Difference between revisions of "Enteritis, Eosinophilic"

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[[Image:eosinophilic_enteritis.jpg|thumb|right|150px|Histology of Eosinophilic enteritis in the horse <sup>©Susan Rhind, University of Edinburgh</sup>]]
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[[Image:eosinophilic_enteritis.jpg|thumb|right|150px|Histology of Eosinophilic enteritis in the horse (Courtesy of Susan Rhind, University of Edinburgh)]]
 
==Introduction==
 
==Introduction==
Eosinophilic enteritis (EE) is the second most common form of [[Inflammatory Bowel Disease#Treatment|IBD]], characterised by a mixed, but predominantly eosiphilic, mucosal inflammatory infiltration.  EGE may be limited to the small intestine or it may affect other areas of the gastrointestinal tract such as stomach or colon; the condition is cetegorised into focal or diffuse EE.
+
==Signalment==
 +
*Seen in any breed or age
 +
*However, more common in younger animal
 +
*More common in
 +
**Boxers
 +
**Dobermans
 +
**German Shepherd Dogs
 +
 
 +
 
 +
==Description==
 +
'''Eosinophilic enteritis (EE)''' is the second most common form of IBD, characterised by a mixed, but predominantly eosiphilic, mucosal inflammatory infiltration.  EGE may be limited to the small intestine or it may affect other areas of the gastrointestinal tract such as stomach or colon.
  
 
An eosinophilic infiltrate may indicate a diet-induced, type 1 hypersensitivity.  However, most dogs do not respond to a purely exclusion diet.  Endoparasitism should also be excluded prior to immunosuppressive therapy for EE.
 
An eosinophilic infiltrate may indicate a diet-induced, type 1 hypersensitivity.  However, most dogs do not respond to a purely exclusion diet.  Endoparasitism should also be excluded prior to immunosuppressive therapy for EE.
  
==Signalment==
+
==Diagnosis==
Focal EE is a disease of young dogs, which can be associated with [[Toxocara canis|''Toxocara canis'']] infection. Pin-head sized white nodules can be seen under the serosa in the bowel, consisting of eosinophils, and occasionally macrophages, plasma cells and [[Toxocara canis|''Toxocara'']] larvae.
+
===Clinical Signs===
 +
*Vomiting
 +
*Diarrhoea; small intestinal is more common
 +
**Haematoemesis or malena, and/or haematochezia; EGE is associated with mucosal erosion or ulceration
 +
*Protein-losing enteropathy in severe cases
 +
*Hypoproteinaemia in severe casese
 +
 
 +
 
  
The diffuse form of EE is seen in the dog, cat and horse; it is described as idiopathic but the aetiology has been suggested to be a hypersensitivity reaction. In this form of the condition, recurrent episodes of diarrhoea with tissue and circulatory eosinophilia occurs, with a heavy infiltrate of eosinophils present histologically in all layers of the stomach and intestines.
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===Laboratory Tests===
 +
====Haematology====
 +
*Anaemia if gastrointestinal haemorrhage is severe.
  
There is a predilection for diffuse EE in:
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====Biochemistry====
<gallery>
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*Eosinophilia
Image:Boxer.jpg|'''Boxer'''<p><small>( © Lilly M WikiMedia Commons)</small>
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**This is not always present. Even when present, alone, it cannot prove the presence of EE.
Image:GermanShep.jpg|'''German Shepherd (Alsatian)'''<p><small>( © Ellen Levy Finch WikiMedia Commons)</small>
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**It is also a marker for parasitism, hypoadrenocorticism, allergic dermatological disease, allergic respiratory disease and mast cell tumour.
Image:Dobermann.jpg|'''Dobermann'''<p><small>( © John Adams WikiMedia Commons)</small>
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*Panhypoproteinaemia
</gallery>
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**Secoondary to concurrent protein-losing enteropathy
  
==Clinical Signs==
 
*Vomiting
 
*Diarrhoea; small intestinal is more common with haematoemesis or malena, and/or haematochezia; EGE is associated with mucosal erosion or ulceration
 
*Protein-losing enteropathy in severe cases
 
*Hypoproteinaemia in severe cases
 
  
==Laboratory Tests==
+
===Diagnostic Imaging===
Haemotology reveals an anaemia if gastrointestinal haemorrhage is severe. Eosinophilia is not always present and even when seen it is not pathogneumonic for EE. Panhypoproteinaemia can be found secoondary to concurrent protein-losing enteropathy
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*Endoscopically, linear ulcers within the duodenal mucosa may be seen grossly.
  
==Diagnostic Imaging==
 
Endoscopically, linear ulcers within the duodenal mucosa may be seen grossly.
 
  
 
===Histopathology===
 
===Histopathology===
Line 33: Line 45:
  
 
==Treatment==
 
==Treatment==
Anti-parasiticide (Fenbendazole) treatment may be given due to the possible endoparasitism or dietary sensitivity. Dietary modification is required with a change to a hypoallergenic diet.
+
*Anti-parasiticide
Immunosuppressive therapy may also be required.
+
**Fenbendazole may be given due to the possible endoparasitism or dietary sensitivity
 +
*Dietary modification
 +
**A hypoallergenic diet should be used
 +
*Immunosuppressive therapy
 +
 
 +
Refer to [[Inflammatory Bowel Disease#Treatment|IBD]] for further information
 +
 
  
 
==Prognosis==
 
==Prognosis==
 
Guarded if the initial response to treatment is poor.  Good if the underlying cause is detected and successfully treated.
 
