TY - JOUR
T1 - Allergic eosinophilic gastroenteritis with protein-losing enteropathy
T2 - Intestinal pathology, clinical course, and long-term follow-up
AU - Chehade, Mirna
AU - Magid, Margret S.
AU - Mofidi, Shideh
AU - Nowak-Wegrzyn, Anna
AU - Sampson, Hugh A.
AU - Sicherer, Scott H.
PY - 2006/5
Y1 - 2006/5
N2 - OBJECTIVES: A subset of patients with allergic eosinophilic gastroenteritis (AEG) has anemia and hypoalbuminemia caused by protein-losing enteropathy (PLE). Our goals were to describe the response to therapy and the long-term outcome of patients in this subgroup and to evaluate their gastric and intestinal biopsies for distinguishing features that might explain their protein and blood loss. METHODS: Patients with AEG + PLE were identified retrospectively and compared with controls and with patients with AEG only. Immunohistochemical staining for tryptase, a mast cell mediator, was performed on gastric and duodenal tissues. Eosinophils identified by hematoxylin/eosin stain and mast cells identified as tryptase-positive cells were counted in one high-power field area with maximal cell infiltration. RESULTS: Although all patients had excellent response to therapy with amino acid-based formula and tolerated gradual introduction of some foods with time, food-responsive disease persisted in all patients over 2.5 to 5.5 years of follow-up. Routine histological evaluation did not show any features differentiating AEG + PLE from AEG. When eosinophils and mast cells were counted in intestinal biopsies, however, significantly more mast cells were found in biopsies of the AEG + PLE group despite comparable numbers of eosinophils. In contrast, in gastric biopsies, eosinophils were more prominent in AEG + PLE, but mast cell numbers were similar in all groups. CONCLUSIONS: Patients with AEG + PLE responded well to therapy with amino acid-based formula. Food hypersensitivities did not completely resolve over up to 5.5 years. Intestinal mast cells were significantly increased in maximally infiltrated areas of the intestine, possibly causing increased intestinal permeability and protein loss.
AB - OBJECTIVES: A subset of patients with allergic eosinophilic gastroenteritis (AEG) has anemia and hypoalbuminemia caused by protein-losing enteropathy (PLE). Our goals were to describe the response to therapy and the long-term outcome of patients in this subgroup and to evaluate their gastric and intestinal biopsies for distinguishing features that might explain their protein and blood loss. METHODS: Patients with AEG + PLE were identified retrospectively and compared with controls and with patients with AEG only. Immunohistochemical staining for tryptase, a mast cell mediator, was performed on gastric and duodenal tissues. Eosinophils identified by hematoxylin/eosin stain and mast cells identified as tryptase-positive cells were counted in one high-power field area with maximal cell infiltration. RESULTS: Although all patients had excellent response to therapy with amino acid-based formula and tolerated gradual introduction of some foods with time, food-responsive disease persisted in all patients over 2.5 to 5.5 years of follow-up. Routine histological evaluation did not show any features differentiating AEG + PLE from AEG. When eosinophils and mast cells were counted in intestinal biopsies, however, significantly more mast cells were found in biopsies of the AEG + PLE group despite comparable numbers of eosinophils. In contrast, in gastric biopsies, eosinophils were more prominent in AEG + PLE, but mast cell numbers were similar in all groups. CONCLUSIONS: Patients with AEG + PLE responded well to therapy with amino acid-based formula. Food hypersensitivities did not completely resolve over up to 5.5 years. Intestinal mast cells were significantly increased in maximally infiltrated areas of the intestine, possibly causing increased intestinal permeability and protein loss.
KW - Amino acid
KW - Eosinophil
KW - Eosinophilic gastroenteritis
KW - Mast cell
KW - Protein-losing enteropathy
UR - http://www.scopus.com/inward/record.url?scp=33744490993&partnerID=8YFLogxK
U2 - 10.1097/01.mpg.0000221903.61157.4e
DO - 10.1097/01.mpg.0000221903.61157.4e
M3 - Article
C2 - 16707973
AN - SCOPUS:33744490993
SN - 0277-2116
VL - 42
SP - 516
EP - 521
JO - Journal of Pediatric Gastroenterology and Nutrition
JF - Journal of Pediatric Gastroenterology and Nutrition
IS - 5
ER -