Preliminary evidence in treatment of eosinophilic gastroenteritis in children: A case series

Abstract

Background: Eosinophilic gastroenteritis is a rare inflammatory disorder in children. However, there is still no standard guideline in the treatment of pediatric eosinophilic gastroenteritis.

Aim: To report our experience with the diagnosis and treatment of children with eosinophilic gastroenteritis.

Methods: From January 2017 to December 2019, a total of 22 children were diagnosed with eosinophilic gastroenteritis.

Results: Endoscopic examination showed eosinophil infiltration in the duodenum [mean number of eosinophils/high-power field (HPF) = 53.1 ± 81.5], stomach (mean number of eosinophils/HPF = 36.8 ± 50.5), and terminal ileum (mean number of eosinophils/HPF = 49.0 ± 24.0). All 18 children with low eosinophil infiltration (< 14%) responded well to the initial drug treatment without relapse, while two of four children with high eosinophil infiltration (> 14%) relapsed after initial methylprednisolone/montelukast treatment. In addition, children with high eosinophil infiltration (> 14%) showed symptomatic relief and histological remission without further relapse after receiving budesonide/methylprednisolone as initial or relapse treatment.

Conclusion: Methylprednisolone/montelukast is still the best treatment for children with low eosinophil infiltration (< 14%). Budesonide can be considered as the initial or relapse treatment for children with high eosinophil infiltration (> 14%).

Keywords: Absolute eosinophil count; Budesonide; Children; Eosinophil gastroenteritis; Methylprednisolone; Montelukast.

Figure 1

Gastrointestinal endoscopy and histopathological examination. A: Gastrointestinal endoscopy depicted erythematous, exudative and erosive gastritis, and congestion in case #21; B: Histopathological examination depicted a high degree of eosinophilic infiltration in case #21 (magnification, 40 ×); C: The gastric mucosa was normal under gastrointestinal endoscopy in case #19; D: Mucosal biopsy revealed a high degree of eosinophilic infiltration in case #19 (magnification, 40 ×).