RESUMEN
Eosinophilic gastroenteritis poses a significant diagnostic challenge, particularly in developing countries, where the awareness of this condition may be limited. Here, the case of a patient in her early 30s, who presented with recurrent episodes of abdominal pain and diarrhea, is reported. Initial standard laboratory investigations revealed normal complete blood counts and elevated total serum immunoglobulin E levels. Upper and lower endoscopic evaluations with systemic biopsies did not reveal any significant abnormalities. However, computed tomography revealed a thickened small intestine wall, halo signs, and mild ascites. Analysis of the ascitic fluid confirmed eosinophilia. These findings prompted a diagnosis of eosinophilic gastroenteritis. The patient responded well to a targeted elimination diet, corticosteroids, and antileukotriene medication. The present case emphasizes the importance of considering eosinophilic gastroenteritis in the differential diagnosis of patients who present with abdominal pain and eosinophilic ascites.
Asunto(s)
Ascitis , Enteritis , Eosinofilia , Gastritis , Humanos , Eosinofilia/diagnóstico , Eosinofilia/patología , Ascitis/diagnóstico , Ascitis/patología , Ascitis/etiología , Femenino , Enteritis/diagnóstico , Enteritis/patología , Vietnam , Gastritis/diagnóstico , Gastritis/patología , Gastritis/complicaciones , Adulto , Tomografía Computarizada por Rayos X , Dolor Abdominal/etiología , Dolor Abdominal/diagnóstico , Diagnóstico DiferencialRESUMEN
Eosinophilic gastroenteritis (EG) is an inflammatory bowel condition characterised by eosinophilic infiltration of the stomach and small bowel. Smoking and certain foods can trigger EG.A man in his 40s presented to the emergency department with acute abdominal pain. He had rebound tenderness and guarding on his initial abdominal examination. A subsequent CT scan showed jejunal wall thickening and ascitesHe had similar attacks of abdominal pain and was misdiagnosed with familial Mediterranean fever and Crohn's disease.Paracentesis revealed eosinophilic ascites. No mucosal abnormality was detected on gastroduodenoscopy and colonoscopy. A double-balloon enteroscopy revealed mucosal inflammation in the jejunum and a biopsy was taken. In this biopsy, eosinophilic jejunitis was detected. He was given corticosteroids and montelukast and his condition was resolved promptly. After discharge, he had attacks of EG until he quit smoking. After quitting smoking, he had an attack once in the last 2 years after consuming eggplant.
Asunto(s)
Abdomen Agudo , Ascitis , Enteritis , Eosinofilia , Gastritis , Humanos , Masculino , Eosinofilia/diagnóstico , Eosinofilia/complicaciones , Abdomen Agudo/etiología , Enteritis/diagnóstico , Enteritis/complicaciones , Enteritis/tratamiento farmacológico , Gastritis/diagnóstico , Gastritis/complicaciones , Adulto , Ascitis/etiología , Diagnóstico Diferencial , Tomografía Computarizada por Rayos XRESUMEN
Introduction: Chronic inflammation of the gastrointestinal tissues underlies gastrointestinal inflammatory disorders, leading to tissue damage and a constellation of painful and debilitating symptoms. These disorders include inflammatory bowel diseases (Crohn's disease and ulcerative colitis), and eosinophilic disorders (eosinophilic esophagitis and eosinophilic duodenitis). Gastrointestinal inflammatory disorders can often present with overlapping symptoms necessitating the use of invasive procedures to give an accurate diagnosis. Methods: This study used peripheral blood mononuclear cells from individuals with Crohn's disease, ulcerative colitis, eosinophilic esophagitis, and eosinophilic duodenitis to better understand the alterations to the transcriptome of individuals with these diseases and identify potential markers of active inflammation within the peripheral blood of patients that may be useful in diagnosis. Single-cell RNA-sequencing was performed on peripheral blood mononuclear cells isolated from the blood samples of pediatric patients diagnosed with gastrointestinal disorders, including Crohn's disease, ulcerative colitis, eosinophilic esophagitis, eosinophilic duodenitis, and controls with histologically healthy gastrointestinal tracts. Results: We identified 730 (FDR < 0.05) differentially expressed genes between individuals with gastrointestinal disorders and controls across eight immune cell types. Discussion: There were common patterns among GI disorders, such as the widespread upregulation of MTRNR2L8 across cell types, and many differentially expressed genes showed distinct patterns of dysregulation among the different gastrointestinal diseases compared to controls, including upregulation of XIST across cell types among individuals with ulcerative colitis and upregulation of Th2-associated genes in eosinophilic disorders. These findings indicate both overlapping and distinct alterations to the transcriptome of individuals with gastrointestinal disorders compared to controls, which provide insight as to which genes may be useful as markers for disease in the peripheral blood of patients.
