Showing papers on "Abdominal pain published in 2002"

A randomized, double-blind, placebo-controlled trial of tegaserod in female patients suffering from irritable bowel syndrome with constipation.

Abstract: Summary Background : Irritable bowel syndrome is a common functional gastrointestinal disorder which affects up to 20% of the population, with a predominance in females. Aim : To evaluate the efficacy and safety of tegaserod in female patients with irritable bowel syndrome characterized by symptoms of abdominal pain/discomfort and constipation. Methods : In a randomized, double-blind, multicentre study, 1519 women received either tegaserod, 6 mg b.d. (n = 767), or placebo (n = 752) for 12 weeks, preceded by a 4-week baseline period without treatment and followed by a 4-week open withdrawal period. The primary efficacy evaluation was the patient's symptomatic response as measured by the Subject's Global Assessment of Relief. Other efficacy variables included abdominal pain/discomfort, bowel habits and bloating. Results : Tegaserod produced significant (P < 0.05) improvements in the Subject's Global Assessment of Relief and other efficacy variables. These improvements were seen within the first week, and were maintained throughout the treatment period. After withdrawal of treatment, the symptoms rapidly returned. Overall, tegaserod was well tolerated. Diarrhoea was the most frequent adverse event; however, this led to discontinuation in only 1.6% of tegaserod-treated patients. Conclusions : Tegaserod, 6 mg b.d., produced rapid and sustained improvement of symptoms in female irritable bowel syndrome patients and was well tolerated.

Liver abscess in adults: ten years experience in a UK centre

Abstract: Background: The epidemiology and management of liver abscess (LA) have evolved over time. Aim : To examine our experience over 10 years in a UK teaching centre. Design: Retrospective review of patient records. Methods : We reviewed the records of all patients aged >16 years discharged from Royal Hallamshire Hospital with a diagnosis of LA between April 1988 and December 1999. Results: There were 69 patients with LA (65 pyogenic, 4 amoebic), giving a crude annual incidence rate of 2.3/100 000/year (18.15/100 000 hospital admissions). Median age was 64 years. Single lesions were found in 41 patients, multiple lesions in 28. Pre‐admission, patients were symptomatic for a median 14 days, with the most common symptoms and signs being fever and abdominal pain/tenderness. Pathogens were identified in 74% and predisposing aetiology in 92% of those undergoing investigation. Spread of infection to the liver via the portal venous system was the commonest route of infection (46%), most frequently in patients aged ≥60 years ( p =0.019). Abdominal ultrasound (US) was diagnostic for LA in >90% of cases. Treatment with anti‐microbial therapy plus interventional radiology was optimal. The case fatality rate was 12.3%, mainly from associated underlying pathology. Discussion: LA is commonly associated with underlying gastrointestinal pathology. Seeking out this underlying aetiology is an integral part of management. We recommend US as the first‐line diagnostic tool with guided intervention plus antibiotic(s) as first‐line treatment. Prognosis depends chiefly on the underlying pathology.

Pictorial review: adult intussusception--a CT diagnosis.

Abstract: Intussusception, usually thought of as a childhood condition, may be encountered in adults as well, and is then more often associated with underlying pathology. While the condition is mostly unsuspected clinically, as patients present with non-specific abdominal pain that is often of long duration, CT findings are characteristic. Examples are shown of intussusception both in the small bowel and colon. Awareness of these findings allows the radiologist to make the correct diagnosis.

The menstrual cycle affects rectal sensitivity in patients with irritable bowel syndrome but not healthy volunteers

