E0695 - Clinicopathological Features and Gastric Motor Functions in Patients With Eosinophilic Gastroenteritis: A Retrospective Single Center Audit

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Ting Zheng, MD

Mayo Clinic
Rochester, MN

Ting Zheng, MD, Catherine Hagen, MD, Christopher Hartley, MD, Michael Camilleri, MD
Mayo Clinic, Rochester, MN

Introduction: Introduction: Eosinophilic gastroenteritis (EGE) is characterized by upper gastrointestinal symptoms, eosinophilic infiltration, and absence of other causes of tissue eosinophilia. Numbers and distributions of eosinophils required for mucosal diagnosis have been proposed. Despite the upper GI symptoms, the association between EGE and gastric emptying and accommodation have only been reported in animal studies and case reports. Our aim was to conduct a review of clinicopathological and endoscopic features in patients with EGE in a single-center, and measurements of gastric motor functions in this cohort.

Methods: Methods: Medical records of 34 patients evaluated at Mayo Clinic Rochester with diagnosis of EGE from 2000-2022 were reviewed. Histological evidence of EGE was based on qualitative report of at least moderate infiltration or quantitation of eosinophils per hpf on biopsy. gastric emptying of solids (320kcal, 30% fat meal) and accommodation in response to 300mL Ensure were measured by validated scintigraphy and SPECT.

Results: Results: Patients’ mean age was 39.0y (range: 19-73) and 67.6% were female. Among 34 patients, 10 (29.4%) had outside diagnosis of EGE overruled upon biopsy review by an expert GI pathologist. Symptoms and comorbidities of 24 confirmed cases are summarized in the table; 2 patients had concurrent celiac disease and 3 had inflammatory bowel disease. Most patients (79.2%) had peripheral blood eosinophilia and abnormal gastroscopic findings (72.7%). Histological reporting was heterogeneous, with 37.5% citing numbers of eosinophils (table). Delayed (47.5%) or rapid (33.3%) gastric emptying (table, figure), as well as reduced gastric accommodation volume < 428mL (3, 42.9%) were documented. Patients were treated with diverse medications: prednisone (15, 62.5%), budesonide (11, 45.8%), fluticasone (4, 16.7%), cromolyn (4, 16.7%), montelukast (1, 4.2%), mepolizumab (1, 4.2%), immunomodulators (azathioprine, 6-MP, methotrexate) (3, 12.5%), and with standard approaches for gastric motor dysfunction (prokinetics, relaxatory agents). Where repeat results were available, 8 (57.1%), 12 (75%), and 4 (100%) patients showed endoscopic, histologic, and gastric emptying improvement after treatment, respectively.

Discussion: Discussion: Although understudied and in need of consensus diagnostic clinical and histological criteria, EGE is associated with altered gastric emptying and reduced accommodation and warrants further prospective studies.

Figure: Delayed (blue) or accelerated (red) gastric emptying is common among patients with eosinophilic gastroenteritis. Shaded area represents normal range of values for proportion emptied at 1, 2, and 4 hours from our prior studies using the same test meal in 319 healthy volunteers (PMID 22747676).

	Data show N (%)
Symptoms
Nausea/vomiting	19 (79.2)
Abdominal pain	19 (79.2)
Anorexia/early satiation	9 (37.5)
Bloating/distention	14 (58.3)
Weight loss	10 (41.7)
Constipation	9 (37.5)
Diarrhea	3 (12.5)
Common Comorbidities Associated with Eosinophils
Eosinophilic esophagitis	7 (29.2)
Eosinophilic colitis	3 (12.5)
Food allergy	5 (20.8)
Atopy (eczema, asthma, allergic rhinitis)	5 (20.8)
Endoscopic Findings
*Positive*	16 (72.7)
Erythema	7 (43.8)
Erosions	5 (31.3)
Nodules	2 (12.5)
Thickened folds	5 (31.3)
Ulcerations	5 (31.3)
Edema	2 (12.5)
*Negative*	6 (27.3)
Histopathology Report
Reported numbers of eosinophils	9 (37.5)
Reported severity of eosinophil infiltration*	10 (41.7)
Reported increased eosinophil infiltration only	5 (20.8)
Gastric Emptying of Solids
Delayed	10 (47.6)
Normal**	4 (19.0)
Rapid	7 (33.3)
Gastric Accommodation
Normal***	4 (57.1)
Impaired	3 (42.9)

Table: Clinical features, endoscopic findings, and histopathology reports on 24 patients with eosinophilic gastroenteritis, as well as results of gastric emptying in 23 patients and gastric accommodation in 7 patients. * Used descriptive terms such as “mild”, “moderate”, “extensive”, “dense”, “marked”, etc. ** Normal range of values for proportion emptied at 1, 2, and 4 h from our prior studies using the same test meal in 319 healthy volunteers. *** Defined as average postprandial gastric volume minus fasting volume of at least 428mL.

Disclosures:

Ting Zheng indicated no relevant financial relationships.

Catherine Hagen indicated no relevant financial relationships.

Christopher Hartley indicated no relevant financial relationships.

Michael Camilleri: Aclipse Therapeutics – Consultant. Aditum Bio – Consultant. AEON Pharma – Consultant. Allergan – Grant/Research Support. Arena – Consultant. Bilayer Therapeutics – Stock Options. BioKier – Consultant. Coloplast – Consultant. Coloplast – Consultant. Colospan – Consultant. Cosmo Pharmaceuticals – Consultant. Dignify Therapeutics – Stock Options. Enterin – Stock Options. Fauna Bio – Consultant. GlaxoSmithKline – Consultant. Invea Therapeutics – Consultant. InveniAI – Consultant. Ironwood – Consultant. Kallyope – Consultant. NGM Biopharmaceuticals – Grant/Research Support. Novome – Consultant. Pfizer – Consultant. Protagonist Therapeutics – Consultant. Protagonist Therapeutics – Consultant. QED Therapeutics – Consultant. Sunovion Pharmaceuticals – Consultant. Takeda – Consultant. Thelium Therapeutics – Stock Options. Vanda – Grant/Research Support. VIPUN Medical – Consultant. Virios – Consultant. Zealand Biopharma – Consultant.

Ting Zheng, MD, Catherine Hagen, MD, Christopher Hartley, MD, Michael Camilleri, MD. E0695 - Clinicopathological Features and Gastric Motor Functions in Patients With Eosinophilic Gastroenteritis: A Retrospective Single Center Audit, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.