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Eosinofilia , Análisis de la Célula Individual , Humanos , Niño , Masculino , Femenino , Eosinofilia/genética , Eosinofilia/inmunología , Adolescente , Gastritis/genética , Gastritis/diagnóstico , Gastritis/inmunología , Transcriptoma , Esofagitis Eosinofílica/genética , Esofagitis Eosinofílica/diagnóstico , Esofagitis Eosinofílica/inmunología , Preescolar , Colitis Ulcerosa/genética , Colitis Ulcerosa/diagnóstico , Colitis Ulcerosa/inmunología , Enteritis/genética , Enteritis/diagnóstico , Enteritis/inmunología , Perfilación de la Expresión Génica , Enfermedad de Crohn/genética , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/inmunología , Leucocitos Mononucleares/metabolismo , Leucocitos Mononucleares/inmunología , Genómica/métodos , BiomarcadoresAsunto(s)
Consenso , Enteritis , Eosinofilia , Esofagitis Eosinofílica , Guías de Práctica Clínica como Asunto , Humanos , Niño , Eosinofilia/diagnóstico , Eosinofilia/terapia , Esofagitis Eosinofílica/diagnóstico , Esofagitis Eosinofílica/terapia , Enteritis/diagnóstico , Enteritis/terapia , Gastritis/diagnóstico , Gastritis/terapia , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/terapiaAsunto(s)
Anticuerpos Monoclonales Humanizados , Cetoacidosis Diabética , Enteritis , Púrpura Trombocitopénica Trombótica , Humanos , Anticuerpos Monoclonales Humanizados/efectos adversos , Cetoacidosis Diabética/inducido químicamente , Cetoacidosis Diabética/diagnóstico , Púrpura Trombocitopénica Trombótica/inducido químicamente , Púrpura Trombocitopénica Trombótica/diagnóstico , Enteritis/inducido químicamente , Enteritis/diagnóstico , Enteritis/inmunología , Femenino , Masculino , Persona de Mediana Edad , Antineoplásicos Inmunológicos/efectos adversos , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 1/inducido químicamenteRESUMEN
Potential prognostic indicators have been associated with decreased survival during canine parvoviral enteritis (CPE), such as body weight, sex, and clinicopathological parameters. Few studies reported the prognostic factors for CPE in Italy; therefore, the aim of this study was to identify prognostic factors associated with the survival of dogs admitted to the Veterinary Teaching Hospital of Perugia University, naturally infected with canine parvovirus. Seventy-six medical records of dogs with a definitive diagnosis of parvoviral infection admitted from 2017 to 2021 have been reviewed and included in the study. From medical records were extracted data on signalment, history, clinical examination, hematology, serum biochemistry, treatments, progression of clinical signs during hospitalization and outcome. The data have been subjected to univariate and multivariate statistical analysis. Our results showed winter season, male sex, dog ownership, small breed, normal sensory status, normal heart rate, normal hydration status, abdominal pain, increased capillary reperfusion time, and normal white blood cell count as positive prognostic factors. The survival model confirmed that parameters such as male sex, small breed, and ownership increased the survival rate during hospitalization. Data reported in the present study are partially in agreement with previous studies and added new information on the possible prognostic factors in dogs affected by CPE in Italy.
