1
|
Marasco G, Visaggi P, Vassallo M, Fiocca M, Cremon C, Barbaro MR, De Bortoli N, Bellini M, Stanghellini V, Savarino EV, Barbara G. Current and Novel Therapies for Eosinophilic Gastrointestinal Diseases. Int J Mol Sci 2023; 24:15165. [PMID: 37894846 PMCID: PMC10607071 DOI: 10.3390/ijms242015165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
Eosinophilic gastrointestinal diseases (EGIDs) are an emerging group of pathological entities characterized by an eosinophil-predominant infiltration of different tracts of the gut in the absence of secondary causes of eosinophilia. According to the specific tract of the gut involved, EGIDs can be classified into eosinophilic esophagitis (EoE), eosinophilic gastritis (EoG), eosinophilic enteritis (EoN), and eosinophilic colitis (EoC). The epidemiology of EGIDs is evolving rapidly. EoE, once considered a rare disease, now has an incidence and prevalence of 7.7 new cases per 100,000 inhabitants per years and 34.4 cases per 100,000 inhabitants per year, respectively. Fewer data are available regarding non-EoE EGIDs, whose prevalence are estimated to range between 2.1 and 17.6 in 100,000 individuals, depending on age, sex, and ethnicity. Diagnosis requires the presence of suggestive symptoms, endoscopic biopsies showing abnormal values of eosinophils infiltrating the gut, and exclusion of secondary causes of eosinophilia. EoE typically presents with dysphagia and episodes of food bolus impactions, while EoG, EoN, and EoC may all present with abdominal pain and diarrhea, with or without other non-specific symptoms. In addition, although different EGIDs are currently classified as different entities, there may be overlap between different diseases in the same patient. Despite EGIDs being relatively novel pathological entities, the research on possible treatments is rapidly growing. In this regard, several randomized controlled trials are currently ongoing to investigate novel molecules, including ad-hoc steroid formulations, immunosuppressants, and mostly monoclonal antibodies that target the specific molecular mediators of EGIDs. This narrative review provides an up-to-date overview of available and investigational drugs for different EGIDs.
Collapse
Affiliation(s)
- Giovanni Marasco
- IRCCS Azienda Ospedaliero, Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy; (G.M.); (M.V.); (M.F.); (C.C.); (M.R.B.); (V.S.)
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Pierfrancesco Visaggi
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, 56126 Pisa, Italy; (P.V.); (N.D.B.); (M.B.)
| | - Mariagiulia Vassallo
- IRCCS Azienda Ospedaliero, Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy; (G.M.); (M.V.); (M.F.); (C.C.); (M.R.B.); (V.S.)
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Miriam Fiocca
- IRCCS Azienda Ospedaliero, Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy; (G.M.); (M.V.); (M.F.); (C.C.); (M.R.B.); (V.S.)
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Cesare Cremon
- IRCCS Azienda Ospedaliero, Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy; (G.M.); (M.V.); (M.F.); (C.C.); (M.R.B.); (V.S.)
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Maria Raffaella Barbaro
- IRCCS Azienda Ospedaliero, Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy; (G.M.); (M.V.); (M.F.); (C.C.); (M.R.B.); (V.S.)
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Nicola De Bortoli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, 56126 Pisa, Italy; (P.V.); (N.D.B.); (M.B.)
| | - Massimo Bellini
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, 56126 Pisa, Italy; (P.V.); (N.D.B.); (M.B.)
| | - Vincenzo Stanghellini
- IRCCS Azienda Ospedaliero, Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy; (G.M.); (M.V.); (M.F.); (C.C.); (M.R.B.); (V.S.)
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Edoardo Vincenzo Savarino
- Gastroenterology Unit, Azienda Ospedale Università of Padua, Via Giustiniani 2, 35128 Padua, Italy;
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Giovanni Barbara
- IRCCS Azienda Ospedaliero, Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy; (G.M.); (M.V.); (M.F.); (C.C.); (M.R.B.); (V.S.)
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| |
Collapse
|
2
|
Gupta S, Allegretti JR. Mimics of Crohn's Disease. Gastroenterol Clin North Am 2022; 51:241-269. [PMID: 35595413 DOI: 10.1016/j.gtc.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Crohn's disease is a chronic inflammatory disease that can affect any portion of the gastrointestinal tract. Associated symptoms can vary based on the severity of disease, extent of involvement, presence of extraintestinal manifestations, and development of complications. Diagnosis is based on a constellation of findings. Many diseases can mimic Crohn's disease and lead to diagnostic conundrums. These include entities associated with the gastrointestinal luminal tract, vascular disease, autoimmune processes, various infections, malignancies and complications, drug- or treatment-induced conditions, and genetic diseases. Careful consideration of possible causes is necessary to establish the correct diagnosis.
Collapse
Affiliation(s)
- Sanchit Gupta
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, 850 Boyslton Street, Suite 201, Chestnut Hill, MA 02467, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Jessica R Allegretti
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, 850 Boyslton Street, Suite 201, Chestnut Hill, MA 02467, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| |
Collapse
|
3
|
A case of eosinophilic cholangiopathy mimicking cholangiocarcinoma. Clin J Gastroenterol 2020; 14:341-345. [PMID: 33191477 DOI: 10.1007/s12328-020-01282-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023]
Abstract
Eosinophilic cholangiopathy is an uncommon etiology of biliary stenosis, which is characterized by eosinophilic infiltration. Clinically, it is difficult to distinguish eosinophilic cholangiopathy from other causes of obstructive cholangiopathy before pathologic confirmation. We report a case of eosinophilic cholangiopathy. A 30-year-old male patient complained of right upper quadrant abdominal pain. Magnetic resonance cholangiopancreatography showed distended gallbladder and multifocal bile duct strictures with diffuse wall thickening. His bilirubin level increased continuously even after endoscopic retrograde cholangiopancreatography. He underwent laparoscopic cholecystectomy for cholecystitis and pathology of resected gallbladder revealed marked eosinophilic infiltration with no malignant component. His pain improved after cholecystectomy and multifocal bile duct strictures with wall thickening were rapidly improved after steroid therapy.
Collapse
|
4
|
Impellizzeri G, Marasco G, Eusebi LH, Salfi N, Bazzoli F, Zagari RM. Eosinophilic colitis: A clinical review. Dig Liver Dis 2019; 51:769-773. [PMID: 31122823 DOI: 10.1016/j.dld.2019.04.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 12/11/2022]
Abstract
Eosinophilic colitis is a rare entity characterized by the presence of a high eosinophilic infiltrate into the colonic wall in symptomatic patients, more often presenting with abdominal pain or diarrhea. These characteristics distinguish eosinophilic colitis from primary colonic eosinophilia, in which patients are asymptomatic. Primary colonic eosinophilia does not need any therapy, while eosinophilic colitis requires a strict treatment, similar to that of the more codified chronic intestinal inflammatory diseases. To date the lack of codified guidelines regarding the diagnostic criteria and the eosinophil threshold values for each colonic segment are the main diagnostic challenge for eosinophilic colitis. In addition, eosinophilic colitis is a diagnosis of exclusion, once all other causes of colonic eosinophilia (food allergens, infections, drugs, etc.) have been excluded. Several treatment options are available for eosinophilic colitis, although the evidence for most of them is limited to case reports and small case series. We examine the epidemiology, etiology, pathophysiology, diagnostic criteria and therapeutic options of eosinophilic colitis reporting recent evidence from the current literature.
