1727 Importance of DIETARY Modification in Successful Management of Eosinophilic Gastroenteritis

Abstract

INTRODUCTION: Eosinophilic gastroenteritis (EGE) is an extremely rare inflammatory disorder with an estimated prevalence of 22-28/100 000. We herein, present a case of EGE in an elderly patient which was successfully managed with dietary restriction. We would like to stress that food allergy is the main culprit in certain cases of EGE and dietary modification should always be the first step in the management of these cases. CASE DESCRIPTION/METHODS: A 70-year-old male with a history of GERD, atopic dermatitis and asthma presented with 2 weeks history of foul-smelling non-bloody diarrhea associated with nausea, vomiting and weight loss. Physical examination was significant for dry oral mucosa and loss of skin turgor. Lab findings were significant for a Hb/Hct (g/dl/%) of 13.2/38.5, MCV of 86.3%, WBC count of 24,200/mm3, albumin of 2.2 g/L, stool fat of 70g, stool osmolar gap of 115, CRP of 1.47. ESR, HIV test, infectious stool work-up were unremarkable. CT abdomen was unremarkable. The mucosa appeared mildly inflamed on upper endoscopy and colonoscopy, and biopsies showed eosinophilic infiltration of the mucosal and muscular layers. A diagnosis of EGE was made after other causes such as parasitic infection, drug use and malignancy were ruled out. The patient was suggested a six-food elimination diet which successfully resolved his diarrhea. The patient did not have any relapses with dietary modification on follow-up. DISCUSSION: The prevalence of EGE is underestimated as it is under diagnosed given the rarity of the condition especially when it presents outside of the age spectrum. The pathogenesis of EGE remains unclear and it is hypothesized to be a hypersensitive response to certain allergens. The recurrence rate of EGE is 50% and a dietary trial could be a long-term solution. A six-food elimination diet or an elemental diet is recommended. Steroids improve symptoms in 90% of cases but the recurrence rates are high. The type, dose and duration of steroid therapy is unclear. Sodium cromoglicate, ketotifen, and Montelukast are other proposed treatments, the results being inconclusive. Bowel resection is performed in intestinal obstruction, but medical therapy is needed as recurrence in other segments in common. The clinical guidelines for the diagnosis of EGE is sparse and the treatment offered is low-evidence based. Dietary modification, a therapy with no side-effects should be the first line of treatment and can result in resolution sparing the patient of steroid induced side effects.