Similarities and differences of clinical manifestations and prognosis between eosinophilic gastroenteritis and eosinophilic granulomatosis with polyangiitis complicating gastrointestinal involvement

Objective: To investigate the similarities and differences of clinical manifestations and long-term prognosis between eosinophilic gastroenteritis (EGE) and eosinophilic granulomatosis with polyangiitis (EGPA) complicating GI involvement (EGPA-GI).

Methods: Sixty-two EGE and 30 EGPA-GI patients were retrospectively enrolled in PUMCH from 2008 to 2023. Baseline clinical records were collected. Kaplan-Meier curves and log-rank tests were used to analyzed the relapse-free and non-adverse-outcome survival rate. Logistic regression was used to construct a predictive model for diagnosing EGE and EGPA-GI.

Results: Both diseases had a middle age onset. EGE had a shorter disease duration (3.5 vs. 11.0 months, p = 0.023), higher prevalence of distension (50.0% vs 20.0%, p = 0.007) and intestinal obstruction (32.3% vs 3.3%, p = 0.001), and lower prevalence of fever (6.5% vs 50.0%, p < 0.001) than EGPA-GI. EGPA-GI had higher prevalence of allergic diseases (86.7% vs 46.8%, p < 0.001) and higher IgE level (445.0 KU/L vs 153.0 KU/L, p = 0.003). Meanwhile, in EGPA-GI, higher ESR (25.0 mm/h vs 4.0 mm/h, p = 0.001) and hsCRP (48.9 mg/L vs 1.8 mg/L, p < 0.001) were observed. Asthma (OR 572.043, 95% CI 21.729-176,210.429, p = 0.0043), fever (OR 25.221, 95% CI 2.334-585.159, p = 0.0157), rash (OR 28.671, 95% CI 1.898-2274.543, p = 0.454), intestinal obstruction (OR 0.015, 95% CI 0.000-0.357, p = 0.0318), higher ESR (OR 1.101, 95% CI 1.035-1.208, p = 0.0099), and hsCRP (OR 1.038, 95% CI 1.010-1.081, p = 0.0208) were found to be independent discriminating factors for EGPA-GI. Both diseases presented recurrent courses. Adverse outcomes including GI perforation, organ failure, and all-cause death occurred in seven EGPA-GI patients while none in EGE (p = 0.00011).

Conclusion: Both diseases have chronic and recurrent disease courses. Clinical manifestations and laboratory tests help to discriminate them. EGPA-GI have more unfavorable prognosis compared with EGE during long-term follow-up. Key Points •Baseline characteristics and long-term prognosis of 62 EGE and 30 EGPA patients with GI involvement (EGPA-GI) were compared in this study. •Both diseases had chronic and recurrent disease duration, eosinophilia, and increased IgE level. •EGPA-GI had higher prevalence of asthma, fever, rash, higher IgE, ESR, and CRP compared with EGE. •EGPA-GI had higher risk for severe adverse outcomes.