Collapse
Affiliation(s)
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | | | - Nunzio Salfi
- Histopathology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Franco Bazzoli
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | | |
Collapse
|
5
|
Hamamoto H, Hashimoto S, Taguchi H, Kojima I, Kasai A, Tsuneyoshi K, Kuwazuru K, Arima S, Kanmura S, Ido A. Eosinophilic Gastroenteritis in Which Obstructive Jaundice Developed due to Invagination of the Duodenal Wall. Intern Med 2018; 57:1841-1847. [PMID: 29434146 PMCID: PMC6064693 DOI: 10.2169/internalmedicine.9312-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A 63-year-old woman was admitted with epigastric pain, eosinophilia, and elevated hepatobiliary enzyme levels. An upper gastrointestinal endoscopic examination showed that the mucosa of the gastroduodenal wall was edematous. Eosinophilic gastroenteritis (EGE) was diagnosed based on eosinophilic infiltration of the gastroduodenal mucosa. Computed tomography showed invagination of the duodenal wall into the common bile duct. The invagination of the duodenal wall improved after conservative therapy, while bile duct drainage was impossible due to the narrowing of the duodenal lumen. EGE was successfully treated without recurrence with steroids and antiallergic therapy. We herein report a rare case of EGE with obstructive jaundice.
Collapse
Affiliation(s)
- Hitomi Hamamoto
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Shinichi Hashimoto
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Hiroki Taguchi
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Issei Kojima
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Ai Kasai
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Kengo Tsuneyoshi
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Kosuke Kuwazuru
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Shiho Arima
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Shuji Kanmura
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Akio Ido
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| |
Collapse
|
6
|
Walter D, Hartmann S, Herrmann E, Peveling-Oberhag J, Bechstein WO, Zeuzem S, Hansmann ML, Friedrich-Rust M, Albert JG. Eosinophilic cholangitis is a potentially underdiagnosed etiology in indeterminate biliary stricture. World J Gastroenterol 2017; 23:1044-1050. [PMID: 28246478 PMCID: PMC5311093 DOI: 10.3748/wjg.v23.i6.1044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/17/2016] [Accepted: 01/11/2017] [Indexed: 02/06/2023] Open
Abstract
AIM
To investigate presence and extent of eosinophilic cholangitis (EC) as well as IgG4-related disease in patients with indeterminate biliary stricture (IBS).
METHODS
All patients with diagnosis of sclerosing cholangitis (SC) and histopathological samples such as biopsies or surgical specimens at University Hospital Frankfurt from 2005-2015 were included. Histopathological diagnoses as well as further clinical course were reviewed. Tissue samples of patients without definite diagnosis after complete diagnostic work-up were reviewed regarding presence of eosinophilic infiltration and IgG4 positive plasma cells. Eosinophilic infiltration was as well assessed in a control group of liver transplant donors and patients with primary sclerosing cholangitis.
RESULTS
one hundred and thirty-five patients with SC were included. In 10/135 (13.5%) patients, no potential cause of IBS could be identified after complete diagnostic work-up and further clinical course. After histopathological review, a post-hoc diagnosis of EC was established in three patients resulting in a prevalence of 2.2% (3/135) of all patients with SC as well as 30% (3/10) of patients, where no cause of IBS was identified. 2/3 patients with post-hoc diagnosis of EC underwent surgical resection with suspicion for malignancy. Diagnosis of IgG4-related cholangitis was observed in 7/135 patients (5.1%), whereas 3 cases were discovered in post-hoc analysis. 6/7 cases with IgG4-related cholangitis (85.7%) presented with eosinophilic infiltration in addition to IgG4 positive plasma cells. There was no patient with eosinophilic infiltration in the control group of liver transplant donors (n = 27) and patients with primary sclerosing cholangitis (n = 14).
CONCLUSION
EC is an underdiagnosed benign etiology of SC and IBS, which has to be considered in differential diagnosis of IBS.
Collapse
|
7
|
Abstract
Eosinophilic ascites is a rare feature of eosinophilic gastroenteritis. We would like to highlight this increasingly recognised diagnosis in a case of unexplained ascites. We present a challenging case of a woman aged 25 years who presented with nausea, vomiting, diarrhoea, generalised abdominal pain and swelling 8-week following delivery of her first baby. Her symptoms were primarily aggravated by eating, and she had also noticed postprandial itching and self-limiting generalised rash. She had a strong history of atopy. Physical examination revealed abdominal tenderness and distension with shifting dullness. Urticarial skin rash was noted on the face, neck, chest and abdomen. Routine biochemistry was normal apart from peripheral eosinophilia. Imaging confirmed moderate ascites. Diagnostic paracentesis showed exudative ascites with numerous eosinophils. Histology of the upper and lower gastrointestinal tract showed infiltration of the oesophageogastroduodenal and rectosigmoid mucosa with eosinophils. The patient significantly improved following a course of steroids and six-food elimination diet.
Collapse
Affiliation(s)
- Hesham Khalil
- Department of Gastroenterology, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Moby Joseph
- Department of Gastroenterology, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| |
Collapse
|
8
|
Ishihara S, Kinoshita Y, Schoepfer A. Eosinophilic Esophagitis, Eosinophilic Gastroenteritis, and Eosinophilic Colitis: Common Mechanisms and Differences between East and West. Inflamm Intest Dis 2016; 1:63-69. [PMID: 29922659 DOI: 10.1159/000445131] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 03/02/2016] [Indexed: 12/20/2022] Open
Abstract
Background Eosinophilic esophagitis (EoE), eosinophilic gastroenteritis (EGE), and eosinophilic colitis (EoC) have been diagnosed with an increasing frequency over the last decades. All these diseases share pathogenic similarities with respect to triggering by food antigens in the majority of patients once secondary causes of tissue eosinophilia have been excluded. While diagnostic criteria for EoE have been published, the exact criteria for EGE and EoC still need to be defined. This review highlights similarities and differences between affected patients when comparing the Western with the Eastern world. Summary The incidence and prevalence of EoE are on the rise in countries from the Western and Eastern world. Very limited epidemiologic data exist regarding EGE and EoC. Characteristics of patients with eosinophilic gastrointestinal disorders regarding gender distribution, age at diagnosis, and associated comorbidities are similar when comparing Eastern with Western countries. Similar modalities are applied to diagnose EoE, EGE, and EoC when comparing Eastern with Western countries. Additionally, comparable therapeutic measures are applied to treat eosinophilic gastrointestinal diseases in Eastern and Western countries. While EoE treatment recommendations are based on increasingly solid evidence, recommendations for the treatment of EGE and EoC are based on low evidence. Key Messages Eosinophilic gastrointestinal diseases are diagnosed and treated using similar approaches in Eastern and Western countries. Further efforts should be undertaken to help clarify the underlying pathogenic mechanisms and to establish evidence-based diagnostic and therapeutic protocols.
