Role Of Ultrasonography in the Diagnosis and Follow-Up of Pediatric Eosinophilic Gastroenteritis: a Case Report and Review of the Literature

Abstract

Eosinophilic gastroenteritis (EG) is a rare disease characterized by the infiltration of one or more layers of the digestive tract by eosinophilic leukocytes. The diagnosis is confirmed by histological examination of a characteristic biopsy, but radiological features are useful for diagnostic suspicion. We report the case of an adolescent boy with recurrent epigastric pain, nausea and vomiting, in whom sonographic features and eosinophilia of the peripheral blood suggested the diagnosis of EG. Moreover, we reviewed the radiological features of EG with particular regard to the role of sonography in the diagnosis and follow-up of EG, especially in children. We emphasize the utility of sonography in pediatric patients presenting with gastrointestinal symptoms, since it may provide useful information in a quick, inexpensive and noninvasive way. Ultrasonographic detection of features such as bowel wall thickness, ascites and peritoneal nodules may be largely suggestive of EG and may prevent other invasive exams and abdominal surgery. Ultrasonography can also be easily used in the follow-up of these patients, and may obviate the frequent and potentially dangerous exposure to radiation.

Zusammenfassung

Die eosinophile Gastroenteritis (EG) ist eine seltene Erkrankung, die durch die Infiltration von eosinophilen Leukozyten in eine oder mehrere Schichten des Verdauungstrakts gekennzeichnet ist. Die Diagnose wird durch die histologische Untersuchung einer charakteristischen Biopsie bestätigt, aber für die Verdachtsdiagnose sind die radiologischen Eigenschaften nützlich. Wir berichten über einen Fall eines männlichen Jugendlichen mit wiederholten Oberbauchschmerzen, Übelkeit und Erbrechen, bei dem das sonografische Bild und die Eosinophilie im peripheren Blut den Verdacht einer EG nahelegten. Darüber hinaus überprüften wir die radiologischen Merkmale einer EG mit speziellem Augenmerk auf der Rolle der Sonografie bei Diagnose und Nachuntersuchung der EG, insbesondere bei Kindern. Wir betonen den Wert der Sonografie bei pädiatrischen Patienten, die gastrointestinale Symptome aufweisen, da diese nützliche Informationen auf eine schnelle, billige und nicht invasive Art liefern kann. Der sonografische Nachweis von Darmwandverdickungen, Aszites und Peritonealknoten ist sehr verdächtig für eine EG und kann andere invasive Untersuchungen und eine Bauchchirurgie verhindern. Ebenso kann die Ultrasonografie sehr einfach bei der Nachuntersuchung dieser Patienten eingesetzt werden und kann die häufige und möglicherweise schädliche Strahlenbelastung unnötig machen.