Abstract: Background: We have previously shown that the menstrual cycle has no effect on rectal sensitivity of normal healthy women, despite them having looser stools at the time of menses. Patients with irritable bowel syndrome (IBS) often report significant exacerbation of their IBS symptoms with menses, raising the possibility that IBS patients may respond differently to the menstrual cycle. Aim and methods: Rectal responses to balloon distension during days 1–4 (menses), 8–10 (follicular phase), 18–20 (luteal phase), and 24–28 (premenstrual phase) of the menstrual cycle were assessed in 29 female IBS patients (aged 21–44 years), diagnosed by the Rome I criteria. During the course of the study patients completed symptom diaries to assess abdominal pain and bloating (visual analogue scale), and frequency and consistency of bowel habits. In addition, levels of anxiety and depression were assessed using the hospital anxiety and depression questionnaire. Results: Menses was associated with a worsening of abdominal pain and bloating compared with most other phases of the menstrual cycle (p<0.05). Bowel habits also became more frequent (p<0.05) and patients tended to have a lower general well being. Rectal sensitivity increased at menses compared with all other phases of the cycle (p<0.05). There was no associated change in rectal compliance, wall tension, or motility index. Neither was there any difference in resting anal pressure or the distension volumes required to relax the internal anal sphincter during the menstrual cycle. Conclusion: These data (1) confirm that IBS symptomatology is exacerbated at menses and (2) show for the first time that in contrast with healthy women, rectal sensitivity changes with the menstrual cycle. These cyclical changes in sensitivity suggest that women with IBS respond differently to fluctuations in their sex hormonal environment or its consequences compared with healthy females.

Acute nontraumatic abdominal pain in adult patients: abdominal radiography compared with CT evaluation.

Abstract: PURPOSE: To compare the diagnostic yield of abdominal radiography with that of computed tomography (CT) in adult patients presenting to the emergency department with nontraumatic abdominal pain. MA...

Acute abdominal pain in systemic lupus erythematosus: focus on lupus enteritis (gastrointestinal vasculitis)

Abstract: Objective: To determine the causes of acute abdominal pain in systemic lupus erythematosus (SLE) and to compare the clinical and laboratory data, especially antiphospholipid antibodies and the SLE Disease Activity Index (SLEDAI), between lupus enteritis (gastrointestinal vasculitis) and acute abdominal pain without lupus enteritis in patients with SLE. Methods: A retrospective study was carried out for all patients admitted with SLE from 1993 to March 2001. The SLEDAI and laboratory data were collected at the time of diagnosis of SLE and at the time of acute abdominal pain. Lupus enteritis (gastrointestinal vasculitis) was diagnosed by clinical investigation and abdominal computed tomographic findings. Results: Chart review identified 175 patients (20 male, 155 female) who had been admitted with SLE. Of these patients, 38 (22%) presented with acute abdominal pain. Lupus enteritis was the most common cause of acute abdominal pain. Patients were divided into three groups: group 1: lupus enteritis (n=17), group 2: acute abdominal pain without lupus enteritis (n=21), and group 3: SLE without acute abdominal pain (n=137). There was no difference in age and sex among the three groups. Antiphospholipid, anti-RNP, anti-Sm, anti-Ro, and anti-La antibodies did not differ among the three groups. There was no difference in the SLEDAI at the time of diagnosis and at the time of acute abdominal pain between groups 1 and 2. Complement, erythrocyte sedimentation rate, C reactive protein, and anti-dsDNA measured at the time of acute abdominal pain did not differ between groups 1 and 2. A drop in the white blood cell count at the time of abdominal pain was more prominent in group 1 than group 2. In lupus enteritis, the jejunum and ileum were the sites most commonly affected. Rectal involvement was rare. Even though four patients relapsed, all the patients with lupus enteritis, including those who relapsed, responded well to corticosteroid. Conclusion: Lupus enteritis is the most common cause of acute abdominal pain in SLE. All patients with lupus enteritis responded well to a high dose of a corticosteroid without surgical intervention. The SLEDAI and laboratory data, except leucopenia, do not correlate with the occurrence of lupus enteritis.

A review of the role of the gut microflora in irritable bowel syndrome and the effects of probiotics.

Abstract: Irritable bowel syndrome (IBS) is a multi-factorial gastrointestinal condition affecting 8-22 % of the population with a higher prevalence in women and accounting for 20-50 % of referrals to gastroenterology clinics. It is characterised by abdominal pain, excessive flatus, variable bowel habit and abdominal bloating for which there is no evidence of detectable organic disease. Suggested aetiologies include gut motility and psychological disorders, psychophysiological phenomena and colonic malfermentation. The faecal microflora in IBS has been shown to be abnormal with higher numbers of facultative organisms and low numbers of lactobacilli and bifidobacteria. Although there is no evidence of food allergy in IBS, food intolerance has been identified and exclusion diets are beneficial to many IBS patients. Food intolerance may be due to abnormal fermentation of food residues in the colon, as a result of disruption of the normal flora. The role of probiotics in IBS has not been clearly defined. Some studies have shown improvements in pain and flatulence in response to probiotic administration, whilst others have shown no symptomatic improvement. It is possible that the future role of probiotics in IBS will lie in prevention, rather than cure.