Collapse
Affiliation(s)
- Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Yoshikazu Kinoshita
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Alain Schoepfer
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois/CHUV, Lausanne, Switzerland
| |
Collapse
|
9
|
Katsinelos P, Lazaraki G, Kountouras J. Eosinophilic Enteritis Initially Presenting as Ampullary Stenosis. Clin Gastroenterol Hepatol 2016; 14:A19-20. [PMID: 26707684 DOI: 10.1016/j.cgh.2015.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/10/2015] [Accepted: 12/11/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Panagiotis Katsinelos
- Gastroenterology Division, Second Department of Internal Medicine, Ippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Lazaraki
- Gastroenterology Division, Second Department of Internal Medicine, Ippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jannis Kountouras
- Gastroenterology Division, Second Department of Internal Medicine, Ippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
10
|
Abstract
Eosinophilic gastrointestinal disease (EGID) can be classified as eosinophilic esophagitis (EoE) when the eosinophilia is limited to the esophagus or as eosinophilic gastritis (EG) if it is limited to the gastric tract, eosinophilic colitis (EC) if it is limited to the colon, and eosinophilic gastroenteritis (EGE) if the eosinophilia involves one or more parts of the gastrointestinal tract. EoE is by far the most common EGID. It is a well-defined chronic atopic disease due to a T helper type 2 (Th2) inflammation triggered often by food allergens. EoE diagnosis is done if an esophageal biopsy shows at least 15 eosinophils per high power field (eos/hpf). Globally accepted long-term therapies for EoE are the use of swallowed inhaled steroids or food antigen avoidance. The treatment of EoE is done not only to control symptoms but also to prevent complications such as esophageal stricture and food impaction. EGE cause non-specific gastrointestinal (GI) symptoms and are diagnosed if esophagogastroduodenoscopy (EGD)/colonoscopy show eosinophilia in one or more parts of the GI tract. They are rare diseases with an unclear pathogenesis, and they are poorly defined in terms of diagnostic criteria and treatment. Before initiating treatment of any EGE, it is imperative to conduct a differential diagnosis to exclude other causes of hypereosinophilia with GI localization. EGE are often poorly responsive to therapy and there is no commonly accepted long-term treatment. EG has many characteristics similar to EoE, including the fact that it is often due to a food allergen-driven Th2 inflammation; transcriptome analysis however shows that it is more a systemic disease and has a different gene signature than EoE. EC is a benign form of delayed food allergy in infant and is instead a difficult-to-treat severe inflammatory condition in older children and adults. EC in the latter groups can be a manifestation of drug allergy or autoimmune disease. Overall EGE, EC, and EG are rare and are a diagnosis of exclusion until more common causes of eosinophilia have been excluded.
Collapse
Affiliation(s)
- Antonella Cianferoni
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, 3615 Civic Center Boulevard, Philadelphia, PA, 19104-4399, USA,
| | | |
Collapse
|
11
|
Abstract
CONTEXT Many diseases that cause granulomas or granulomatous inflammation involve the liver. Some of these disease processes are intrinsic hepatic diseases, whereas others are disseminated systemic diseases that involve the liver as well as other organs. OBJECTIVE To review the evaluation of granulomas in the liver with an emphasis on infectious causes, as well as the use of special stains, serologic studies, and molecular diagnostic techniques. Pertinent noninfectious causes of hepatic granulomas that are in the differential diagnosis are also discussed. DATA SOURCES Literature review and cases acquired during years of practice. CONCLUSIONS A wide variety of infectious and noninfectious entities cause hepatic granulomas.
Collapse
Affiliation(s)
- Laura W Lamps
- From the Department of Pathology, University of Arkansas for Medical Sciences, Little Rock
| |
Collapse
|
12
|
Hokuto D, Yamato I, Nomi T, Yasuda S, Obara S, Yamada T, Chihiro K, Nakajima Y. Eosinophilic cholangitis coexisted with idiopathic thrombocytopenic purpura: Report of a case. Hepatol Res 2015; 45:595-600. [PMID: 24976135 DOI: 10.1111/hepr.12380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 06/19/2014] [Accepted: 06/23/2014] [Indexed: 12/26/2022]
Abstract
Eosinophilic cholangitis is a rare disease of which only 31 cases have been reported. Eosinophilic infiltration causes stricture of the bile duct diffusely or locally, and the imaging of eosinophilic cholangitis resembles primary sclerosing cholangitis or cancer of the bile tract. For eosinophilic cholangitis, treatment with steroid is effective and the prognosis is good. Therefore, its accurate diagnosis is very important. Here, we describe a patient with eosinophilic cholangitis who was also diagnosed with idiopathic thrombocytopenic purpura (ITP). He was treated for ITP using prednisolone, the unexpected sudden interruption of which caused severe deterioration of eosinophilic cholangitis and acute cholecystitis. Cholecystectomy and choledochojejunostomy were performed, and the addition of treatment by prednisolone resulted in a good clinical course. This is the first report on eosinophilic cholangitis coexisting with ITP.
Collapse
Affiliation(s)
- Daisuke Hokuto
- Department of Surgery, Nara Medical University, Nara, Japan
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Wang XY, Dai YH, Yang YM. Unusual cause of a giant antral ulcer. Gut 2015; 64:730, 856. [PMID: 25480309 DOI: 10.1136/gutjnl-2014-308699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 11/18/2014] [Indexed: 12/08/2022]
Affiliation(s)
- Xiang-Yang Wang
- Department of Gastroenterology, Hunan Provincial People's Hospital, Hunan Normal University, Changsha, Hunan, China
| | - Ying-Huan Dai
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yu-Ming Yang
- Department of Gastroenterology, Hunan Provincial People's Hospital, Hunan Normal University, Changsha, Hunan, China
| |
Collapse
|
14
|
Abstract
Eosinophilic gastroenteritis (EGE) represents one member within the spectrum of diseases collectively referred to as eosinophilic gastrointestinal disorders, which includes eosinophilic esophagitis (EoE), gastritis, enteritis, and colitis. EGE is less common than EoE and involves a different site of disease but otherwise shares many common features with EoE. The clinical manifestations of EGE are protean and can vary from nausea and vomiting to protein-losing enteropathy or even bowel obstruction requiring surgery. Although systemic corticosteroids are an effective treatment for EGE, their use results in substantial corticosteroid toxicity. Accordingly, there is a great need for improved therapies for these patients.
Collapse
Affiliation(s)
- Calman Prussin
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 10 Center Drive, MSC-1881, Bethesda, MD 20892-1881, USA.
| |
Collapse
|
15
|
Elliott JA, McCormack O, Tchrakian N, Conlon N, Ryan CE, Lim KT, Ullah N, Mahmud N, Ravi N, McKiernan S, Feighery C, Reynolds JV. Eosinophilic ascites with marked peripheral eosinophilia: a diagnostic challenge. Eur J Gastroenterol Hepatol 2014; 26:478-84. [PMID: 24535594 DOI: 10.1097/meg.0000000000000037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Eosinophilic disease of the gastrointestinal tract is rare and is characterized by the presence of gastrointestinal symptoms in association with eosinophilic infiltration of any part of the gastrointestinal tract. Clinical presentation of eosinophilic gastroenteritis (EGE) varies not only by the part of the gastrointestinal tract involved but also with the depth of eosinophilic infiltration of the gut wall. We describe the case of a 41-year-old woman with a history of atopy who presented with severe abdominal pain and diarrhoea. Investigations showed large-volume eosinophil-rich ascites and a markedly elevated peripheral blood eosinophil count and immunoglobulin E level. Bone marrow aspirate, trephine biopsy and T-cell studies showed no evidence of underlying haematological malignancy. Vasculitic disease and parasitic infection were systematically excluded. Colonic and upper gastrointestinal biopsies confirmed a diagnosis of EGE with eosinophilic ascites. The patient was treated with systemic corticosteroids and dietary allergen elimination with dramatic therapeutic response. The diagnostic and therapeutic challenges associated with EGE in its various forms are discussed.