Key words

eosinophilic gastroenteritis - ultrasound - children - radiological features

• References

• 1 Steffen RM, Wyllie R, Petras RE et al. The spectrum of eosinophilic gastroenteritis. Report of six pediatric cases and review of the literature. Clin Pediatr 1991; 30: 404-411
• 2 Khan S. Eosinophlic gastroenteritis. Best Pract Res Clin Gastroenterol 2005; 19: 177-198
• 3 Maroy B. Nonmucosal eosinophilic gastroenteritis: sonographic appearance at presentation and during follow-up of response to prednisone therapy. J Clin Ultrasound 1998; 26: 483-486
• 4 Cello JP. Eosinophilic gastroenteritis – a complex disease entity. Am J Med 1979; 67: 1097-1104
• 5 Puylaert JB. Acute appendicitis: US evaluation using graded compression. Radiology 1986; 158: 355-360
• 6 Puylaert JB, Rutgers PH, Lalisang RI et al. A prospective study of ultrasonography in the diagnosis of appendicitis. N Engl J Med 1987; 317: 666-669
• 7 Jeffrey Jr RB, Laing FC, Lewis FR. Acute appendicitis: high-resolution real-time US findings. Radiology 1987; 163: 11-114
• 8 Kaijser R. Zur Kenntnis der allergischen affektioner desima Verdauungskanal von Standpunkt desima Chirurgen aus. Arch Klin Chir 1937; 188: 36-64
• 9 Ureles AL, Alschibaja T, Lodico D et al. Idiopathic eosinophilic infiltration of the gastrointestinal tract, diffuse and circumscribed. Am J Med 1961; 30: 899-909
• 10 Klein NC, Hargrove RL, Sleisenger MH et al. Eosinophilic gastroenteritis. Medicine 1970; 49: 299-319
• 11 Talley NJ, Shorter RG, Phillips SF et al. Eosinophilic gastroenteritis: a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues. Gut 1990; 31: 54-58
• 12 Chen MJ, Chu CH, Lin SC et al. Eosinophilic gastroenteritis: Clinical experience with 15 patients. World J Gastroenterol 2003; 9: 2813-2816
• 13 Matsushita M, Hajiro K, Morita Y et al. Eosinophilic gastroenteritis involving the entire digestive tract. Am J Gastroenterol 1995; 90: 1868-1870
• 14 Liacouras CA, Markowitz JE. Eosinophilic esophagitis: A subset of eosinophilic gastroenteritis. Curr Gastroenterol Rep 1999; 1: 253-258
• 15 Zhou HB, Chen JM, Du Q. Eosinophilic gastroenteritis with ascites and hepatic dysfunction. World J Gastroenterol 2007; 13: 1303-1305
• 16 Liacouras CA. Eosinophilic esophagitis: treatment in 2005. Curr Opin Gastroenterol 2006; 22: 147-152
• 17 Straumann A, Simon HU. Eosinophilic esophagitis: escalating epidemiology?. J Allergy Clin Immunol 2005; 115: 418-419
• 18 Repiso Ortega A, Alcántara Torres M, González de Frutos C et al. Gastrointestinal anisakiasis. Study of a series of 25 patients. . Gastroenterol Hepatol 2003; 26: 341-346
• 19 Caldwell JH. Eosinophilic Gastroenteritis. Curr Treat Options Gastroenterol 2002; 5: 9-16
• 20 Siahanidou T, Mandyla H, Dimitriadis D et al. Eosinophilic gastroenteritis complicated with perforation and intussusception in a neonate. J Pediatr Gastroenterol Nutr 2001; 32: 335-337
• 21 Blackshaw AJ, Levison DA. Eosinophilic infiltrates of the gastrointestinal tract. J Clin Pathol 1986; 39: 1-7
• 22 Oh HE, Chetty R. Eosinophilic gastroenteritis: a review. J Gastroenterol 2008; 43: 741-750
• 23 Furuta GT, Forbes D, Boey C et al. Eosinophlic gastrointestinal disease (EGIDs). J Pediatr Gastroenterol Nutr 2008; 47: 234-238
• 24 Sheikh RA, Prindiville TP, Pecha RE et al. Unusual presentation of eosinophilic gastroenteritis: case series and review of literature. World J Gastroenterol 2009; 15: 2156-2161
• 25 Buljevac M, Urek MC, Stoos-Veić T. Sonography in diagnosis and follow-up of serosal eosinophilic gastroenteritis treated with corticosteroid. J Clin Ultrasound 2005; 33: 43-46
• 26 Seelen JL, You PH, de Vries AC et al. Eosinophilic enteritis presenting as acute abdomen: US features of two cases. Gastrointest Radiol 1992; 17: 19-20