Permanent sacral nerve stimulation for treatment of idiopathic constipation

Abstract: Background: Constipation can usually be managed using conservative therapies. A proportion of patients require more intensive treatment. Surgery provides variable results. This paper describes an alternative approach, in which the neural control of the bowel and pelvic floor is modified, using permanent sacral nerve stimulation. Methods: Four women (aged 27–36 years), underwent temporary and then permanent stimulation. All had idiopathic constipation, resistant to maximal therapy, with symptoms for 8–32 years. Clinical evaluation, bowel diary, Wexner constipation score, symptom analogue score, quality of life questionnaire and anorectal physiology were completed. Results: There was a marked improvement in all patients with temporary, and in three with permanent, stimulation. Median follow-up was 8 (range 1–11) months. Bowel frequency increased from 1–6 to 6–28 evacuations per 3 weeks. Improvement occurred, at longest‒follow‒up, in median (range) evacuation score (4 (0–4) versus 1 (0–4)), time with abdominal pain (98 (95–100) versus 12 (0–100) per cent), time with bloating (100 (95–100) versus 12 (5–100) per cent), Wexner score (21 (20–22) versus 9 (1–20)), analogue score (22 (16–32) versus 80 (20–98)) and quality of life. Maximum anal resting and squeeze pressures increased. Rectal sensation was altered. Transit time normalized in one patient. Conclusion: Permanent sacral nerve stimulation can be used to treat patients with resistant idiopathic constipation. © 2002 British Journal of Surgery Society Ltd

Recurrent pain in children, socio-economic factors and accumulation in families.

Abstract: The aim of this study was to estimate the prevalence of parent-reported pain among children in the Nordic countries in 1996, and to describe the association between recurrent pain in children and parental socio-economic factors. We also wanted to estimate the association between parental pain and childhood pain and co-occurrence of different pain patterns in the same child. Data were obtained from a cross-sectional survey on children's health and well-being in the Nordic countries in 1996. About 10, 000 children aged 2–17 years of age were selected from population registries. Mean response rate was 68%. We selected the cases ≥7 years where the respondent was the child's biological mother or father, yielding a total of 6230 subjects. The adjusted analyses were performed using logistic regression in SPSS. The total prevalence of headache, abdominal pain and back pain among children 7–17 years of age was 14.9, 8.3 and 4.7%, respectively. The most common pain combination was headache and abdominal pain. Pain was most frequent among girls. The prevalence was slightly higher in low educated or low-income families compared to those of high status. Children living in low educated, low-income, worker families had approximately a 1.4-fold odds of having pain. There was a strong association between the different pain conditions, and between pain and other forms of distress in the same child. A site-specific association between parental and child pain was also shown, but we assume that this might have been mediated through subjective (information) bias.

Management of irritable bowel syndrome.

Abstract: Irritable bowel syndrome is the most common functional disorder of the gastrointestinal tract and is frequently treated by family physicians. Despite patients' worries about the symptoms of irritable bowel syndrome, it is a benign condition. The diagnosis should be made using standard criteria after red flags that may signify organic disease have been ruled out. An effective physician-patient relationship is vital to successful management. Episodes of diarrhea are best managed with loperamide, while constipation often will respond to fiber supplements. Antispasmodics or anticholinergic agents may help relieve the abdominal pain of irritable bowel syndrome. Refractory cases are often treated with tricyclic antidepressants. Newer agents such as tegaserod and ondansetron target neurotransmitter receptors in the gastrointestinal tract Some forms of psychologic treatment may be helpful, and gastroenterology consultation is occasionally needed to reassure the patient. Comorbid conditions such as depression or anxiety should be investigated and treated.