Collapse
Affiliation(s)
- Jessie A Elliott
- aDepartment of Surgery, Trinity Centre, St James's Hospital and Trinity College bDepartment of Pathology cDepartment of Immunology dDepartment of Gastroenterology, St James's Hospital, Dublin, Ireland
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Eosinophilic ascites and duodenal obstruction in a patient with liver cirrhosis. Case Rep Gastrointest Med 2014; 2014:928496. [PMID: 24772356 PMCID: PMC3977568 DOI: 10.1155/2014/928496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/01/2014] [Indexed: 12/23/2022] Open
Abstract
Eosinophilic gastroenteritis (EG) is a rare disease characterized by eosinophilic infiltration of portions of the gastrointestinal tract. Eosinophilic ascites is probably the most unusual and rare presentation of EG and is generally associated with the serosal form of EG. Hereby, we report a case of eosinophilic ascites with duodenal obstruction in a patient with liver cirrhosis. A 50-year-old woman was admitted to our hospital because of abdominal pain, nausea, bloating, and constipation. She had a history of laparotomy because of duodenal obstruction 2 years ago. Based on clinical, radiological, endoscopic, and pathological findings, and given the excluding the other causes of peripheral eosinophilia, the diagnosis of eosinophilic gastroenteritis along with liver cirrhosis and spontaneous bacterial peritonitis was established. Based on the findings of the present case, it is highly recommended that, in the patients presented with liver cirrhosis associated with peripheral blood or ascitic fluid eosinophilia, performing gastrointestinal endoscopy and biopsy can probably reveal this rare disorder of EG.
Collapse
|
17
|
Alfadda AA, Shaffer EA, Urbanski SJ, Storr MA. Eosinophilic colitis is a sporadic self-limited disease of middle-aged people: a population-based study. Colorectal Dis 2014; 16:123-9. [PMID: 24138295 DOI: 10.1111/codi.12464] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 08/03/2013] [Indexed: 02/08/2023]
Abstract
AIM Eosinophilic colitis (EC) is a rare manifestation of eosinophilic gastrointestinal disorders. Due to its rarity, little information is available on its natural history. METHOD From the single population-based pathology database of the Calgary Health Region (comprising a population of 1.28 million in 2008), cases of EC during the period 1996-2008 were identified. Medical records of all adults diagnosed with EC were identified and the pathology reviewed. The patients were then contacted for follow-up using a standardized questionnaire. RESULTS Seven cases of EC (four in women) were identified, with a median follow-up of 45 (23-79) months. The median age at diagnosis was 42 (22-70) years. Symptoms at diagnosis were abdominal pain (86%), nonbloody diarrhoea (57%), bloody diarrhoea (29%) and significant (>10%) weight loss (29%). Three patients gave a history of allergic reactions to drugs and four reported allergy to cows' milk. Endoscopic findings were nonspecific, ranging from oedema to small aphthous ulceration. An eosinophilic infiltrate was identified in the lamina propria in the initial colonic biopsy in all patients. Over the longer term, three patients experienced spontaneous resolution without treatment. Two continued to have mild diarrhoea and abdominal cramps but did not require medical therapy. Two patients required medical treatment by 5-aminosalicylic acid, with one requiring prednisone and azathioprine maintenance therapy. CONCLUSION Eosinophilic colitis is a rare mostly self-limiting disease affecting middle-aged adults. It usually has a mild clinical course and drug treatment is not usually necessary. When required, drug treatment follows the standard medication for other inflammatory bowel disease.
Collapse
Affiliation(s)
- A A Alfadda
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Calgary, Alberta, Canada
| | | | | | | |
Collapse
|
18
|
Gunji N, Katakura K, Takahashi A, Fujiwara T, Suzuki R, Watanabe H, Ohira H. Concurrent primary sclerosing cholangitis and eosinophilic colitis. Intern Med 2014; 53:2319-24. [PMID: 25318795 DOI: 10.2169/internalmedicine.53.2765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 39-year-old man presented with diarrhea and abdominal pain. At 26 years of age, he was found to have eosinophilia and abnormal liver function parameters, for which prednisolone therapy was started. He subsequently underwent a liver biopsy and endoscopic retrograde cholangiopancreatography, and received a diagnosis of primary sclerosing cholangitis (PSC). On presentation to our hospital, he was further diagnosed with eosinophilic colitis based on aggravation of diarrhea and severe eosinophilic infiltration in the colonic mucosa. We herein report a rare case of concurrent PSC and eosinophilic colitis.
Collapse
Affiliation(s)
- Naohiko Gunji
- Department of Gastroenterology and Rheumatology, Fukushima Medical University, Japan
| | | | | | | | | | | | | |
Collapse
|
19
|
Aihara Y, Yoshiji H, Yamazaki M, Ikenaka Y, Noguchi R, Morioka C, Kaji K, Tastumi H, Nakanishi K, Nakamura M, Yamao J, Toyohara M, Mitoro A, Sawai M, Yoshida M, Fujimoto M, Uemura M, Fukui H. A case of severe acalculous cholecystitis associated with sorafenib treatment for advanced hepatocellular carcinoma. World J Gastrointest Oncol 2012; 4:115-8. [PMID: 22645635 PMCID: PMC3360105 DOI: 10.4251/wjgo.v4.i5.115] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 02/14/2012] [Accepted: 02/20/2012] [Indexed: 02/05/2023] Open
Abstract
Sorafenib, a multikinase inhibitor, is the first and only drug, which improves significantly the overall survival in patients with advanced hepatocellular carcinoma (HCC). However, many patients experience diverse side effects, some of them severe and unexpected. To date, acute acalculous cholecystitis has not been documented in association with a HCC patient treated with sorafenib. Here, we report the case of a 43-year-old woman with hepatitis C virus-related advanced HCC. She received sorafenib, and later complained of a sudden onset of severe right hypocondrial pain with rebound tenderness and muscle defense. Laboratory examination showed mild elevation of transaminases, biliary enzymes, bilirubin, inflammation markers, and a marked peripheral eosinophilia. Abdominal computed tomography (CT) revealed a swollen gallbladder with exudate associated with severe inflammation without stones or debris. Consequently, sorafenib treatment was stopped immediately, and steroid-pulse therapy was performed. Steroid therapy drastically improved all clinical manifestations along with normalization of CT findings, eosinophilia, and liver functions. In summary, we herein report a rare case of acute severe acalculous cholecystitis associated with sorafenib in the patient with advanced HCC.
Collapse
Affiliation(s)
- Yosuke Aihara
- Yosuke Aihara, Hitoshi Yoshiji, Masaharu Yamazaki, Yasuhide Ikenaka, Ryuichi Noguchi, Chie Morioka, Kosuke Kaji, Haruki Tastumi, Keisuke Nakanishi, Maiko Nakamura, Junichi Yamao, Masahisa Toyohara, Akira Mitoro, Masayoshi Sawai, Motoyuki Yoshida, Masao Fujimoto, Masahito Uemura, Hiroshi Fukui, Third Department of Internal Medicine, Nara Medical University, Nara 634-8522, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Hepatobiliary disease associated with hypereosinophilia: a report of two patients and a review of the literature. Dig Dis Sci 2011; 56:3689-94. [PMID: 21647653 DOI: 10.1007/s10620-011-1764-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 05/18/2011] [Indexed: 12/09/2022]
|
21
|
Alfadda AA, Storr MA, Shaffer EA. Eosinophilic colitis: epidemiology, clinical features, and current management. Therap Adv Gastroenterol 2011; 4:301-9. [PMID: 21922029 PMCID: PMC3165205 DOI: 10.1177/1756283x10392443] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Primary eosinophilic gastrointestinal disorders (EGIDs) represent a spectrum of inflammatory gastrointestinal disorders in which eosinophils infiltrate the gut in the absence of known causes for such tissue eosinophilia. EGIDs can be subgrouped as eosinophilic esophagitis (EE), eosinophilic gastroenteritis (EG), and eosinophilic colitis (EC). The least frequent manifestation of EGIDs is EC. EC is a heterogeneous entity with a bimodal age distribution, presenting with either an acute self-limited bloody diarrhea in otherwise healthy infants or as a more chronic relapsing colitis in young adults. The pathophysiology of primary EC appears related to altered hypersensitivity, principally as a food allergy in infants and T lymphocyte-mediated (i.e. non-IgE associated) in young adults. In adults, symptoms include diarrhea, abdominal pain, and weight loss. Endoscopic changes are generally modest, featuring edema and patchy granularity. Although standardized criteria are not yet established, the diagnosis of EC depends on histopathology that identifies an excess of eosinophils. Therapeutic approaches are based on case reports and small case series, as prospective randomized controlled trials are lacking. Eosinophilic colitis in infants is a rather benign, frequently food-related entity and dietary elimination of the aggressor often resolves the disorder within days. Adolescent or older patients require more aggressive medical management including: glucocorticoids, anti-histamines, leukotriene receptors antagonists as well as novel approaches employing biologics that target interleukin-5 (IL-5) and IgE. This review article summarizes the current knowledge of EC, its epidemiology, clinical manifestations, diagnosis, and treatment.
