S1286 Eosinophilic Gastroenteritis: A Tale of Two Phenotypes

Abstract

INTRODUCTION: Eosinophilic gastroenteritis, defined by the presence of gastrointestinal symptoms and eosinophilic infiltrate on histopathology, is a rare disorder with an uncertain clinical course and features. We aimed to determine the natural history of eosinophilic gastroenteritis and to characterize the phonotypes of disease. METHODS: Retrospective chart review was performed at a large tertiary medical center to include patients diagnosed with eosinophilic gastroenteritis diagnosed by the presence of gastrointestinal symptoms and eosinophilic infiltrate on duodenal biopsy. Two groups were identified based on clinical presentation. One group was classified as “severe disease” based on presence of any of the following characteristics: weight loss at time of presentation, hypoalbuminemia at presentation, serosal disease involvement, or anemia at diagnosis. Patients not having any of the above criteria were classified as “mild disease.” From 2007 to 2018 a total of 31 patients with eosinophilic gastroenteritis were identified: 17 with severe disease and 14 with mild disease. Data collected included demographic information, peripheral eosinophil count at diagnosis, history of allergy, and course of the disease. RESULTS: Peripheral eosinophilia at diagnosis was found in 16/17 (94%) of patients with severe disease and 11/14 (79%) of patients with mild disease (P = 0.2). 16/17 (94%) of patients with severe disease had a history of allergy, while 6/14 (43%) of patients with mild disease reported a history of allergy (P < 0.01). Finally, using the described mild and severe classification criteria at diagnosis, 10/15 (67%) of those defined as severe presentation had refractory symptoms requiring chronic medications while only 3/12 (25%) of those with the mild disease defined at presentation required chronic medication therapy to suppress symptoms (P = 0.03). CONCLUSION: Based on this study, eosinophilic gastroenteritis appears to have two phenotypes that may be distinguished based on clinical presentation of weight loss at time of presentation, hypoalbuminemia, serosal involvement on biopsy, and anemia at diagnosis. Patients with these clinical features at presentation are more likely to have a severe disease course requiring chronic medications. Peripheral eosinophilia is common in both groups and absolute values do not appear to be higher in the more severe disease type.Table 1.: Characteristics of eosinophilic gastroenteritis according to phenotypes.