Evaluation of early abdominopelvic computed tomography in patients with acute abdominal pain of unknown cause: prospective randomised study

Abstract: Objectives: To evaluate the impact of early abdominopelvic computed tomography in patients with acute abdominal pain of unknown cause on length of hospital stay and accuracy of diagnosis. Design: Randomised, prospective controlled trial. Setting: Teaching hospital in England. Participants: 120 patients admitted with acute abdominal pain for which no immediate surgical intervention or computed tomography was indicated. Intervention: 55 participants were prospectively randomised to early computed tomography (within 24 hours of admission) and 65 to standard practice (radiological investigations as indicated). Main outcome measures: Length of hospital stay, accuracy of diagnosis, and, owing to a possible effect on inpatient mortality, deaths during the study. Results: Early computed tomography reduced the length of hospital stay by 1.1 days (geometric mean 5.3 days (range 1 to 31) v 6.4 days (1 to 60)), but the difference was non-significant (95% confidence interval, 8% shorter stay to 56% longer stay, P=0.17). Early computed tomography missed significantly fewer serious diagnoses. Seven inpatients in the standard practice arm died. Only 50% (59 of 118) of diagnoses on admission were correct at follow up at 6 months, but this improved to 76% (90) of diagnoses after 24 hours. Conclusions: Early abdominopelvic computed tomography for acute abdominal pain may reduce mortality and length of hospital stay. It can also identify unforeseen conditions and potentially serious complications. What is already known on this topic Computed tomography improves the accuracy of diagnosis of several acute abdominal conditions Uncontrolled studies have shown improvements in accuracy of diagnosis after computed tomography; none have described an effect on mortality What this study adds Early abdominopelvic computed tomography for acute abdominal pain can identify unforeseen serious abdominal conditions It may also reduce length of hospital stay and might reduce inpatient mortality

Parent Reports of Coping and Stress Responses in Children With Recurrent Abdominal Pain

Abstract: Objective: To examine relationships among coping, stress responses, pain, somatic symptoms, and anxious/ depressed symptoms in a sample of children and adolescents with recurrent abdominal pain (RAP). Method: We assessed parents’ reports of coping and involuntary responses to stress in relation to pain, somatic symptoms, and symptoms of anxiety and depression in a sample of 174 children and adolescents with RAP. Results: Based on parent reports, children’s primary control engagement coping (e.g., problem solving, emotional modulation) and secondary control engagement coping (e.g., acceptance, distraction, positive thinking) in response to pain were associated with fewer somatic complaints and symptoms of anxiety and depression; secondary control engagement coping was also associated with less pain. Involuntary engagement (e.g., physiological reactivity, rumination) and disengagement (e.g., escape, inaction) responses to pain were associated with more somatic symptoms and higher levels of anxiety and depression. Conclusions: We highlight implications of these findings for understanding processes of coping and stress reactivity in children with RAP.

Role of visceral sensitivity in the pathophysiology of irritable bowel syndrome

Abstract: Visceral hypersensitivity has been recognised as a characteristic of patients with irritable bowel syndrome (IBS). It may be involved in the pathogenesis of abdominal pain/discomfort, and seems to result from the sensitisation of nerve afferent pathways originating from the gastrointestinal tract. From a clinical point of view, hypersensitivity, although frequent, is not a constant finding among patients with IBS and cannot therefore be considered as a diagnostic marker of the condition. The advances made in understanding visceral hypersensitivity in patients with IBS are reviewed: the factors that influence abdominal distension are defined and different therapeutic perspectives are examined.

Risk factors of renal involvement and significant proteinuria in Henoch-Schönlein purpura

Abstract: Risk factors of renal involvement and significant proteinuria in patients with Henoch-Schonlein purpura (HSP) were retrospectively evaluated by univariate and multivariate analyses. The analysis was performed in 134 patients with HSP. Renal involvement was found in 65 patients (49%) and 97% of the renal involvement was found within 3 months of disease onset. Moderate or severe proteinuria was recognised in 25 patients. A univariate analysis revealed that an age of more than 4 years at the onset, severe abdominal pain with gastrointestinal bleeding, persistent purpura over a month, coagulation factor XIII activity <80%, and treatment with factor XIII concentrate were associated with developing renal involvement. A multivariate analysis showed that severe abdominal symptoms, an age of more than 4 years, and persistent purpura increased the risk of renal involvement. Risk factors of moderate or severe proteinuria were also examined. The risk factors in a univariate analysis were severe abdominal symptoms, persistent purpura, decreased factor XIII activity, treatment with steroids, and treatment with factor XIII concentrate. Of those, persistent purpura, treatment with factor XIII concentrate, and factor XIII activity <80% were associated with significant proteinuria in a multivariate analysis. Among the patients with severe abdominal symptoms, factor XIII activity was significantly decreased in patients with significant proteinuria compared to other patients without significant proteinuria. Conclusion: Long-term prognosis of Henoch-Schonlein purpura is dependent on the severity of renal involvement. In those patients who have the risk factors of renal involvement, especially significant proteinuria, close attention should be paid to a urinalysis for at least 3 months from the onset of the disease.