Collapse
Affiliation(s)
- Abdulrahman A. Alfadda
- Division of Gastroenterology, Faculty of Medicine, University of Calgary, Alberta, Canada
| | - Martin A. Storr
- Division of Gastroenterology, Faculty of Medicine, University of Calgary, Alberta, Canada
| | - Eldon A. Shaffer
- Professor of Medicine, Division of Gastroenterology, Faculty of Medicine, University of Calgary, Teaching Research and Wellness Building, Room 6D48, 3280 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1
| |
Collapse
|
22
|
Ikeda H, Katayanagi K, Kurumaya H, Harada K, Sato Y, Sasaki M, Nakanuma Y. A Case of Hypereosinophilia-Associated Multiple Mass Lesions of Liver Showing Non-Granulomatous Eosinophilic Hepatic Necrosis. Gastroenterology Res 2011; 4:168-173. [PMID: 27942335 PMCID: PMC5139729 DOI: 10.4021/gr336e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2011] [Indexed: 11/03/2022] Open
Abstract
Hypereosinophilic syndrome (HES) is defined by elevation more than 1.5×109/L of presence of a peripheral blood count, evidence of organ involvement, and exclusion of secondary eosinophilia such as allergic, vasculitis, drugs, or parasite infection and also clonal eosinophilia. We present the HES case with hepatic involvement. The patient is 70-year-old male. He complained fever and back pain. Blood examination showed marked peripheral eosinophilia, elevation of transaminase and biliary enzymes. Multiple irregular mass lesions of the liver were pointed out by CT and MRI. The liver biopsy was done for differentiation from malignancy. In parenchyma, hepatic necrotic lesion was observed accompanying severe eosinophilic infiltration with Charcot-Leyden's crystals. There was granulomatous reaction. He was diagnosed as HES and got recovery due to steroid therapy. From the review of HES article, the hepatic histology is categorized into four types as below: 1) cholangitis type; 2) chronic active hepatitis type; 3) vasculopathic type, 4) hepatic necrosis type. Our case is classified in hepatic necrosis type. This type seems to be important to distinguish malignant tumor and also visceral larva migrans by liver biopsy.
Collapse
Affiliation(s)
- Hiroko Ikeda
- Section of Diagnostic Pathology, Kanazawa University Hospital, Japan
| | | | - Hiroshi Kurumaya
- Department of Pathology, Ishikawa Prefectural Central Hospital, Japan
| | - Kenichi Harada
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Yasunori Sato
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Motoko Sasaki
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Yasuni Nakanuma
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| |
Collapse
|
23
|
Alfadda AA, Storr MA, Shaffer EA. Eosinophilic colitis: an update on pathophysiology and treatment. Br Med Bull 2011; 100:59-72. [PMID: 22012125 DOI: 10.1093/bmb/ldr045] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Primary eosinophilic gastrointestinal disorders, a spectrum of inflammatory conditions, occurs when eosinophils selectively infiltrate the gut in the absence of known causes for such tissue eosinophilia. These may be classified into eosinophilic esophagitis, eosinophilic gastroenteritis and eosinophilic colitis (EC). This review focuses on EC: its pathogenesis, epidemiology, clinical presentation, diagnosis and current approach to treatment. SOURCES OF DATA A literature review published in English was performed using Pubmed, Ovid, Google scholar search engines with the following keywords: eosinophilic gastrointestinal disorder, EC, eosinophils, colitis and gastrointestinal. AREAS OF AGREEMENT The basis for primary EC appears related to increased sensitivity to allergens, principally as a food allergy in infants and a T lymphocyte-mediated event in adults. Endoscopic changes are generally modest, featuring edema and patchy granularity. AREAS OF CONTROVERSY Clear clinical and pathological diagnostic criteria of EC and its management strategy. GROWING POINTS Intestinal involvement of EC is primarily mucosal, presenting as a mild self-limited proctitis in infants and self-limited colitis in young adults. Therapeutic approaches based on case reports tend to use either elimination diets to avoid a presumed allergen; agents traditionally used in inflammatory disease or targeted drugs like anti-histamines or leukotriene receptor antagonists. AREAS TIMELY FOR DEVELOPING RESEARCH Prospective randomized controlled trials addressing the disease natural history, possible preventive methods and effective medical approach and long-term prognosis are required.
Collapse
Affiliation(s)
- Abdulrahman A Alfadda
- Division of Gastroenterology, Faculty of Medicine, University of Calgary, Teaching Research & Wellness Building, Room 6D48, 3280 Hospital Dr NW, Calgary, AB, Canada T2N4N1
| | | | | |
Collapse
|
24
|
Hepburn IS, Sridhar S, Schade RR. Eosinophilic ascites, an unusual presentation of eosinophilic gastroenteritis: A case report and review. World J Gastrointest Pathophysiol 2010; 1:166-70. [PMID: 21607158 PMCID: PMC3097962 DOI: 10.4291/wjgp.v1.i5.166] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 09/28/2010] [Accepted: 10/05/2010] [Indexed: 02/06/2023] Open
Abstract
Eosinophilic ascites (EA) is a rare disorder of unknown etiology that has been reported in both adult and pediatric patients. It is a part of the syndrome of eosinophilic gastroenteritis, which is characterized by eosinophilic infiltration of any or all layers of the gut wall and may involve any segment of the gastrointestinal tract. Peripheral eosinophilia may or may not be present. We report a case of EA that developed post partum.
Collapse
|
25
|
Eosinophilic cholangitis and cholangiopathy: a sheep in wolves clothing. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2010; 2010:906496. [PMID: 21076681 PMCID: PMC2976516 DOI: 10.1155/2010/906496] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 10/07/2010] [Indexed: 12/13/2022]
Abstract
Background. Eosinophilic cholangitis (EC) is a rare benign disorder of the biliary tract which can cause biliary obstruction. Similar to other disease processes involving the bile ducts, this disorder can pose a difficult diagnostic challenge as it can mimic cholangiocarcinoma.
Methods. A systematic search of the scientific literature was carried out using PubMed to access all publications related to EC. Search keywords that were utilized included “eosinophilic cholangitis,” “etiology,” “treatment,” and “obstructive jaundice.” Results. Twenty-three cases of EC have been reported. Nineteen patients (82.6%) who presented with EC remain disease-free; 15 of these 19 patients (78.9%) with followup time remain disease-free at a mean of 9.7 months (range, 2–24 months).
Conclusion. EC is a rare form of biliary obstruction which can masquerade as a malignancy. Unlike cholangiocarcinoma, EC occurs more commonly in younger patients and in men. Most patients will require surgical treatment.
