Back ground :
@EN Idiopathic eosinophilic gastroenteritis(EGE) is a rare disease characterized by massive tissue eosinophilia that can involve any area of the gastrointestinal tract. Its etiology is uncertain and the clinical and radiologic pictures mimicked
many
other gastrointestinal diseases. So its clinical diagnosis is very difficult and also choice of treatment is controversial,
@ES Purpose :
@EN The aims of this study are to review the clinicopathologic features, to define the differential diagnosis and to evaluate the outcome of treatment in patients with EGE.
@ES Patients and methods :
Ninety Korean patients with EGE treated from 1970 to 1993 were enrolled in this study. Twenty eight cases are authors and sixty two cases are collected from Korean literatures. Patients were divided into two groups according to classification
proposed
by Ureles45); diffuse infiltrated from (64 case) and circumscribed for (26 cases) Follow up data were available in 48 cases(59%) in surgery group and all 8 medical treatment group.
@ES Results ;
@EN Overall median age of patients was 38 years(ranged 25 to 76 years) and the male to female ratio was 2.6 : 1. Common clinical manifestations were intermittent abdominal pain and tenderness(99%), nausea and vomiting(52%) and abdominal
distension(21%).
Symptoms of nausea and vomiting were more prominent in diffuse form compared to circumscribed form(63% vs 27%). There were only 2 cases of diffuse form with history of allergy. Median duration of symptoms was 2 days in diffuse form and 7 days in
circumscribed form. The predominant layer of eosinophilic infiltration in diffuse form was mucosa, 23% muscularis, 14% serosa, 13% and whole layer, 50%. The unique symptom was diarrhea or melena in mucosal lesion and ascites in serosal or whole
layer
lesio. Incidence of peripheral blood eosinophilia was 20% in diffuse form but of circumscribed form was none. The most common site of involvement was ileum(45%), almost terminal ileum, followed by stomach(21%) and cecum(14%), and multiple site
was
6% of
all cases. Eighty-six percent of ileal lesions and 65% of gastric lesions were diffuse form, but 71% of cecal lesions were circumscribed form. Correct clinical diagnosis was made only in 11 cases(12%) through gastrofiberoscopic biopsy(9 cases),
sigmoidoscopic biopsy(1 case) and paracentesis(1 case). Usual preoperative diagnoses or indications of operation were suspicion of gastric cancer in a half of gastric lesions. Operation was performed in 82 cases(91%), mainly resection, such as
segmental
resection of small bowel(44 cases), right hemicolectomy(17 cases) and subtotal gastrectomy(7 cases) under the intraoperative impression of other disease such as neoplasm in circumscribed form or chronic inflammatory bowel disease of unknown
etiology in
diffuse form. Surgery group showed no postoperative mortality or major morbidity and no clinical recurrence during the median follow up of 8 months. Among 8 medical treatment group of gastric lesion with diffuse form, 2 patients showed treatment
failure
during the median follow up of 1 year.
@ES Conclusion :
@EN Possibility of eosinophilic infiltrative gastrointestinal disease especially of the terminal ileum or cecum should be considered in cases of unexplained mechanical intestinal obstruction or of suspicion of acute appendicitis even though with
no
allergic history or peripheral eosinophilia. 2) Surgical resection is safe and definitive form of treatment.
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