Criteria

    • Infiltrate predominantly composed of eosinophils
      • Published criteria vary from 10-50/HPF, focally to diffusely
    • Peripheral eosinophilia in 40-50% of cases, but usually <1500/ml
    • Variable distribution within the bowel wall with any of the following patterns
      • Predominantly mucosal
        • Infiltrates epithelium and may form crypt abscesses
      • Predominantly mural or transmural, involving muscularis propria
      • Predominantly serosal
      • Cases lacking mucosal involvement may not be apparent on endoscopic biopsy
    • Variable distribution in GI tract
      • Gastric antrum involved in 90% of cases
      • Small intestine involved in 75%
      • In combination with the stomach or small intestine, the esophagus and/or colorectum may also be involved
        • Isolated involvement of esophagus or colorectum is considered separately
          • If isolated, both tend to remain localized and are usually due to food allergy
    Robert V Rouse MD
    Department of Pathology
    Stanford University School of Medicine
    Stanford CA 94305-5342

    Original posting : November 11, 2009

    Differential Diagnosis

    Eosinophilic GI disorders by location

    Eosinophilic Esophagitis Eosinophilic Gastroenteritis Eosinophilic Proctocolitis
    Confined to esophagus Involves stomach and/or small intestine Confined to rectum and colon
    Good response to dietary manipulation Poor response to dietary manipulation Good response to dietary manipulation

     

    • Eosinophils may be numerous in other diseases
      • Drug related gastroenteritis must be ruled out clinically
      • Hypereosinophilic syndrome
        • Requires >1500 eosinophils / microliter
      • Parasitic disease must be ruled out by stool examination
      • Crohn disease
        • May contain many eosinophils in the infiltrate but they do not predominate
      • Milk protein enteropathy must be ruled out clinically, especially in infants
      • Systemic diseases
        • Churg Strauss vasculitis
        • Polyarteritis nodosa
        • Scleroderma
        • Stevens-Johnson syndrome
      • Graft versus host disease
      • Inflammatory fibroid polyp
        • Isolated polypoid lesion

    Clinical

    • May occur at any age
    • Peripheral eosinophilia in 40-50% of cases, but usually <1500/ml
    • Symptoms:
      • Abdominal pain
      • Vomiting and diarrhea
      • GI bleeding
      • Ascites
      • Protein losing enteropathy
      • Associated with asthma, eczema, atopy

    Bibliography

    • Noffsinger A, Fenoglio-Preiser CM, Maru D, Gilinisky N. Gastrointestinal Diseases, AFIP Atlas of Nontumor Pathology, First Series, Fascicle 5, 2007.
    • Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS, Tai DI, Sheen-Chen SM, Chen WJ, Wu CS. Eosinophilic gastroenteritis: 10 years experience. Am J Gastroenterol. 1993 Jan;88(1):70-4.
    • Talley NJ, Shorter RG, Phillips SF, Zinsmeister AR. Eosinophilic gastroenteritis: a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues. Gut. 1990 Jan;31(1):54-8.
    • Mueller S. Classification of eosinophilic gastrointestinal diseases. Best Pract Res Clin Gastroenterol. 2008;22(3):425-40.
    • Khan S, Orenstein SR. Eosinophilic gastroenteritis. Gastroenterol Clin North Am. 2008 Jun;37(2):333-48.
    • Hurrell JM, Genta RM, Melton SD. Histopathologic diagnosis of eosinophilic conditions in the gastrointestinal tract. Adv Anat Pathol. 2011 Sep;18(5):335-48.
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