A randomized clinical trial of analgesia in children with acute abdominal pain.

Abstract: Objective: To evaluate the effects of in- travenous morphine on pain reduction, physical ex- amination, and diagnostic accuracy in children with acute abdominal pain. Methods: A randomized, dou- ble-blind, placebo-controlled clinical trial was con- ducted at an emergency department of a tertiary care children's hospital. Children aged 5-18 years with abdominal pain of #5 days' duration, pain score $5 on a 0-10 visual analog scale, and need for surgical evaluation were eligible. Following the initial assess- ment, patients were randomized to receive either 0.1 mg/kg morphine or an equal volume of saline. The pediatric emergency medicine physician and surgical consultant independently recorded the areas of ten- derness to palpation and percussion, and their diag- noses before the study medication and 15 to 30 minutes later. Results: Sixty patients were enrolled, and 29 received morphine and 31 received saline. The demographic characteristics between the two groups were similar. The median reduction of pain score be- tween the two study groups was 2 (95% CI = 1 to 4; p = 0.002). There was no significant change in the areas of tenderness in both study groups. Children with surgical conditions had persistent tenderness to palpation and/or percussion. There was no significant change in the diagnostic accuracy between the study groups and between the physician groups. All pa- tients requiring laparotomy were identified and no significant complication was noted in the morphine group. Conclusions: Intravenous morphine provides significant pain reduction to children with acute ab- dominal pain without adversely affecting the exami- nation, and morphine does not affect the ability to identify children with surgical conditions. Key words: analgesia; acute abdominal pain; children; pediatrics. ACADEMIC EMERGENCY MEDICINE 2002; 9: 281-287

Randomized clinical trial of early laparoscopy in the management of acute non-specific abdominal pain.

Abstract: Background: Abdominal pain of uncertain aetiology (non-specific abdominal pain; NSAP) is the commonest reason for emergency surgical admission. The aim of this study was to examine the role of early laparoscopy in the management of NSAP. Methods: Some 120 patients, admitted between November 1995 and October 1998 with acute abdominal pain of uncertain aetiology, were randomized into two groups: group 1 had laparoscopy during the first 18 h of admission and group 2 had close observation, conventional investigation and surgical intervention if signs of peritonism developed. Outcome measures were diagnosis, operative procedures, duration of hospital stay, readmission rate, morbidity and death, patient satisfaction and total number of investigations performed. Results: Median hospital stay was 2 (range 1–13) days in both groups (P = 0·87). A diagnosis was established in 48 (81 per cent) of 59 patients in group 1 compared with 22 (36 per cent) of 61 in group 2 (P < 0·0001). The morbidity rate was 14 (24 per cent) of 59 in group 1 and 19 (31 per cent) of 61 in group 2 (P = 0·3629). The readmission rate at a median follow-up of 21 (range 1–35) months was 17 (29 per cent) of 59 in group 1 compared with 20 (33 per cent) of 61 in group 2 (P = 0·6375). Well-being scores improved from 134 on admission to 149 of 177 6 weeks later in group 1 (P = 0·007) and from 132 to 143 of 177 in group 2 (P = 0·089). Conclusion: Early laparoscopy provided a higher diagnostic accuracy and improved quality of life in patients with NSAP. © 1999 British Journal of Surgery Society Ltd

Small bowel obstruction after appendicectomy.

Abstract: Background: This study analysed the risk of surgically treated small bowel obstruction after open appendicectomy. Methods: This was a historical cohort study of 245 400 patients who underwent open appendicectomy and population-based matched controls, identified by linkage of computer registries. Analyses were made with the life-table technique, Kaplan–Meier plots and Cox proportional hazards regression analysis. Results: The cumulated risk of surgically treated small bowel obstruction after appendicectomy was 0·41 per cent after 4 weeks, 0·63 per cent after 1 year and 1·30 per cent after 30 years of follow-up, compared with 0·003 per cent at 1 year and 0·21 per cent after 30 years of follow-up among the non-operated controls. The highest risk was found after operation for other diagnoses (adjusted hazard ratio 5·2 (95 per cent confidence interval 4·6–5·8)), followed by operation for perforated appendicitis (adjusted hazard ratio 3·5 (3·1–3·8)), non-specific abdominal pain (adjusted hazard ratio 2·6 (2·3–3·0)) and mesenteric lymphadenitis (adjusted hazard ratio 2·4 (2·0–2·8)) compared with operation for non-perforated appendicitis. The relation with age was J shaped, with the lowest risk at 20–39 years. Women had a slightly lower risk than men. Conclusion: The risk of postoperative small bowel obstruction needing surgical treatment after open appendicectomy is lower than previously thought. Perforated appendicitis, negative appendicectomy and high age are the risk factors. © 2001 British Journal of Surgery Society Ltd