Asunto(s)
Enfermedades de los Perros , Enteritis , Hospitales Veterinarios , Hospitales de Enseñanza , Infecciones por Parvoviridae , Italia , Estudios Retrospectivos , Parvovirus Canino , Enteritis/diagnóstico , Enteritis/epidemiología , Enteritis/veterinaria , Enfermedades de los Perros/diagnóstico , Enfermedades de los Perros/epidemiología , Pronóstico , Análisis de Supervivencia , Factores de Riesgo , Infecciones por Parvoviridae/diagnóstico , Infecciones por Parvoviridae/epidemiología , Infecciones por Parvoviridae/veterinaria , Animales , PerrosRESUMEN
BACKGROUND: The gut microbiota is strongly associated with radiation-induced gut damage. This study aimed to assess the effectiveness and safety of intestinal microecological transplantation for treating patients with chronic radiation enteritis. CASE SUMMARY: A 64-year-old female with cervical cancer developed abdominal pain, diarrhea, and blood in the stool 1 year after radiotherapy. An electronic colonoscopy was performed to diagnose chronic radiation enteritis. Two courses of intestinal microecological transplantation and full-length 16S rRNA microbiological analysis were performed. The patient experienced short- and long-term relief from symptoms without adverse effects. Whole 16S rRNA sequencing revealed significant differences in the intestinal flora's composition between patient and healthy donors. Pathogenic bacteria, such as Escherichia fergusonii and Romboutsia timonensis, were more in the patient. Beneficial bacteria such as Faecalibacterium prausnitzii, Fusicatenibacter saccharivorans, Ruminococcus bromii, and Bifidobacterium longum were more in the healthy donors. Intestinal microbiota transplantation resulted in a significant change in the patient's intestinal flora composition. The composition converged with the donor's flora, with an increase in core beneficial intestinal bacteria, such as Eubacterium rectale, and a decrease in pathogenic bacteria. Changes in the intestinal flora corresponded with the patients' alleviating clinical symptoms. CONCLUSION: Intestinal microecological transplantation is an effective treatment for relieving the clinical symptoms of chronic radiation enteritis by altering the composition of the intestinal flora. This study provides a new approach for treating patients with chronic radiation enteritis.
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Enteritis , Trasplante de Microbiota Fecal , Microbioma Gastrointestinal , Traumatismos por Radiación , Neoplasias del Cuello Uterino , Humanos , Femenino , Persona de Mediana Edad , Enteritis/microbiología , Enteritis/diagnóstico , Enteritis/etiología , Enteritis/terapia , Traumatismos por Radiación/diagnóstico , Traumatismos por Radiación/microbiología , Traumatismos por Radiación/etiología , Traumatismos por Radiación/cirugía , Microbioma Gastrointestinal/efectos de la radiación , Trasplante de Microbiota Fecal/métodos , Neoplasias del Cuello Uterino/radioterapia , ARN Ribosómico 16S/genética , Resultado del Tratamiento , Enfermedad Crónica , Colonoscopía , Intestinos/microbiología , Intestinos/efectos de la radiación , Heces/microbiología , Radioterapia/efectos adversosRESUMEN
Endoscopic evaluation with biopsies is a mainstay of the diagnosis of eosinophilic esophagitis (EoE) and non-EoE eosinophilic gastrointestinal diseases (EGIDs). Increasing knowledge has resulted in the development of 2 standardized scoring systems: the Endoscopic REFerence Score (EREFS) for EoE and the EG-REFS for eosinophilic gastritis, although the latter has not been validated. In EGIDs, diagnosis and follow-up focus on eosinophil infiltration in biopsies. In this article, we will discuss the most commonly used endoscopic scores in EoE and non-EoE EGIDs, their validity for the diagnosis and follow-up of disease activity, as well as endoscopic interventions and areas of uncertainty.
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Enteritis , Eosinofilia , Esofagitis Eosinofílica , Gastritis , Humanos , Endoscopía/métodos , Esofagitis Eosinofílica/diagnóstico , Esofagitis Eosinofílica/terapia , Enteritis/diagnóstico , Enteritis/terapia , Gastritis/diagnósticoAsunto(s)
Enteritis , Eosinofilia , Gastritis , Peritonitis , Humanos , Eosinofilia/diagnóstico , Eosinofilia/patología , Gastritis/diagnóstico , Gastritis/complicaciones , Enteritis/diagnóstico , Enteritis/complicaciones , Enteritis/patología , Peritonitis/diagnóstico , Peritonitis/etiología , Masculino , Tomografía Computarizada por Rayos X , Femenino , Resultado del TratamientoRESUMEN
Eosinophilic gastrointestinal disorder (EGID) is an umbrella term encompassing a group of chronic, immune-mediated disorders characterized by eosinophil-rich inflammation affecting one or more segments of the gastrointestinal tract. A recent consensus in nomenclature and emerging data made possible through multi-center consortia are beginning to unravel the molecular and cellular underpinnings of EGIDs below the esophagus. These emerging findings are revealing both overarching commonalities related to a food allergen-driven, chronic, Th2-mediated immune response as well as location-specific nuances in the pathophysiology of the collective EGIDs. Altogether, these advances offer promise for improved diagnoses and more efficacious interventional strategies.
