Gastrointestinal Eosinophilia

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Gastrointestinal eosinophilia, a broad term for abnormal eosinophil accumulation in the gastrointestinal tract, involves many different disease identities. These diseases include primary eosinophil associated gastrointestinal diseases, gastrointestinal eosinophilia in hypereosinophilic syndrome, and all gastrointestinal eosinophilic states associated with known causes. Each of these diseases has its unique features but there is no absolute boundary between them. All three groups of gastrointestinal eosinophila are described in this article, although the focus is on primary gastrointestinal eosinophilia.

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Physiological presence of eosinophils in the gastrointestinal tract

Even though eosinophils have been noted to be present at low levels in numerous tissues as well as in the blood circulation, when a large series of biopsy and autopsy specimens were analyzed, the only organs that demonstrated tissue eosinophils (at substantial levels) were the GI tract, spleen, lymph nodes, and thymus [1]. Notably, eosinophil infiltrations were only associated with eosinophil degranulation in the GI tract. Examination of eosinophils throughout the GI tract of conventional

Function of eosinophilia in the gastrointestinal system

Despite the significant progress in histological studies of GI eosinophilia, the function of eosinophils in the GI tract is still not well understood. In general, eosinophils play both protective and pathologic roles in the GI tract. As part of their protective role, eosinophils are involved in host response against parasitic infections. As part of their involvement in eliciting tissue pathology, allergen-triggered Th2 responses, mediated by IL-5 and IL-13 (for example) have been shown to

Primary gastrointestinal eosinophilia

Patients with EGID suffer from a variety of problems, including failure to thrive, abdominal pain, irritability, gastric dysmotility, vomiting, diarrhea, and dysphagia [26]. Even though the term “primary” is used here, evidence is accumulating supporting the concept that EGID arises secondary to the interplay of genetic and environmental factors. A large percentage (approximately 10%) of patients suffering from EGID have an immediate family member with EGID [27]. Several lines of evidence

Gastrointestinal eosinophilia in hypereosinophilic syndrome

The term HES was introduced by Anderson and Hardy in 1968 to designate patients with marked eosinophilia in the absence of other causes of eosinophilia [66]. They reported three patients, all males between the ages of 34 and 47, who suffered from cardiopulmonary symptoms, fever, diaphoresis, weight loss and marked eosinophilia. Two of the patients died, and at autopsy their hearts were enlarged and showed mural thrombi. Multiple organs are involved in HES, including heart, lung, skin, nervous

Gastrointestinal eosinophilia from known causes

There are a variety of other known causes of GI eosinophilia, including parasitic infections, other allergic disorders, GERD, IBD, drug reactions, malignancy, Churg-Strauss syndrome, celiac disease, systemic lupus erythematosus, and solid organ transplantation. Among those causes, parasitic infections are the most common cause of gastrointestinal eosinophilia in developing countries. In developed countries, allergic causes have become the dominant cause for gastrointestinal eosinophilia. Among

Summary

Gastrointestinal eosinophilia, as a broad term for abnormal eosinophil accumulation in the GI tract, involves many different disease identities. These diseases include primary eosinophil associated gastrointestinal diseases, gastrointestinal eosinophilia in HES, and all gastrointestinal eosinophilic states associated with known causes. Although each of these diseases has its unique features, it is important to recognize that there is no absolute boundary between them. As an example, HES is a

Acknowledgments

The authors are grateful to Andrea Lippelman for her help during the writing of this article.

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    This work was supported by NIH grants AI 45898-09, NIH AI 070235-02 and T32 DK 07727-12, The Buckeye Foundation, Campaign Urging Research for Eosinophilic Diseases (CURED) Foundation, The Food Allergy Project, and The Food Allergy and Anaphylaxis Network (FAAN).

    This article was adapted from: Rothenberg ME. Eosinophilic gastrointestinal disorders (EGID). J Allergy Clin Immunol 2004;113(1):11–28.

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