Published online Nov 6, 2016. doi: 10.4292/wjgpt.v7.i4.513
Peer-review started: December 7, 2015
First decision: February 15, 2016
Revised: July 23, 2016
Accepted: August 15, 2016
Article in press: August 17, 2016
Published online: November 6, 2016
Processing time: 100 Days and 4.2 Hours
Eosinophilic gastroenteritis (EGE) is a rare and benign inflammatory disorder that predominantly affects the stomach and the small intestine. The disease is divided into three subtypes (mucosal, muscular and serosal) according to klein’s classification, and its manifestations are protean, depending on the involved intestinal segments and layers. Hence, accurate diagnosis of EGE poses a significant challenge to clinicians, with evidence of the following three criteria required: Suspicious clinical symptoms, histologic evidence of eosinophilic infiltration in the bowel and exclusion of other pathologies with similar findings. In this review, we designed and applied an algorithm to clarify the steps to follow for diagnosis of EGE in clinical practice. The management of EGE represents another area of debate. Prednisone remains the mainstay of treatment; however the disease is recognized as a chronic disorder and one that most frequently follows a relapsing course that requires maintenance therapy. Since prolonged steroid treatment carries of risk of serious adverse effects, other options with better safety profiles have been proposed; these include budesonide, dietary restrictions and steroid-sparing agents, such as leukotriene inhibitors, azathioprine, anti-histamines and mast-cell stabilizers. Single cases or small case series have been reported in the literature for all of these options, and we provide in this review a summary of these various therapeutic modalities, placing them within the context of our novel algorithm for EGE management according to disease severity upon presentation.
Core tip: Eosinophilic gastroenteritis (EGE) is a heterogeneous inflammatory bowel disorder, which commonly follows a chronic and relapsing course. To date, only single cases or small case series provide insights into its diagnosis and management. This manuscript reviews the different diagnostic tools utilized in practice and provides an algorithm for diagnosis. It also provides a summary of the therapeutic modalities applied in EGE management, which are placed within the context of an algorithm for systematic application of the different strategies according to the initial disease severity.