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Eosinophilic gastroenteropathy in childhood
P F Whitington1, G L Whitington
1Department of Pediatrics, University of Chicago Pritzker School of Medicine, Illinois 60637.
Insights
Eosinophilic gastroenteropathy (EG) in children involves severe intestinal eosinophilic inflammation. Diagnosis requires careful evaluation, and while treatments like cromolyn sodium and prednisone can be effective, some children may need long-term therapy.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Gastrointestinal Pathology
Background:
- Eosinophilic gastroenteropathy (EG) is a rare pediatric disorder.
- It is characterized by eosinophilic inflammation of the gastrointestinal tract.
Purpose of the Study:
- To review clinical data of pediatric EG patients.
- To assess disease severity, diagnostic criteria, and treatment outcomes.
Main Methods:
- Retrospective review of clinical data from 17 infants and children with EG over 7 years.
- Histopathological evaluation using a scale for mucosal eosinophilia.
- Analysis of peripheral eosinophilia, bone marrow precursors, and serum IgE levels.
Main Results:
- All patients exhibited severe mucosal eosinophilia, exceeding other childhood intestinal disorders.
- Peripheral eosinophilia was present in 12 patients; two others showed increased eosinophil precursors.
- Serum IgE levels correlated with disease severity, with extreme elevations in chronic cases.
- Viral infection and dietary factors were noted in some patients, questioning histology specificity.
Conclusions:
- EG in children presents with significant intestinal eosinophilic infiltration.
- Diagnosis may require more than histology alone, considering potential triggers.
- Oral cromolyn sodium and prednisone are effective treatments, though long-term management may be necessary.
Abstract:
Eosinophilic gastroenteropathy (EG) is an uncommon, idiopathic disease in children that is characterized by eosinophilic inflammation of the intestine. Over a 7-year period 17 infants and children with EG were evaluated; the retrospective review of their clinical data constitutes the basis of this report. A scale developed for grading the degree of mucosal eosinophilia was used in the evaluation of the intestinal histopathology; all patients had eosinophilic infiltration that was far more severe than that seen in other intestinal disorders of childhood. Peripheral eosinophilia was observed in 12 patients. However, two more had evidence of rapid turnover of eosinophils with significantly increased numbers of precursors in bone marrow and intense intestinal infiltration. Serum IgE correlated with the severity of the disease; extreme elevations were associated with chronic severe illness similar to that commonly reported in adults. Evidence of viral infection in two patients and dietary responsiveness in two infants bring to question the specificity of diagnosis on histology alone. Treatment with oral cromolyn sodium and/or prednisone was effective, but some patients have remained dependent upon therapy.
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