• 27 Alnaser S, Aljebreen AM. Endoscopic ultrasound and hisopathologic correlates in eosinophilic gastroenteritis. Saudi J Gastroenterol 2007; 13: 91-94
• 28 Stevoff C, Rao S, Parsons W et al. EUS and histopathologic correlates in eosinophilic esophagitis. Gastrointest Endosc 2001; 54: 373-377
• 29 Fox VL, Nurko S, Teitelbaum JE et al. High-resolution EUS in children with eosinophilic “allergic” esophagitis. Gastrointest Endosc 2003; 57: 30-36
• 30 Andriulli A, Recchia S, Valente G et al. Endoscopic ultrasonography in eosinophilic infiltration of gastric wall. Ital J Gastroenterol 1990; 22: 129-132
• 31 Quack I, Sellin L, Buchner NJ et al. Eosinophilic gastroenteritis in a young girl – long term remission under Montelukast. BMC Gastroenterol 2005; 5: 24
• 32 Shiraishi E, Yasunaga Y, Nagai K et al. A case of eosinophilic gastroenteritis with ascites and protein-losing gastroenteropathy. Nippon Shokakibyo Gakkai Zasshi 2009; 106: 1625-1635
• 33 Goletti O, Cartei F, De Negri F et al. Eosinophilic gastroenteritis: possible role of sonography in diagnosis and follow-up. Hepatogastroenterology 1993; 40: 41-43
• 34 Khan S, Orenstein SR. Eosinophilic gastroenteritis: epidemiology, diagnosis and management. Paediatr Drugs 2002; 4: 563-570
• 35 Yun MY, Cho YU, Park IS et al. Eosinophilic gastroenteritis presenting as small bowel obstruction: a case report and review of the literature. World J Gastroentero 2007; 13: 1758-1760
• 36 Box JC, Tucker J, Watne AL et al. Eosinophilic colitis presenting as a left-sided colocolonic intussusception with secondary large bowel obstruction: an uncommon entity with a rare presentation. Am Surg 1997; 63: 741-743
• 37 Tran D, Salloum L, Tshibaka C et al. Eosinophilic gastroenteritis mimicking acute appendicitis. Am Surg 2000; 66: 990-992
• 38 Redondo Cerezo E, Moreno Platero JJ, García DomínguezE et al. Comments to a report: eosinophilic gastroenteritis presenting as an obstructing cecal mass: review literature and our own experience. Am J Gastroenterol 2000; 95: 3655-3657
• 39 Tsai MJ, Lai NS, Huang YF et al. Allergic eosinophilic gastroenteritis in a boy with congenital duodenal obstruction. J Microbiol Immunol Infect 2000; 33: 197-201
• 40 Markowitz JE, Russo P, Liacouras CA. Solitary duodenal ulcer: a new presentation of eosinophilic gastroenteritis. Gastrointest Endosc 2000; 52: 673-676
• 41 Kristopaitis T, Neghme C, Yong SL et al. Giant antral ulcer: a rare presentation of eosinophilic gastroenteritis – case report and review of the literature. Am J Gastroenterol 1997; 92: 1205-1208
• 42 Lyngbaek S, Adamsen S, Aru A et al. Recurrent acute pancreatitis due to eosinophilic gastroenteritis. Case report and literature review. JOP 2006; 7: 211-217
• 43 Shen HQ. Clinical analysis of eosinophilic gastroenteritis in six children. Zhonghua Er Ke Za Zhi 2010; 48: 614-616
• 44 Shi PP, Zhang JJ. Eosinophilic gastroenteritis in a boy. Zhongguo Dang Dai Er Ke Za Zhi 2010; 12: 676-677
• 45 Jeon EJ, Lee KM, Jung DY et al. Clinical characteristics of 17 cases of eosinophilic gastroenteritis. Korean J Gastroenterol 2010; 55: 361-367
• 46 Freeman HJ. Longstanding eosinophilic gastroenteritis of more than 20 years. Can J Gastroenterol 2009; 23: 632-634
• 47 Verheijden NA, Ennecker-Jans SA. A rare cause of abdominal pain: eosinophilic gastroenteritis. Neth J Med 2010; 68: 367-369
• 48 Chang F, Anderson S. Clinical and pathological features of eosinophilic oesophagitis: a review. Pathology 2008; 40: 3-8
• 49 Cherian S, Smith NM, Forbes DA. Rapidly increasing prevalence of eosinophilic oesophagitis in Western Australia. Arch Dis Child 2006; 91: 1000-1004
• 50 Tang KT, Lee MJ, Yang W. Pediatric eosinophilic gastroenteritis: report of one case. Acta Pediatr Taiwan 2000; 41: 273-275