Collapse
|
26
|
Raptou G, Pliakos I, Hytiroglou P, Papavramidis S, Karkavelas G. Severe eosinophilic cholangitis with parenchymal destruction of the left hepatic lobe due to hydatid disease. Pathol Int 2009; 59:395-8. [PMID: 19490470 DOI: 10.1111/j.1440-1827.2009.02383.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hydatid cysts of the liver are known to occasionally rupture into the bile ducts and cause cholangitis. The histological features of this complication have not been adequately described in the literature. Herein is reported a case of severe eosinophilic cholangitis of the left hepatic lobe, occurring in a 24-year-old man with a large (16 cm) hydatid cyst, which obstructed and eroded the left hepatic duct. The patient presented with upper abdominal discomfort and low-grade fever of 3 weeks' duration. Sections of the left lobectomy specimen showed marked inflammatory infiltrates in the portal tracts, predominantly composed of eosinophils, extensively involving bile ducts of all sizes. Occasional small bile ducts were replaced by epithelioid cell granulomas surrounding eosinophilic microabscesses. The inflammatory infiltrates extended into the lobules, resulting in marked hepatocyte loss. This case demonstrates that echinococcosis may cause severe eosinophilic cholangitis with extensive parenchymal destruction, apparently resulting from a hypersensitivity reaction to parasitic antigens.
Collapse
Affiliation(s)
- Georgia Raptou
- Department of Pathology, Aristotle University Medical School, Thessaloniki, Greece
| | | | | | | | | |
Collapse
|
27
|
Abstract
Much is known about the eosinophilic processes associated with antigens, tumors, and infection, yet data on other causes of eosinophilic inflammation are scarce. This paper investigates the locations and causes of other nonrespiratory eosinophilic inflammation. Although eosinophilic inflammation can involve locomotor, urinary, cardiovascular, nervous, gastrointestinal, and other mucosal surfaces, such inflammation also can accompany tissue trauma, foreign-body reactions, and necrotic or granulomatous processes. Despite their cytolytic/histolytic effects, eosinophil leukocytes are a component of tissue remodeling, can be antigen-presenting cells, and have a role in the reproductive system and in blood coagulation. The study of various types of eosinophilic inflammation may increase our understanding of the biological responses of eosinophil leukocytes to different inflammatory stimuli.
Collapse
Affiliation(s)
- Ugur Gonlugur
- Cumhuriyet University Medical School, Department of Chest Diseases, Sivas, Turkey.
| | | |
Collapse
|
28
|
Sheikh RA, Prindiville TP, Pecha RE, Ruebner BH. Unusual presentations of eosinophilic gastroenteritis: Case series and review of literature. World J Gastroenterol 2009; 15:2156-61. [PMID: 19418590 PMCID: PMC2678588 DOI: 10.3748/wjg.15.2156] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Eosinophilic gastroenteritis (EG) is an uncommon disease characterized by focal or diffuse eosinophilic infiltration of the gastrointestinal tract, and is usually associated with dyspepsia, diarrhea and peripheral eosinophilia. Diffuse gastrointestinal tract and colonic involvement are uncommon. The endoscopic appearance may vary from normal to mucosal nodularity and ulceration. Gastrointestinal obstruction is unusual and is associated with predominantly muscular disease. We present five unusual cases of EG associated with gastric outlet and duodenal obstruction. Two cases presented with acute pancreatitis and one had a history of pancreatitis. Four cases responded well to medical therapy and one had recurrent gastric outlet obstruction that required surgery. Four out of the five cases had endoscopic and histological evidence of esophagitis and two had colitis. Two patients had ascites. These cases reaffirm that EG is a disorder with protean manifestations and may involve the entire gastrointestinal tract. Gastric outlet and/or small bowel obstruction is an important though uncommon presentation of EG. It may also present as esophagitis, gastritis with polypoid lesions, ulcers or erosions, colitis and pancreatitis and may mimic malignancy.
Collapse
|
29
|
Eosinophilic cholangitis with obstructive jaundice mimicking bile duct carcinoma. ACTA ACUST UNITED AC 2009; 16:242-5. [PMID: 19194647 DOI: 10.1007/s00534-008-0041-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Accepted: 01/15/2008] [Indexed: 10/21/2022]
Abstract
A 55-year-old male who presented with obstructive jaundice and radiographically documented extrahepatic biliary tract obstruction is reported. Eosinophilic infiltration of the gallbladder, common bile duct, intrahepatic bile ducts, and bone marrow was observed. Eosinophilic cholangitis, a rare inflammatory condition that clinically resembles a biliary malignancy, should be taken into consideration in the differential diagnosis in the evaluation of presumed neoplasm of the bile ducts.
Collapse
|
30
|
Abstract
Granulomas are aggregates of macrophages, often admixed with other inflammatory cells, which usually result from chronic antigen presentation. Many diseases that produce granulomas involve the liver. Some are intrinsic hepatic diseases, whereas others are disseminated systemic diseases that involve the liver and other organs. Hepatic granulomas are reportedly present in 2% to 10% of all liver biopsy specimens examined in general practice, and of those supposedly as many as 36% have no discoverable etiology even after extensive evaluation of the specimen. This review focuses on the diagnosis of granulomas in infectious diseases affecting the liver, including use of special stains, serologic studies, and molecular diagnostic techniques, and discusses pertinent noninfectious causes of hepatic granulomas that are in the differential diagnosis.
Collapse
|
31
|
Eosinophilic cholangiopathy with concurrent eosinophilic colitis in a patient with idiopathic hypereosinophilic syndrome. Eur J Gastroenterol Hepatol 2008; 20:574-7. [PMID: 18467919 DOI: 10.1097/meg.0b013e3282f1cc11] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Eosinophilic cholangiopathy is a rare cholestatic disorder of unknown etiology. Simultaneous histologic documentation of eosinophilic involvement of the bile ducts and gastrointestinal tract has been reported previously in only a few well-documented cases. We report a 52-year-old man with a history of idiopathic hypereosinophilic syndrome who presented with acute diarrhea and cholestatic hepatitis. Colonoscopy revealed colitis, and a biopsy showed eosinophilic infiltrates in the colonic mucosa. Liver biopsy showed dense eosinophilic inflammation in the portal areas with bile duct damage. This case demonstrates the entity of hepatic involvement in idiopathic hypereosinophilic syndrome and the difficulties related to diagnosis and treatment.
Collapse
|
32
|
Abstract
Diagnosis of eosinophilic gastrointestinal diseases is based on morphological evaluation with regard to localization and density of eosinophil infiltration of the mucosa and/or deeper parts of the oesophagus, stomach, and bowel in biopsy or resection specimens. As with eosinophils in any tissue, in the majority of diseases they are probably a sequel of acute inflammation and do not indicate any specific disease. Eosinophil morphology includes intact cells with bilobated nuclei and eosinophil granules in the cytoplasm and extracellular tissue following activation/degranulation. There is no fixed number of eosinophils that can be used as a cut-off criterion to define disease. Associated histopathological features observed in eosinophilic gastrointestinal disease depend on the site of manifestation and primary disease. Eosinophils are typically increased in allergy-associated colitis in adults and allergic proctocolitis in infants, eosinophilic gastroenteritis and eosinophilic oesophagitis. Their presence can also suggest a drug-induced eosinophilia or the presence of a parasitic infection. In general, eosinophils are increased in inflammatory bowel disease (IBD). They are seen in reflux oesophagitis, coeliac disease, and microscopic and infectious colitis. Eosinophils may be a feature of polyarteriitis nodosa and Churg-Strauss syndrome, and can accompany connective-tissue disease as well as malignant lymphomas and adenocarcinomas of gastrointestinal mucosa.