Asunto(s)
Enteritis , Eosinofilia , Esofagitis Eosinofílica , Gastritis , Humanos , Enteritis/diagnóstico , Enteritis/terapia , Gastritis/diagnóstico , Eosinofilia/diagnóstico , Esofagitis Eosinofílica/diagnóstico , Esofagitis Eosinofílica/terapiaRESUMEN
BACKGROUND: Crohn's disease (CD) is often misdiagnosed as intestinal tuberculosis (ITB). However, the treatment and prognosis of these two diseases are dramatically different. Therefore, it is important to develop a method to identify CD and ITB with high accuracy, specificity, and speed. AIM: To develop a method to identify CD and ITB with high accuracy, specificity, and speed. METHODS: A total of 72 paraffin wax-embedded tissue sections were pathologically and clinically diagnosed as CD or ITB. Paraffin wax-embedded tissue sections were attached to a metal coating and measured using attenuated total reflectance fourier transform infrared spectroscopy at mid-infrared wavelengths combined with XGBoost for differential diagnosis. RESULTS: The results showed that the paraffin wax-embedded specimens of CD and ITB were significantly different in their spectral signals at 1074 cm-1 and 1234 cm-1 bands, and the differential diagnosis model based on spectral characteristics combined with machine learning showed accuracy, specificity, and sensitivity of 91.84%, 92.59%, and 90.90%, respectively, for the differential diagnosis of CD and ITB. CONCLUSION: Information on the mid-infrared region can reveal the different histological components of CD and ITB at the molecular level, and spectral analysis combined with machine learning to establish a diagnostic model is expected to become a new method for the differential diagnosis of CD and ITB.
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Enfermedad de Crohn , Enteritis , Tuberculosis Gastrointestinal , Humanos , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/patología , Espectroscopía Infrarroja por Transformada de Fourier , Diagnóstico Diferencial , Parafina , Tuberculosis Gastrointestinal/diagnóstico , Tuberculosis Gastrointestinal/patología , Enteritis/diagnóstico , Aprendizaje Automático , Proteínas de la Ataxia Telangiectasia MutadaRESUMEN
Mast cells play a central role in the pathogenesis of eosinophilic gastrointestinal disorders (EGIDs), including eosinophilic esophagitis. Their interactions with immune and structural cells, involvement in tissue remodeling, and contribution to symptoms make them attractive targets for therapeutic intervention. More is being discovered regarding the intricate interplay of mast cells and eosinophils. Recent studies demonstrating that depletion of eosinophils is insufficient to improve symptoms of EGIDs have raised the question of whether other cells may play a role in symptomatology and pathogenesis of EGIDs.
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Enteritis , Eosinofilia , Esofagitis Eosinofílica , Gastritis , Humanos , Mastocitos , Enteritis/terapia , Enteritis/diagnóstico , Gastritis/diagnóstico , Gastritis/terapia , Esofagitis Eosinofílica/terapia , Esofagitis Eosinofílica/diagnósticoRESUMEN
GUIDELINE TITLE: Joint ESPGHAN/NASPGHAN Guidelines on Childhood Eosinophilic Gastrointestinal Disorders Beyond Eosinophilic Esophagitis RELEASE DATE: July 4, 2023 (e-publication ahead of print) PRIOR VERSION(S): None DEVELOPER: European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the North American Society for Pediatrics Gastroenterology, Hepatology and Nutrition (NASPGHAN) FUNDING SOURCE: ESPGHAN and NASPGHAN TARGET POPULATION: Children with eosinophilic gastrointestinal disorders beyond eosinophilic esophagitis.
Asunto(s)
Enteritis , Eosinofilia , Esofagitis Eosinofílica , Gastritis , Médicos Hospitalarios , Humanos , Eosinofilia/diagnóstico , Eosinofilia/terapia , Esofagitis Eosinofílica/diagnóstico , Esofagitis Eosinofílica/terapia , Niño , Gastritis/diagnóstico , Gastritis/terapia , Enteritis/diagnóstico , Enteritis/terapia , Guías de Práctica Clínica como AsuntoRESUMEN
Eosinophilic gastrointestinal diseases (EGID), such as eosinophilic gastritis (EoG), eosinophilic enteritis, and eosinophilic colitis (EoC), are chronic inflammatory conditions characterized by persistent gastrointestinal symptoms and elevated levels of activated eosinophils in the gastrointestinal tract. EoG and eosinophilic duodenitis (EoD) are strongly associated with food allergen triggers and TH2 inflammation, whereas EoC shows minimal transcriptomic overlap with other EGIDs. The level of expression of certain genes associated with TH2 immune response is associated with certain histopathologic findings of EoG, EoD, and EoC. Current immune therapy for EoG depletes tissue eosinophilia with persistence of other histopathologic features of disease.
