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

Original posting : November 11, 2009

Differential Diagnosis

Eosinophilic GI disorders by location

• 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.