Collapse
|
33
|
Adachi W, Kishimoto K, Shiozawa H, Komatsu O, Matsushita T, Fukushima M. Eosinophilic gastroenteritis with eosinophilic infiltration of the gall bladder. Clin J Gastroenterol 2008; 1:23-7. [PMID: 26193356 DOI: 10.1007/s12328-008-0004-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Accepted: 02/04/2008] [Indexed: 11/26/2022]
Abstract
Eosinophilic gastroenteritis (EG) is a rare disease of unknown etiology characterized by eosinophilic infiltration of the gastrointestinal tract wall with various gastrointestinal manifestations. Several organs in the digestive tract may be involved by EG, but biliary tract involvements are rare. We report here a case of EG with eosinophilic infiltration of the gall bladder. A 57-year-old man was admitted to the hospital complaining of abdominal pain and diarrhea. As ultrasonography and magnetic resonance imaging showed thickened gall bladder wall and debris in the neck of gall bladder, we performed cholecystectomy, but his symptoms were not improved. Esophagogastroduodenoscopy showed multiple erosions, redness and edema in the duodenum and stomach. Biopsy specimens from the duodenum and stomach showed infiltration of eosinophils, plasma cells and lymphocytes. Microscopic findings of resected gall bladder showed eosinophilic infiltration into the all layers of gall bladder wall without vasculitis. Based on these findings, EG with eosinophilic infiltration of the gall bladder was diagnosed. Following oral steroid administration, clinical symptoms were immediately improved. One month after the therapy, esophagogastroduodenoscopy did not show any findings of gastritis or duodenitis, and there were no eosinophilic infiltrations in biopsy specimens from duodenum and stomach.
Collapse
Affiliation(s)
- Wataru Adachi
- Department of Surgery, Fujimi-kogen Hospital, 11100 Ochiai, Fujimi, Suwa-gun, 399-0214, Japan.
| | - Kyo Kishimoto
- Department of Surgery, Fujimi-kogen Hospital, 11100 Ochiai, Fujimi, Suwa-gun, 399-0214, Japan
| | - Hideki Shiozawa
- Department of Surgery, Fujimi-kogen Hospital, 11100 Ochiai, Fujimi, Suwa-gun, 399-0214, Japan
| | - Osamu Komatsu
- Department of Internal Medicine, Fujimi-kogen Hospital, Suwa-gun, Japan
| | | | - Mana Fukushima
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| |
Collapse
|
34
|
Yoshiji H, Yoshikawa M, Kaji K, Fukui H. Eosinophilic cholecystitis as a rare manifestation of visceral larva migrans. World J Gastroenterol 2007; 13:6119. [PMID: 18023114 PMCID: PMC4250905 DOI: 10.3748/wjg.v13.45.6119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Eosinophilic cholecystitis is an infrequent form of cholecystitis. The etiology of eosinophilic cholecystitis is still obscure, and it is sometimes accompanied with several complications, but a simultaneous onset with pericarditis is very rare. We would like to make an alternative interpretation of our recent report "Kaji K, Yoshiji H, Yoshikawa M, Yamazaki M, Ikenaka Y, Noguchi R, Sawai M, Ishikawa M, Mashitani T, Kitade M, Kawaratani H, Uemura M, Yamao J, Fujimoto M, Mitoro A, Toyohara M, Yoshida M, Fukui H. Eosinophilic cholecystitis along with pericarditis caused by Ascaris lumbricoides: A case report. World J Gastroenterol 2007; 13: 3760-3762."
Collapse
|
35
|
Kaji K, Yoshiji H, Yoshikawa M, Yamazaki M, Ikenaka Y, Noguchi R, Sawai M, Ishikawa M, Mashitani T, Kitade M, Kawaratani H, Uemura M, Yamao J, Fujimoto M, Mitoro A, Toyohara M, Yoshida M, Fukui H. Eosinophilic cholecystitis along with pericarditis caused by Ascaris lumbricoides: A case report. World J Gastroenterol 2007; 13:3760-2. [PMID: 17659742 PMCID: PMC4250654 DOI: 10.3748/wjg.v13.i27.3760] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although the etiology of eosinophilic cholecystitis is still obscure, the postulated causes include allergies, parasites, hypereosinophilic syndrome, and eosinophilic gastroenteritis. It is sometimes accompanied by several complications, but a simultaneous onset with pericarditis is very rares. A 28-year-old woman complained of acute right hypocondrial pain and dyspnea associated with systemic eruption. Several imaging modalities revealed acute cholecystitis and pericarditis with massive pericardial effusion. A marked peripheral blood eosinophilia was observed, and the eruption was diagnosed as urticaria. Her serum had a high titer of antibody against Ascaris lumbricoides. Treatment with albendazole drastically improved all clinical manifestations along with normalization of the imaging features and eosinophilia. We report herein a rare case of simultaneous onset of acute cholecystitis and pericarditis associated with a marked eosinophilia caused by parasitic infection.
Collapse
Affiliation(s)
- Kosuke Kaji
- Third Department of Internal Medicine, Nara Medical University, Shijo-cho 840, Kashihara, Nara 634-8522, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Matsumoto N, Yokoyama K, Nakai K, Yamamoto T, Otani T, Ogawa M, Tanaka N, Iwasaki A, Arakawa Y, Sugitani M. A case of eosinophilic cholangitis: Imaging findings of contrast-enhanced ultrasonography, cholangioscopy, and intraductal ultrasonography. World J Gastroenterol 2007; 13:1995-7. [PMID: 17461504 PMCID: PMC4146980 DOI: 10.3748/wjg.v13.i13.1995] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 38-year-old woman was referred to our institution due to epigastralgia. She presented with obstructive jaundice and eosinophilia. Endoscopic retrograde cholangiopancreatography showed diffuse narrowing from the distal common bile duct to the bifurcation of the hepatic ducts. An endoscopic plastic biliary stent was inserted; the specimen obtained from the common bile duct wall revealed dense infiltration by eosinophils. Treatment was started with prednisolone 60 mg daily. The patient’s biliary stenosis and eosinophilia gradually improved. Eosinophilic infiltration in the lungs or stomach is relatively common, but it is rare in the common bile duct. Most of the reported cases of eosinophilic cholangitis presented with eosinophilia; our patient’s eosinophil count was over 1000/mm3. Since our patient had allergies to pollen and house dust, a relationship between the allergies and the eosinophilic cholangitis was suspected, but no cause was identified.
Collapse
Affiliation(s)
- Naoki Matsumoto
- Department of Gastroenterology and Hepatology, Nihon University Surugadai Hospital, 1-8-13, Kandasurugadai, Chiyoda-ku, Tokyo 101-8309, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Duseja A, Nada R, Dhiman RK, Chawla YK, Kalra N, Prashad S, Karwasra RK. Eosinophilic cholangiopathy--a case report. Dig Dis Sci 2005; 50:1422-5. [PMID: 16110830 DOI: 10.1007/s10620-005-2856-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | | | | | | | | | | | | |
Collapse
|
38
|
Charalabopoulos A, Charalabopoulos K, Avuzuklidou M, Charalabopoulos AK, Ioachim E, Lebren F, Fotiadis K. Eosinophilic gastroenteritis: presentation of two patients with unusual affect of terminal ileum and caecum with manifestations of acute abdomen and literature review. Int J Clin Pract 2004; 58:413-6. [PMID: 15161129 DOI: 10.1111/j.1368-5031.2004.0125.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Eosinophilic gastroenteritis is a rare disease; the long-term personal history with digestive symptoms and the course of the disease with relapses and remissions is the key for the disease to be suspected. Endoscopy, CT scan and sonographic studies may provide important indirect signs of the disease and in combination with histological examination the diagnosis can be achieved. The administration of corticosteroids is an important factor for the treatment or the remission of the disease. In this study two cases with unusual location of the disease, on the terminal ileum and caecum, are presented and a literature review is attempted. The disease process, clinical and laboratory findings as well as the surgical approach used are described. Eosinophilic gastroenteritis is a very rare disease with its surgical complications. The disease is a non-surgical disease, thus presurgical diagnosis is important because the entity discussed can be under control by conservative treatment. A high disease suspicious index must be kept in the physicians' mind.
