A Study on the Clinical Profiles of Patients with Eosinophilic Gastroenteritis in a Singapore Tertiary Hospital

Abstract

Purpose: Eosinophilic gastroenteritis (EG) is a rare but important gastrointestinal (GI) disease. It can mimic symptoms of common GI disorders but responds well to appropriate treatment. Identification is thus important for management. Data for EG in the Southeast Asia is scarce. We aimed to study the clinical profiles of patients with EG in a Singapore Tertiary Hospital. Methods: This retrospective study involved archival search of patients with GI biopsies that showed eosinophilic infiltration from 2004 to 2009. Review of patients' clinical data was performed from clinical notes and computerized hospital records. The biopsies were reviewed by a single consultant pathologist. The diagnostic criteria for EG included the presence of GI symptoms and eosinophilic infiltrates of more than 30 eosinophils/high power field on biopsies in the absence of secondary causes for GI eosinophilia. Results: Thirty-four patients were identified. Eighteen patients with secondary causes of eosinophilic infiltrates were excluded. These included inflammatory bowel disease, drug-induced colitis, hypereosinophilic syndrome, autoimmune pancreatitis and gastroesophageal reflux disease. There were 16 patients with EG (10 females). Mean age was 54 years (22-85). Racial distribution was 13 Chinese, 2 Indians and 1 Malay. Fourteen patients (87.5%) had peripheral blood eosinophilia (absolute eosinophil count ranged 0.52 to 21.8 X 109/L). Six patients had atopic conditions. Most common symptoms were diarrhoea and abdominal pain. Ten patients (62.5%) had hypoalbuminemia. Eight of the16 patients had at least 2 different sites of GI tract involvement. Small intestine was the most common site involved. The most common endoscopic finding was mucosal hyperemia. Eight patients were treated with tapering regimes of prednisolone (starting at 30-40 mg/day) over 1 to 3 months. Their symptoms resolved within 2 weeks. Four patients relapsed on cessation of prednisolone and 3 of them required low dose steroids maintenance. Half of the remaining 8 patients who were suboptimally treated with antispasmodics, proton-pump inhibitors and antibiotics had recurrent symptoms. Conclusion: EG does occur in Singapore. It responds well to corticosteroids but relapses are common. Small intestine is commonly affected. EG should be considered in the investigation of unexplained chronic recurrent GI symptoms. This is to ensure that these potentially treatable group of patients receive optimal management.