Eosinophilic Gastroenteritis

There are no evidence-based studies of the treatment of patients with eosinophilic gastroenteritis. Treatment decisions depend on experience gained from observations linking causative entities, principal clinical manifestations, and anticipated natural history of the disease. Because clinical symptoms and organ involvement probably vary with etiology, classification as to the likely cause (eg, food allergy or other dietary intolerance, idiosyncratic drug reaction, occult infection, idiopathic) determines the decisions made about dietary, pharmacologic, and surgical treatment. Elimination of foods and the use of elemental diets, corticosteroids, and mast cell inhibitors (eg, cromolyn sodium, ketotifen), alone or in combination, all have their place, depending on the age of the patient, organ involved, clinical presentation, and clinical urgency. Isolated cases are diagnosed only at surgical exploration for acute abdominal catastrophes; in these instances, further therapy depends on whether resection is done, but most patients remain in remission after surgery. Occult parasitism remains an elusive and unrecognized cause of an unknown number of cases, suggesting that empiric antihelminthic therapy should be tried in some patients. Individual reports of success with nonsystemic steroids and leukotriene inhibitors have been published.