Collapse
Affiliation(s)
- A Charalabopoulos
- Third Department of Surgery, Athens University Medical School, Sotiria General Hospital, Athens, Greece
| | | | | | | | | | | | | |
Collapse
|
39
|
Affiliation(s)
- Jean-Nicolas Vauthey
- Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Box 444, 1515 Holcombe Blvd, Houston, TX 77030, USA.
| | | | | | | |
Collapse
|
40
|
Jimenez-Saenz M, Villar-Rodriguez JL, Torres Y, Carmona I, Salas-Herrero E, Gonzalez-Vilches J, Herrerias-Gutierrez JM. Biliary tract disease: a rare manifestation of eosinophilic gastroenteritis. Dig Dis Sci 2003. [PMID: 12757181 DOI: 10.1023/a: 1022521707420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Eosinophilic gastroenteritis (EGE) is a rare inflammatory disease characterized by diffuse or scattered eosinophilic infiltration of the digestive tract and usually by peripheral blood eosinophilia. The most common presenting symptoms of EGE are abdominal pain, vomiting and diarrhea, but clinical features depend on which layers or location of gastrointestinal tract are involved. Treatment with corticosteroids results in clinical and histological remission in most patients and surgery can be avoided if a correct diagnosis is made. Previous history of allergy is a key to diagnosing EGE, but peripheral eosinophilia may be absent in some patients under concomitant treatment with corticosteroids. Radiological and endoscopic findings are also nonspecific and diagnosis must always be histologically confirmed. The gastrointestinal involvement is patchy in distribution, so more than one panendoscopic examination is often necessary to establish the diagnosis, and surgical or CT-guided full-thickness biopsy is needed in patients with muscular or serosal involvement. It emphasises the importance of a high index of clinical suspicion, which mainly depends on knowledge of natural history of the disease. We report here a case of EGE associated with transmural eosinophilic cholecystocholangitis, in a patient who presented with dyspeptic symptoms and recurrent cholestasis responsive to corticoesteroids. To our knowledge, this patient represents the second case, in the English literature, in which corticoid-responsive cholangitis was associated to histologically proven eosinophilic cholecystitis and gastrointestinal involvement, suggesting that EGE must always be considered in the differential diagnosis of biliary tract disease in patients with eosinophilia and/or atopic diseases.
Collapse
Affiliation(s)
- Manuel Jimenez-Saenz
- Division of Gastroenterology, Department of Pathology, Hospital Virgen Macarena, Seville, Spain
| | | | | | | | | | | | | |
Collapse
|
41
|
Jimenez-Saenz M, Villar-Rodriguez JL, Torres Y, Carmona I, Salas-Herrero E, Gonzalez-Vilches J, Herrerias-Gutierrez JM. Biliary tract disease: a rare manifestation of eosinophilic gastroenteritis. Dig Dis Sci 2003; 48:624-7. [PMID: 12757181 DOI: 10.1023/a:1022521707420] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Eosinophilic gastroenteritis (EGE) is a rare inflammatory disease characterized by diffuse or scattered eosinophilic infiltration of the digestive tract and usually by peripheral blood eosinophilia. The most common presenting symptoms of EGE are abdominal pain, vomiting and diarrhea, but clinical features depend on which layers or location of gastrointestinal tract are involved. Treatment with corticosteroids results in clinical and histological remission in most patients and surgery can be avoided if a correct diagnosis is made. Previous history of allergy is a key to diagnosing EGE, but peripheral eosinophilia may be absent in some patients under concomitant treatment with corticosteroids. Radiological and endoscopic findings are also nonspecific and diagnosis must always be histologically confirmed. The gastrointestinal involvement is patchy in distribution, so more than one panendoscopic examination is often necessary to establish the diagnosis, and surgical or CT-guided full-thickness biopsy is needed in patients with muscular or serosal involvement. It emphasises the importance of a high index of clinical suspicion, which mainly depends on knowledge of natural history of the disease. We report here a case of EGE associated with transmural eosinophilic cholecystocholangitis, in a patient who presented with dyspeptic symptoms and recurrent cholestasis responsive to corticoesteroids. To our knowledge, this patient represents the second case, in the English literature, in which corticoid-responsive cholangitis was associated to histologically proven eosinophilic cholecystitis and gastrointestinal involvement, suggesting that EGE must always be considered in the differential diagnosis of biliary tract disease in patients with eosinophilia and/or atopic diseases.
Collapse
Affiliation(s)
- Manuel Jimenez-Saenz
- Division of Gastroenterology, Department of Pathology, Hospital Virgen Macarena, Seville, Spain
| | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
Eosinophilic gastroenteritis is a rare gastrointestinal (GI) disorder of undetermined cause characterized by infiltration of eosinophils in the GI tract. Eosinophils accumulate in tissues and may release highly cytotoxic granular proteins, which cause severe tissue damage characteristic of eosinophilic gastroenteritis. Eotaxin may play a role in the recruitment of eosinophils into tissue in combination with chemoattractants and cytokines, including interleukin 3 and 5 and granulocyte-macrophage colony-stimulating factor. Food allergy, especially in children, can be a triggering factor, and an amino acid-based diet may be helpful. Accumulation of eosinophils in the gut is a common feature in food-induced GI disorders that can be regulated through a complex molecular network involving Th2 cells, various cytokines, and chemokines. Eosinophilic gastroenteritis has a wide spectrum of clinical presentation depending on the site of involvement. It may be confused with irritable bowel syndrome or dyspepsia and, rarely, mimics pancreatitis or appendicitis. Diagnosis is important and is usually made by a pathologist. Eosinophilic gastroenteritis is a treatable disease; patients generally respond to steroid therapy, although relapse is common. Non-enteric-coated budesonide, a locally acting corticosteroid with little risk of adrenal suppression, may be substituted, although more experience is needed. Promising new drugs for eosinophilic gastroenteritis include montelukast, a selective leukotriene receptor antagonist, and suplaplast tosilate, a selective Th2 cytokine inhibitor with inhibitory effects on allergy-induced eosinophilic infiltration and IgE production. Although it is likely a separate disease, more experience has accumulated, and an elimination or specific amino acid-based diet appears to be helpful in treatment.
Collapse
Affiliation(s)
- Rahim Daneshjoo
- University of Sydney, Nepean Hospital, Level 5 South Block, PO Box 63, Penrith NSW 2751, Australia
| | | |
Collapse
|
43
|
|
44
|
Delèvaux I, André M, Chipponi J, Milési-Lecat AM, Déchelotte P, Aumaître O. A rare manifestation of idiopathic hypereosinophilic syndrome: sclerosing cholangitis. Dig Dis Sci 2002; 47:148-51. [PMID: 11837715 DOI: 10.1023/a:1013236125057] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Isabelle Delèvaux
- Department of Internal Medicine, G Montpied Hospital, Clermont-Ferrand, France
| | | | | | | | | | | |
Collapse
|
45
|
Affiliation(s)
- M Persić
- Department of Pediatrics, Clinical Hospital Center Rijeka, Croatia
| | | | | | | |
Collapse
|
46
|
Affiliation(s)
- S Tenner
- Endoscopy Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | | |
Collapse
|