Internal hernia formation after laparoscopic Roux-en-Y gastric bypass for morbid obesity.

Abstract: There is mounting concern that internal hernia formation after laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity remains unrecognized until complications develop. In this report we present our experience with this complication. Out of 100 patients who underwent LRYGB we identified five patients who were diagnosed with postoperative internal hernia formation. The medical records and operative details of these patients were reviewed. Of the five patients four were female and the average age was 36 years (range 30-43). All Roux limbs were placed in a retrocolic position. The average time interval to presentation was 104 days (range 4-305). All patients had abdominal pain and four patients experienced vomiting. One patient had obstipation. Only one patient had fever (38.1° C) and the highest white cell count was 14,500. The average loss in body-mass index was 5.21 kg/m 2 (range 2.5-14.8). Plain abdominal films revealed dilated bowel in the upper abdomen in three patients. Contrast bowel series was diagnostic in only one patient. One patient had a CT scan, which was diagnostic of small bowel obstruction. All patients underwent operative reduction of the internal hernia; two of these were completed laparoscopically. All hernias had occurred at the mesocolic window and were caused by sutures that had pulled through tissue at the dorsal and lateral aspect of the initial repair. One patient had a nonviable segment of small bowel. There were no deaths. Patients who undergo LRYGB are at a 5 per cent risk for developing small bowel obstruction secondary to internal hernia formation at the mesocolic window. Clinical evaluation and traditional study modalities may not be effective diagnostic tools. A high index of suspicion and low threshold to explore these patients may be the best way to avoid serious sequelae. Modification of operative techniques may reduce the occurrence of internal hernia formation.

Eosinophilic gastroenteritis: epidemiology, diagnosis and management.

Abstract: Eosinophilic gastroenteritis is a heterogeneous and uncommon disorder characterized by eosinophilic inflammation of the gastrointestinal tissues. The location and depth of infiltration determine its varied manifestations, and the latter is also the basis for the proposed classification into mucosal, muscular and serosal eosinophilic gastroenteritis. Abdominal pain, vomiting, and diarrhea are each present in nearly 50% of the patients, with some overlap. Peripheral eosinophilia is seen in approximately two-thirds of patients with eosinophilic gastroenteritis. It is now clear that eotaxin, a specific eosinophil chemoattractant, plays a pivotal role in the process of eosinophil production. The differential diagnosis of eosinophilic gastroenteritis in children includes parasitic infections, inflammatory bowel disease, connective tissue diseases, some malignancies and adverse effects of drugs. Eosinophilic gastroenteritis itself has been strongly associated with food allergies, and concomitant atopic diseases or a family history of allergies is elicited in about 70% of cases. The pediatric experience is unique with respect to recognition of distinctive entities such as allergic procto-colitis, almost exclusively seen in infants, and eosinophilic esophagitis being increasingly reported among children and young adults. The gold standard for diagnosis, usually demonstrated on endoscopic biopsies, is prominent tissue eosinophilia. However, the diagnosis may be obscured by the patchy nature of the disease, and muscular and serosal eosinophilic gastroenteritis subtypes. In the latter cases, full thickness biopsies would be indicated for a definitive diagnosis. There are many reports of successful treatment of eosinophilic gastroenteritis in children, using a variety of treatment regimens including elimination diets. Corticosteroids remain the most effective agents for controlling symptoms, but unfortunately the relapsing nature of the disease would mandate prolonged corticosteroid use. Reports of favorable responses to new leukotriene inhibitors in patients with eosinophilic gastroenteritis are encouraging; these responses should stimulate future research on the pathophysiology and management of eosinophilic gastroenteritis.