Overview
Eosinophilic gastrointestinal granuloma is a rare chronic inflammatory disorder characterized by eosinophilic infiltration in the gastrointestinal tract, distinct from eosinophilic esophagitis. Diagnosis requires exclusion of secondary causes and systemic diseases, based on clinical symptoms and histologic evidence 1.Diagnosis
Clinical Symptoms: Abdominal pain, vomiting, diarrhea, or feeding difficulties (pediatrics) 4.
Histologic Findings: Presence of eosinophilic infiltration in biopsy specimens 1.
Exclusion of Secondary Causes: Rule out parasitic infections, malignancies, and other systemic diseases 1.
Imaging and Endoscopy: Radiographic contrast studies and endoscopic examinations may be necessary, especially in pediatric cases 4.
Laboratory Tests: Elevated peripheral eosinophil counts may support the diagnosis but are not definitive 14.Management
First-Line Treatments:
- Corticosteroids: Oral or topical, depending on the location of involvement (e.g., budesonide for small bowel involvement) 1.
Adjunctive Treatments:
- Dietary Modifications: Elemental or oligoantigenic diets may be considered in refractory cases 1.
- Immunomodulators: Consider in severe or refractory cases (e.g., azathioprine, 5-aminosalicylates) 1.Special Populations
Pediatrics: Deliberate examination and observation are crucial due to varied clinical presentations and diagnostic challenges 4.
Comorbidities: Management may need to consider concurrent conditions like hypereosinophilic syndrome 4.Key Recommendations
Establish Diagnosis Through Histologic Evidence and Exclusion of Secondary Causes (Evidence: Strong 1).
Initiate Treatment with Corticosteroids Based on Disease Severity and Location (Evidence: Moderate 1).
Consider Dietary Interventions for Refractory Cases (Evidence: Weak 1).
Monitor and Manage Comorbid Conditions Such as Hypereosinophilic Syndrome (Evidence: Expert opinion 4).References
1 Papadopoulou A, Amil-Dias J, Auth MK, Chehade M, Collins MH, Gupta SK et al.. Joint ESPGHAN/NASPGHAN Guidelines on Childhood Eosinophilic Gastrointestinal Disorders Beyond Eosinophilic Esophagitis. Journal of pediatric gastroenterology and nutrition 2024. link
2 Wright BL, Abonia JP, Abud EM, Aceves SS, Ackerman SJ, Braskett M et al.. Advances and ongoing challenges in eosinophilic gastrointestinal disorders presented at the CEGIR/TIGERs Symposium at the 2024 American Academy of Allergy, Asthma & Immunology meeting. The Journal of allergy and clinical immunology 2024. link
3 Spergel JM, Aceves SS, Kliewer K, Gonsalves N, Chehade M, Wechsler JB et al.. New developments in patients with eosinophilic gastrointestinal diseases presented at the CEGIR/TIGERS Symposium at the 2018 American Academy of Allergy, Asthma & Immunology Meeting. The Journal of allergy and clinical immunology 2018. link
4 Yamada Y, Nishi A, Ebara Y, Kato M, Yamamoto H, Morita H et al.. Eosinophilic gastrointestinal disorders in infants: a Japanese case series. International archives of allergy and immunology 2011. link