Introduction: Introduction: Eosinophilic gastroenteritis (EGE) is characterized by upper gastrointestinal symptoms, eosinophilic infiltration, and absence of other causes of tissue eosinophilia. Numbers and distributions of eosinophils required for mucosal diagnosis have been proposed. Despite the upper GI symptoms, the association between EGE and gastric emptying and accommodation have only been reported in animal studies and case reports. Our aim was to conduct a review of clinicopathological and endoscopic features in patients with EGE in a single-center, and measurements of gastric motor functions in this cohort.
Methods: Methods: Medical records of 34 patients evaluated at Mayo Clinic Rochester with diagnosis of EGE from 2000-2022 were reviewed. Histological evidence of EGE was based on qualitative report of at least moderate infiltration or quantitation of eosinophils per hpf on biopsy. gastric emptying of solids (320kcal, 30% fat meal) and accommodation in response to 300mL Ensure were measured by validated scintigraphy and SPECT.
Results: Results: Patients’ mean age was 39.0y (range: 19-73) and 67.6% were female. Among 34 patients, 10 (29.4%) had outside diagnosis of EGE overruled upon biopsy review by an expert GI pathologist. Symptoms and comorbidities of 24 confirmed cases are summarized in the table; 2 patients had concurrent celiac disease and 3 had inflammatory bowel disease. Most patients (79.2%) had peripheral blood eosinophilia and abnormal gastroscopic findings (72.7%). Histological reporting was heterogeneous, with 37.5% citing numbers of eosinophils (table). Delayed (47.5%) or rapid (33.3%) gastric emptying (table, figure), as well as reduced gastric accommodation volume < 428mL (3, 42.9%) were documented. Patients were treated with diverse medications: prednisone (15, 62.5%), budesonide (11, 45.8%), fluticasone (4, 16.7%), cromolyn (4, 16.7%), montelukast (1, 4.2%), mepolizumab (1, 4.2%), immunomodulators (azathioprine, 6-MP, methotrexate) (3, 12.5%), and with standard approaches for gastric motor dysfunction (prokinetics, relaxatory agents). Where repeat results were available, 8 (57.1%), 12 (75%), and 4 (100%) patients showed endoscopic, histologic, and gastric emptying improvement after treatment, respectively.
Discussion: Discussion: Although understudied and in need of consensus diagnostic clinical and histological criteria, EGE is associated with altered gastric emptying and reduced accommodation and warrants further prospective studies.
