Single-Organ and Multisystem Hypereosinophilic Syndrome Patients with Gastrointestinal Manifestations Share Common Characteristics.
Eosinophilia
Eosinophilic colitis
Eosinophilic gastritis
Eosinophilic gastroenteritis
Eosinophilic gastrointestinal disorders
Hypereosinophilic syndrome
Journal
The journal of allergy and clinical immunology. In practice
ISSN: 2213-2201
Titre abrégé: J Allergy Clin Immunol Pract
Pays: United States
ID NLM: 101597220
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
25
10
2019
revised:
05
03
2020
accepted:
06
04
2020
pubmed:
29
4
2020
medline:
15
5
2021
entrez:
29
4
2020
Statut:
ppublish
Résumé
Eosinophilic gastrointestinal diseases (EGIDs) are defined by marked eosinophilia in the gastrointestinal (GI) tract resulting in a wide variety of GI symptoms. When accompanied by blood hypereosinophilia (HE; absolute eosinophil count ≥1500/mm To describe the GI disease of patients categorized as those with HES/EGID overlap versus those with Multisystem HES. Consecutively enrolled patients on a natural history protocol to study eosinophilia with biopsy-proven EGID involving the esophagus, stomach, small-bowel, and/or colon were evaluated for clinical, histopathologic, and endoscopic features by retrospective chart review. Among the 56 patients with EGID and HE, 34 were categorized as HES/EGID overlap and 22 as Multisystem HES. Demographics, GI symptoms, and associated comorbidities were similar between the 2 groups. Multisegment GI eosinophilia was present in 20 of 30 (67%) patients who underwent tissue sampling of all 4 GI segments. Tissue eosinophilia in all 4 GI segments was found in 5 of 30 (17%) patients. Dietary therapy was more common in patients with HES/EGID overlap (65% vs 23%, P = .0028). Patients with Multisystem HES were more likely to receive glucocorticoids (100% vs 79%, P = .0349) and nonglucocorticoid systemic therapies (77% vs 38%, P = .0061). One-third (8 of 22) of patients with Multisystem HES presented with isolated GI symptoms before developing extraintestinal manifestations at a median of 1 year (range, 0.25-15 years). There are striking clinical similarities between patients with Multisystem HES and those with HES/EGID overlap, despite differing treatment approaches. Moreover, Multisystem HES can present with isolated GI involvement. Larger prospective studies are needed to confirm these findings.
Sections du résumé
BACKGROUND
Eosinophilic gastrointestinal diseases (EGIDs) are defined by marked eosinophilia in the gastrointestinal (GI) tract resulting in a wide variety of GI symptoms. When accompanied by blood hypereosinophilia (HE; absolute eosinophil count ≥1500/mm
OBJECTIVE
To describe the GI disease of patients categorized as those with HES/EGID overlap versus those with Multisystem HES.
METHODS
Consecutively enrolled patients on a natural history protocol to study eosinophilia with biopsy-proven EGID involving the esophagus, stomach, small-bowel, and/or colon were evaluated for clinical, histopathologic, and endoscopic features by retrospective chart review.
RESULTS
Among the 56 patients with EGID and HE, 34 were categorized as HES/EGID overlap and 22 as Multisystem HES. Demographics, GI symptoms, and associated comorbidities were similar between the 2 groups. Multisegment GI eosinophilia was present in 20 of 30 (67%) patients who underwent tissue sampling of all 4 GI segments. Tissue eosinophilia in all 4 GI segments was found in 5 of 30 (17%) patients. Dietary therapy was more common in patients with HES/EGID overlap (65% vs 23%, P = .0028). Patients with Multisystem HES were more likely to receive glucocorticoids (100% vs 79%, P = .0349) and nonglucocorticoid systemic therapies (77% vs 38%, P = .0061). One-third (8 of 22) of patients with Multisystem HES presented with isolated GI symptoms before developing extraintestinal manifestations at a median of 1 year (range, 0.25-15 years).
CONCLUSION
There are striking clinical similarities between patients with Multisystem HES and those with HES/EGID overlap, despite differing treatment approaches. Moreover, Multisystem HES can present with isolated GI involvement. Larger prospective studies are needed to confirm these findings.
Identifiants
pubmed: 32344186
pii: S2213-2198(20)30376-7
doi: 10.1016/j.jaip.2020.04.025
pmc: PMC7483350
mid: NIHMS1587875
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2718-2726.e2Subventions
Organisme : CCR NIH HHS
ID : HHSN261200800001C
Pays : United States
Organisme : NCI NIH HHS
ID : HHSN261200800001E
Pays : United States
Organisme : Intramural NIH HHS
ID : ZIA AI001130
Pays : United States
Informations de copyright
Published by Elsevier Inc.
Références
Gut Liver. 2018 May 15;12(3):288-296
pubmed: 29212311
Dig Dis Sci. 2011 Nov;56(11):3254-61
pubmed: 21655949
Clin Gastroenterol Hepatol. 2010 Aug;8(8):669-75; quiz e88
pubmed: 20451664
Pediatr Gastroenterol Hepatol Nutr. 2015 Dec;18(4):253-60
pubmed: 26770900
J Allergy Clin Immunol. 2014 Nov;134(5):1114-24
pubmed: 25234644
Dig Liver Dis. 2015 Mar;47(3):197-201
pubmed: 25547198
Gastroenterol Res Pract. 2011;2011:857508
pubmed: 21837236
Med J Malaysia. 2015 Aug;70(4):232-7
pubmed: 26358020
Mod Pathol. 2011 Apr;24(4):556-63
pubmed: 21169993
Gut. 1990 Jan;31(1):54-8
pubmed: 2318432
Clin Gastroenterol Hepatol. 2017 Nov;15(11):1733-1741
pubmed: 28603057
Dig Dis Sci. 2019 Jan;64(1):152-157
pubmed: 30267171
Pediatr Dev Pathol. 2006 May-Jun;9(3):210-8
pubmed: 16944979
Gastroenterology. 2019 Mar;156(4):838-842
pubmed: 30452923
Blood. 2015 Aug 27;126(9):1069-77
pubmed: 25964669
J Leukoc Biol. 2018 Jul;104(1):69-83
pubmed: 29672914
J Gastroenterol. 2013 Mar;48(3):333-9
pubmed: 22847555
Am J Gastroenterol. 2019 Jun;114(6):984-994
pubmed: 31008735
J Allergy Clin Immunol. 2006 Jun;117(6):1292-302
pubmed: 16750989
Front Med (Lausanne). 2018 Jan 15;4:261
pubmed: 29379785
Colorectal Dis. 2014 Feb;16(2):123-9
pubmed: 24138295
Front Med (Lausanne). 2017 Dec 05;4:216
pubmed: 29259972
Bioinformatics. 2017 Sep 15;33(18):2938-2940
pubmed: 28645171
Am J Gastroenterol. 2018 Mar;113(3):348-357
pubmed: 29336433