Allergic Eosinophilic Gastroenteritis With Protein-losing Enteropathy: Intestinal Pathology, Clinical Course, and Long-term Follow-up
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 inte...
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Published in | Journal of pediatric gastroenterology and nutrition Vol. 42; no. 5; pp. 516 - 521 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Hagerstown, MD
Lippincott Williams & Wilkins, Inc
01.05.2006
Lippincott |
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Abstract | 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. JPGN 42:516-521, 2006. |
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AbstractList | 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.
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.
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.
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. OBJECTIVESA 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.METHODSPatients 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.RESULTSAlthough 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.CONCLUSIONSPatients 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. 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. JPGN 42:516-521, 2006. |
Author | Nowak-Wegrzyn, Anna Sampson, Hugh A Sicherer, Scott H Magid, Margret S Mofidi, Shideh Chehade, Mirna |
AuthorAffiliation | Pediatric Allergy and Immunology; † Pediatric Gastroenterology and Nutrition; and ‡Pediatric Pathology, Mount Sinai School of Medicine, New York, NY |
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Author_xml | – sequence: 1 givenname: Mirna surname: Chehade fullname: Chehade, Mirna organization: Pediatric Allergy and Immunology; † Pediatric Gastroenterology and Nutrition; and ‡Pediatric Pathology, Mount Sinai School of Medicine, New York, NY – sequence: 2 givenname: Margret surname: Magid middlename: S fullname: Magid, Margret S – sequence: 3 givenname: Shideh surname: Mofidi fullname: Mofidi, Shideh – sequence: 4 givenname: Anna surname: Nowak-Wegrzyn fullname: Nowak-Wegrzyn, Anna – sequence: 5 givenname: Hugh surname: Sampson middlename: A fullname: Sampson, Hugh A – sequence: 6 givenname: Scott surname: Sicherer middlename: H fullname: Sicherer, Scott H |
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Cites_doi | 10.1016/S1542-3565(04)00240-X 10.1016/S0022-3476(78)80888-9 10.1016/j.jaci.2004.03.014 10.1016/0091-6749(84)90090-3 10.1097/00005176-200001001-00013 10.1002/j.1536-4801.1988.tb09551.x 10.1016/S0016-5085(19)33649-2 10.1034/j.1398-9995.2000.00464.x 10.1067/mai.2002.121458 10.1111/j.1572-0241.2003.07390.x 10.1016/S0016-5085(77)80034-6 10.1136/thorax.56.5.341 10.1073/pnas.1231488100 10.1016/0016-5085(95)90637-1 10.1136/adc.59.3.236 10.1056/NEJM196704062761401 10.1164/ajrccm/147.3.677 10.1053/gast.2001.23031 10.1016/S0002-9440(10)64010-2 |
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Keywords | Immunopathology Allergy Eosinophilic gastroenteritis-Protein-losing enteropathy-Mast cell-Eosinophil-Amino acid Metabolic diseases Long term Eosinophil Inflammatory disease Protein losing enteropathy Eosinophilic gastroenteritis Anatomic pathology Intestinal malabsorption Aminoacid Gastroenterology Digestive diseases Intestinal disease Mast cell Gastric disease |
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Snippet | OBJECTIVES:A subset of patients with allergic eosinophilic gastroenteritis (AEG) has anemia and hypoalbuminemia caused by protein-losing enteropathy (PLE). Our... A subset of patients with allergic eosinophilic gastroenteritis (AEG) has anemia and hypoalbuminemia caused by protein-losing enteropathy (PLE). Our goals were... OBJECTIVESA subset of patients with allergic eosinophilic gastroenteritis (AEG) has anemia and hypoalbuminemia caused by protein-losing enteropathy (PLE). Our... |
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SubjectTerms | Biological and medical sciences Eosinophils Feeding. Feeding behavior Fundamental and applied biological sciences. Psychology Gastroenteritis - complications Gastroenteritis - pathology Gastroenterology. Liver. Pancreas. Abdomen Humans Intestines - pathology Medical sciences Other diseases. Semiology Protein-Losing Enteropathies - complications Protein-Losing Enteropathies - pathology Retrospective Studies Stomach - pathology Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Vertebrates: anatomy and physiology, studies on body, several organs or systems |
Title | Allergic Eosinophilic Gastroenteritis With Protein-losing Enteropathy: Intestinal Pathology, Clinical Course, and Long-term Follow-up |
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