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Author Spotlight: Investigating the Pathophysiology of Eosinophilic Esophagitis
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Eosinophilic Gastrointestinal Disorders Pathology.

Margaret H Collins1,2, Kelley Capocelli3,4, Guang-Yu Yang5

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|January 31, 2018
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Eosinophilic gastrointestinal disorders (EGID) involve excess eosinophils in the GI tract. This review offers guidelines for the pathological diagnosis of EGID, including eosinophilic esophagitis and gastritis.

Keywords:
allergycolitisesophagitisgenomeinflammatory bowel disease

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Area of Science:

  • Gastroenterology
  • Immunology
  • Pathology

Background:

  • Eosinophilic gastrointestinal disorders (EGID) are defined by eosinophil accumulation in gastrointestinal biopsies.
  • Eosinophilic esophagitis (EoE) is the most studied EGID, often triggered by food antigens and diagnosed via specific biopsy criteria.
  • Other EGIDs, like eosinophilic gastritis (EG), lack standardized diagnostic guidelines.

Purpose of the Study:

  • To provide pathological diagnostic guidelines for various forms of EGID.
  • To clarify diagnostic challenges in differentiating EGID subtypes and their etiologies.

Main Methods:

  • Review of existing literature and diagnostic criteria for EGID.
  • Focus on pathological findings in mucosal biopsies across different GI segments.
  • Discussion of clinical and histological features associated with EGID.

Main Results:

  • EoE diagnosis requires esophageal symptoms, lack of response to PPIs, and ≥15 eosinophils/HPF on biopsy.
  • EG is characterized by lamina propria eosinophilic infiltrates and may present with anemia and hypoalbuminemia.
  • Eosinophilic enteritis and colitis have complex presentations, with EC often challenging to distinguish from inflammatory bowel disease.

Conclusions:

  • Standardized pathological diagnostic criteria are needed for most EGID subtypes beyond EoE.
  • Accurate diagnosis of EGID is crucial for appropriate management and differentiating from other GI conditions.
  • Parasitic infestation is the only currently identifiable histological etiology for EGID.