PMID- 30982212
OWN - NLM
STAT- MEDLINE
DCOM- 20200225
LR  - 20200309
IS  - 1573-2568 (Electronic)
IS  - 0163-2116 (Linking)
VI  - 64
IP  - 8
DP  - 2019 Aug
TI  - Eosinophilic Gastroenteritis: Clinical Manifestation, Natural Course, and 
      Evaluation of Treatment with Corticosteroids and Vedolizumab.
PG  - 2231-2241
LID - 10.1007/s10620-019-05617-3 [doi]
AB  - BACKGROUND: Eosinophilic gastroenteritis (EGE) is a rare, chronic inflammatory 
      condition of the gastrointestinal tract. Little is known about its natural 
      history and treatment outcomes. The aims of our analysis were to describe 
      clinical presentation, response to current medical treatments, and to evaluate 
      the response of refractory EGE to anti-integrin therapy. METHODS: Patients with 
      confirmed diagnosis of EGE fulfilling the diagnostic criteria: (1) the presence 
      of gastrointestinal symptoms, (2) dense eosinophilic infiltration of the 
      gastrointestinal mucosa, and (3) exclusion of other conditions leading to 
      gastrointestinal eosinophilia were included in this analysis. In patients 
      non-responding to corticosteroids and/or anti-TNF treatment the integrin blocker 
      vedolizumab was used. RESULTS: EGE patients (n = 22) were predominantly female 
      (63%) with a median age at diagnosis of 41.5 years. The most frequent symptoms 
      were abdominal pain (100%), diarrhea (59%), nausea/vomiting (36%), and bloating 
      (27%). No pathognomonic endoscopic alterations were found. Eosinophilic 
      infiltration was observed in the majority of patients in more than one segment. 
      Patients were treated with systemic steroids, topical, and enteral release 
      steroids in 21/22 (95%) patients, proton pump inhibitors in 7/22 (32%), TNFalpha 
      inhibitors in 3/22 (14%), and vedolizumab in 4/22 (18%) patients. In 3/4 of 
      steroid-refractory patients vedolizumab induced a clinical and histological 
      improvement. CONCLUSIONS: The combination of highly variable clinical 
      presentation, subtle endoscopic abnormalities, and involvement of several GI 
      segments undermines the difficulty to diagnose EGE and the need for structured 
      biopsy sampling. Corticosteroids were efficient in the majority of patients to 
      induce remission. Response to the integrin blocker vedolizumab suggests further 
      assessment in refractory cases.
FAU - Grandinetti, Tanja
AU  - Grandinetti T
AD  - Department of Gastroenterology and Hepatology, University Hospital Basel, 
      Petersgraben 4, 4031, Basel, Switzerland.
FAU - Biedermann, Luc
AU  - Biedermann L
AD  - Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, 
      Switzerland.
FAU - Bussmann, Christian
AU  - Bussmann C
AD  - Institute of Pathology Viollier, Basel, Switzerland.
FAU - Straumann, Alex
AU  - Straumann A
AD  - Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, 
      Switzerland.
AD  - Swiss EoE Clinic, Division of Gastroenterology, University Hospital Zurich, 
      Zurich, Switzerland.
FAU - Hruz, Petr
AU  - Hruz P
AUID- ORCID: 0000-0003-2767-0445
AD  - Department of Gastroenterology and Hepatology, University Hospital Basel, 
      Petersgraben 4, 4031, Basel, Switzerland. petr.hruz@usb.ch.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20190413
PL  - United States
TA  - Dig Dis Sci
JT  - Digestive diseases and sciences
JID - 7902782
RN  - 0 (Adrenal Cortex Hormones)
RN  - 0 (Antibodies, Monoclonal, Humanized)
RN  - 0 (Gastrointestinal Agents)
RN  - 9RV78Q2002 (vedolizumab)
RN  - Eosinophilic enteropathy
SB  - IM
CIN - Dig Dis Sci. 2019 Sep;64(9):2688-2689. PMID: 31190203
CIN - Dig Dis Sci. 2019 Aug;64(8):2068-2071. PMID: 31273593
MH  - Adolescent
MH  - Adrenal Cortex Hormones/adverse effects/*therapeutic use
MH  - Adult
MH  - Aged
MH  - Antibodies, Monoclonal, Humanized/adverse effects/*therapeutic use
MH  - Child
MH  - Enteritis/diagnosis/*drug therapy/immunology
MH  - Eosinophilia/diagnosis/*drug therapy/immunology
MH  - Female
MH  - Gastritis/diagnosis/*drug therapy/immunology
MH  - Gastrointestinal Agents/adverse effects/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Remission Induction
MH  - Retrospective Studies
MH  - Time Factors
MH  - Treatment Outcome
MH  - Young Adult
OTO - NOTNLM
OT  - Eosinophilic gastroenteritis
OT  - Steroid-refractory
OT  - Vedolizumab
EDAT- 2019/04/15 06:00
MHDA- 2020/02/26 06:00
CRDT- 2019/04/15 06:00
PHST- 2018/09/21 00:00 [received]
PHST- 2019/04/08 00:00 [accepted]
PHST- 2019/04/15 06:00 [pubmed]
PHST- 2020/02/26 06:00 [medline]
PHST- 2019/04/15 06:00 [entrez]
AID - 10.1007/s10620-019-05617-3 [pii]
AID - 10.1007/s10620-019-05617-3 [doi]
PST - ppublish
SO  - Dig Dis Sci. 2019 Aug;64(8):2231-2241. doi: 10.1007/s10620-019-05617-3. Epub 2019 
      Apr 13.