Guarded if the initial response to treatment is poor.  Good if the underlying cause is detected and successfully treated.
 +
  
 
==References==
 
==References==
Line 44: Line 63:
 
*Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''.
 
*Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''.
  
{{Learning
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|Vetstream = [https://www.vetstream.com/canis/Content/Disease/dis01035.asp, Canine eosinophillic enteritis]
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==Eosinophilic Enteritis==
}}
+
 
 +
* Can be either focal or diffuse.
 +
 
 +
===Focal===
 +
 
 +
* A disease of young dogs.
 +
* Associated with [[Toxocara canis|''Toxocara canis'']] infection.
 +
** Pin-head sized white nodules can be seen under the serosa in the bowel.
 +
*** Consist of of eosinophils and occasionally macrophages and plasma cells.
 +
*** Can sometimes see [[Toxocara canis|''Toxocara'']] larvae in the nodules.
 +
 
 +
===Diffuse===
 +
 
 +
* Seen in the dog, cat and horse.
 +
* Idiopathic
 +
* Has a predilection for German Shepherd Dogs, but also occcurs in other breeds of dogs and in cats.
 +
** Recurrent episodes of diarrhoea with tissue and circulatory eosinophilia.
 +
*** Eosinophils heavily infiltrate all layers of stomach and intestines.
 +
**It has been suggested that it is a type of hypersensitivity reaction.
  
  
[[Category:Intestinal Diseases - Dog]][[Category:Intestine_-_Inflammatory_Pathology_by_Type]]
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[[Image:eosinophilic_enteritis.jpg|thumb|right|150px|Eosinophilic enteritis - horse(Courtesy of Susan Rhind, University of Edinburgh)]]
[[Category:To Do - Clinical]]
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[[Category:Dog]][[Category:Intestine_-_Inflammatory_Pathology_by_Type]][[Category:To_Do_-_Clinical]]

Revision as of 10:13, 1 November 2010

Histology of Eosinophilic enteritis in the horse (Courtesy of Susan Rhind, University of Edinburgh)

Introduction

Signalment

  • Seen in any breed or age
  • However, more common in younger animal
  • More common in
    • Boxers
    • Dobermans
    • German Shepherd Dogs


Description

Eosinophilic enteritis (EE) is the second most common form of IBD, characterised by a mixed, but predominantly eosiphilic, mucosal inflammatory infiltration. EGE may be limited to the small intestine or it may affect other areas of the gastrointestinal tract such as stomach or colon.

An eosinophilic infiltrate may indicate a diet-induced, type 1 hypersensitivity. However, most dogs do not respond to a purely exclusion diet. Endoparasitism should also be excluded prior to immunosuppressive therapy for EE.

Diagnosis

Clinical Signs

  • Vomiting
  • Diarrhoea; small intestinal is more common
    • Haematoemesis or malena, and/or haematochezia; EGE is associated with mucosal erosion or ulceration
  • Protein-losing enteropathy in severe cases
  • Hypoproteinaemia in severe casese


Laboratory Tests

Haematology

  • Anaemia if gastrointestinal haemorrhage is severe.

Biochemistry

  • Eosinophilia
    • This is not always present. Even when present, alone, it cannot prove the presence of EE.
    • It is also a marker for parasitism, hypoadrenocorticism, allergic dermatological disease, allergic respiratory disease and mast cell tumour.
  • Panhypoproteinaemia
    • Secoondary to concurrent protein-losing enteropathy


Diagnostic Imaging

  • Endoscopically, linear ulcers within the duodenal mucosa may be seen grossly.


Histopathology

Biopsy is required for a definitive diagnosis.

Treatment

  • Anti-parasiticide
    • Fenbendazole may be given due to the possible endoparasitism or dietary sensitivity
  • Dietary modification
    • A hypoallergenic diet should be used
  • Immunosuppressive therapy

Refer to IBD for further information


Prognosis

Guarded if the initial response to treatment is poor. Good if the underlying cause is detected and successfully treated.


References

  • Ettinger, S.J. and Feldman, E. C. (2000) Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2 (Fifth Edition) W.B. Saunders Company.
  • Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition) BSAVA
  • Nelson, R.W. and Couto, C.G. (2009) Small Animal Internal Medicine (Fourth Edition) Mosby Elsevier.


Eosinophilic Enteritis

  • Can be either focal or diffuse.

Focal

  • A disease of young dogs.
  • Associated with Toxocara canis infection.
    • Pin-head sized white nodules can be seen under the serosa in the bowel.
      • Consist of of eosinophils and occasionally macrophages and plasma cells.
      • Can sometimes see Toxocara larvae in the nodules.

Diffuse

  • Seen in the dog, cat and horse.
  • Idiopathic
  • Has a predilection for German Shepherd Dogs, but also occcurs in other breeds of dogs and in cats.
    • Recurrent episodes of diarrhoea with tissue and circulatory eosinophilia.
      • Eosinophils heavily infiltrate all layers of stomach and intestines.
    • It has been suggested that it is a type of hypersensitivity reaction.


Eosinophilic enteritis - horse(Courtesy of Susan Rhind, University of Edinburgh)