Asunto(s)
Enteritis , Eosinofilia , Esofagitis Eosinofílica , Gastritis , Humanos , Esofagitis Eosinofílica/diagnóstico , Esofagitis Eosinofílica/terapia , Enteritis/diagnóstico , Enteritis/terapia , Gastritis/diagnóstico , Gastritis/terapia , InflamaciónRESUMEN
Patients with non-eosinophilic esophagitis eosinophilic gastrointestinal diseases (non-EoE EGIDs) are prone to nutritional deficiencies due to food-avoidant behaviors, malabsorption, and high nutrition impact symptoms. Nutrient deficiencies correspond to the segment, depth, and extent of the gastrointestinal tract involved and can impact organs distant from the gut. Patients with non-EoE EGIDs are often atopic, and some appear to respond to dietary avoidance of specific food allergens. Tests to identify food triggers other than response to elimination diets are lacking. Dietary restriction therapy should be considered in such patients and is best implemented through a multidisciplinary approach to avoid nutritional complications.
Asunto(s)
Enteritis , Eosinofilia , Hipersensibilidad a los Alimentos , Gastritis , Humanos , Enteritis/diagnóstico , Enteritis/terapia , Gastritis/diagnóstico , Gastritis/terapia , Eosinofilia/terapia , Eosinofilia/diagnóstico , Hipersensibilidad a los Alimentos/terapia , AlérgenosRESUMEN
Data for pharmacologic treatments for non-eosinophilic esophagitis (EoE) eosinophilic gastrointestinal diseases (EGIDs) are limited. Nevertheless, because of the increasing understanding of EGID pathogenesis, a number of medications are used to treat EGIDs, though all are currently off-label. Initial therapy generally starts with corticosteroids, and "topical" delivery is preferred over systemic due to long-term side effects. A number of other small molecules could potentially be used, ranging from allergy medications to immunosuppressants. Biologics are also being used and investigated for EGIDs and represent promising targeted therapies. Multiple therapeutic targets have also been identified, many of which overlap with EoE targets.
Asunto(s)
Enteritis , Eosinofilia , Esofagitis , Humanos , Eosinofilia/diagnóstico , Eosinofilia/tratamiento farmacológico , Esofagitis/tratamiento farmacológico , Corticoesteroides/uso terapéutico , Inmunosupresores , Enteritis/diagnóstico , Enteritis/tratamiento farmacológico , Enteritis/etiologíaRESUMEN
The clinical presentation of eosinophilic gastrointestinal diseases beyond eosinophilic esophagitis (non-EoE EGIDs) varies depending on the gastrointestinal segments affected by the eosinophilic inflammation, the extent of eosinophilic inflammation within the gastrointestinal tract and its depth through the bowel wall. Non-EoE EGIDs with mucosal involvement tend to present with diarrhea, malabsorption, and sometimes bleeding, those with muscular involvement may present with symptoms of obstruction or pseudo-obstruction, intussusception, and even perforation, whereas those with serosal involvement may present with eosinophilic ascites. Here we describe the differences in symptoms experienced by children with non-EoE EGIDs with varying degrees of eosinophilic inflammation through the bowel wall.
Asunto(s)
Enteritis , Eosinofilia , Esofagitis Eosinofílica , Gastritis , Niño , Humanos , Esofagitis Eosinofílica/diagnóstico , Esofagitis Eosinofílica/terapia , Gastritis/diagnóstico , Enteritis/diagnóstico , Enteritis/terapia , InflamaciónRESUMEN
PURPOSE OF REVIEW: This review seeks to understand novel avenues for eosinophilic GI disease management. Biomarkers offer a unique and non-invasive approach to tracking EoE disease progression. While no biomarkers have definitively met the diagnostic criteria for eosinophilic GI diseases, some biomarkers have been shown to be associated with disease activity. Here, we examine the potential of recently studied biomarkers. RECENT FINDINGS: Current research shows advancements in blood, luminal fluid, and breath testing. Particular areas of interest include mRNA analyses, protein fingerprinting, amplicon sequence variants (ASVs), T cells and IgE receptors, eosinophilic cationic proteins, cytokines, and nitric oxide exhalation. Preliminary results showed that mucosal biomarkers, directly captured from the esophagus, may reflect the best representation of biopsy-based results, in contrast to biomarkers obtained from indirect or peripheral (blood, breath) methods. However, this is based on limited clinical studies without sufficient numbers to evaluate true diagnostic accuracy. Large-scale randomized trials are needed to fully ascertain both the optimal sampling technique and the specific biomarkers that reflect diagnostic status of the disease.