Eosinophilic gastroenteritis: Pathophysiology & Imaging appearance

 

Eosinophilic gastroenteritis: Pathophysiology & Imaging appearance

A rare and benign inflammatory bowel disorder disorder with a chronic and relapsing course

More common in pediatric population

Affects stomach and the small intestine

Pathological Hallmark: 

Characterized by eosinophilic infiltration of the intestinal wall

3 sub types based on the infiltration of the wall: mucosal / muscular / serosal. 

Mucosal type is the most common, which may progress to muscular & serosal layer (centrifugal disease)

Pathophysiology: 

Concomitant allergic disorders and family history of Atopy is common and, suggests that it may be a result from "immune dysregulation" in response to allergic reaction

Eosinophils induce a significant inflammatory response

Diagnosis: 

Symptoms (abdominal pain / diarrhoea / malabsorption), histology and exclusion of other causes

Treatment: Steroids

Imaging (CT Scan):

- Diffuse thickening of the mucosal folds / Intestinal wall thickening

- Ascites & Obstruction

- Halo Sign: Layering of the wall (submucosal edema)

- Araneid-limb-like (spider legs): orally administered oral contrast coats the mucosal folds and sinks into the sinuses between the folds. Similar to "accordion sign" seen in pseudomembranous colitis. 

Non of the signs are specific

Other findings: strictures / polypoid lesions with ulcerations / thickened and flattened valvulae conniventis / mural thickening with luminal narrowing and rarely obstruction. 

Prepared by Dr. Sharad Maheshwari

23.12.2022

Updated: 26.12.2022

References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5095570/

2. https://pubs.rsna.org/doi/epdf/10.1148/rg.220004

3. https://dirjournal.org/content/files/sayilar/42/buyuk/pdf_DIR_418.pdf