Any or all parts of the bowel may be affected. Involvement may be patchy or diffuse. Eosinophilic esophagitis is described previously (above).
Clinical findings - 1 or more of the following GI complaints:
(1) nausea and vomiting
(2) abdominal pain, which may be severe
(3) diarrhea
(4) malabsorption with steatorrhea or protein losing enteropathy
(5) intestinal obstruction
(6) ascites
Clinical findings - atopy or immune dysfunction common:
(1) hay fever
(2) allergic rhinitis
(3) eczema
(4) asthma
(5) food allergy
(6) connective tissue disorder
Laboratory findings:
(1) peripheral eosinophilia
(2) elevated serum IgE concentration
(3) positive RAST findings for food antigens common (but may be absent)
(4) Charcot-Leyden crystals in the stool
(5) eosinophils in ascites fluid
Biopsy shows eosinophilic infiltrates in the bowel wall.
(1) There are infiltrates in the lamina propria, submucosa and muscularis propria.
(2) Eosinophils are present within the epithelium of the villi and/or crypts.
(3) There should be large numbers present (single field with over 50 eosinophils or multiple fields with elevated numbers).
(4) Edema in the mucosa and submucosa is usually present.
(5) Mast cells may be present in large numbers.
(6) Fibrosis and/or smooth muscle hyperplasia may develop in more severe and extensive disease.
Complications:
(1) growth retardation and/or weight loss
(2) iron deficiency anemia due to poor iron absorption
(3) hypoalbuminemia
(4) bowel wall thickening and obstruction
The diagnosis requires exclusion of other conditions associated with an eosinophilic infiltrate of the bowel wall (false positive):
(1) parasitic infestation
(2) Crohn's disease
(3) malignant lymphoma or Hodgkin's disease
(4) hypereosinophilic syndrome
False negative biopsies may occur if the disease is patchy or the biopsies suboptimal.
A positive response to exclusion of food allergens supports the diagnosis, but it may be difficult to identify and eliminate all triggering antigens.
