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DR. K. K. RAWALM.D. D.M.(GASTRO)
Consultant GastroenterologistMilestone Hospital Vidyanagar main roadRajkot (0281-2480843 / 44)
EOSINOPHILIC GASTROENTERITIS (EG)
ESOPHAGITIS GASTRITIS ENTERITIS COLITIS
DIAGNOSTIC CRITERIA
ABNORMAL GI SYMPTOMS (PAIN, DIARRHEA)
EOSINOPHILIC INFILTRATION > 20 / hpf INFILTRATION LIMITED TO GIT ONLYNO KNOWN CAUSE OF EOSINOPHILIA 80 % PERIPHERAL EOSINOPHILIA 50 % ATOPY (ASTHMA,FOOD
ALLERGY)
INCIDENCE
M>F PEAK – 20 TO 50 YEARS MATHAN (1998 IJG)
EOSINOPHILS CYTOKINES (IL-3,IL-4,IL-13) LEUKOTRIENE (C4) CHEMOKINES
TYPES OF EG
MUCOSAL FORM MUSCULAR FORM SEROSAL FORM OVERLAP POSSIBLE
MUCOSAL FORM
ALLERGY MOST COMMON VOMITING, ABDOMINAL PAIN DIARRHEA, MALABSORPTION BLOOD IN STOOL FAILURE TO THRIVE DELAYED PUBERTY / AMENORRHEA (AEC – 2000)
MUSCULAR FORM ALLERGY LEAST COMMON
OBSTRUCTIVE SYMPTOMS PYLORIC STENOSIS INTESTINAL OBSTRUCTION
(PROXIMAL) (AEC – 1000)
SEROSAL FORM
LEAST COMMON ASCITES –
EXUDATIVE/EOSINOPHILIC LEAKAGE OF FLUID (STERILE) ENTIRE GI WALL INVOLVED (AEC – 8000)
DIAGNOSIS CBC - E >2000 (AEC) LOW IRON/ALBUMIN STOOL R/M IgE HIGH SKIN PRICK TEST
DIAGNOSIS
BIOPSY 6 Bx FROM N/Abn AREA (PATCHY) > 20 E/hpf R/O VASCULITIS
LAPAROSCOPY
FULL THICKNESS Bx IN OBSTRUCTIVE MASS LESION MIMICKING MALIGNANCY
DIFFERENTIAL DIAGNOSIS PARASITE INFECTION CELIAC DISEASE VASCULITIS IBD GERD MASTEOCYTOSIS HES NEOPLASM
TREATMENT
ELIMINATION DIET MILK WHEAT(GLUTEN) SOY EGG/BEEF ELEMENTAL DIET ( VARIABLE
EFFECT)
DRUGS
STEROIDS PREDNISOLONE - 40 mg, 2-4Wk FLUTICASONE - 220mu puff/ bd BUDESONIDE CROMOLYN - 200 mg qid KETOTIFEN MONTILUKAST
SURGERY
AVOIDED (PERSISTENT OBSTRUCTION)
RECURRENCES
PROGNOSIS
MORTALITY – RARE MORBIDITY – MALNUTRITION OBSTRUCTION PERFORATION WAXING AND WANING COURSE RISK OF CANCER IS NOT
INCREASED