2034 Upper GI Bleed in a Young Male: A Rare Presentation of Eosinophilic Gastroenteritis

Abstract

INTRODUCTION: Eosinophilic gastroenteritis (EGE) is a rare idiopathic disease affecting multiple organs (stomach and small intestine) of the gastrointestinal tract (GIT). It is characterized by eosinophilic infiltration of the bowel wall to a variable depth and symptoms associated with GIT. Klein et al classified EGE into 3 subtypes predominant mucosal, muscular or subserosal. The prevalence has been found to be ranging from 8.4 to 28 per 100,000. CASE DESCRIPTION/METHODS: Our patient is 28-year-old male with PMHx EGE, duodenal ulcers and stricture who presented to hospital with chief complaint of 3 episodes of dizziness and melena for one day. Allergies included food allergies to peanuts. Home medications included prednisone, montelukast and pantoprazole. On admission he was found to be tachycardic (150). Initial labs showed a hemoglobin (hgb) of 9.3. His hospital course included 1 episode of large volume hematemesis >1.5L and brief loss of consciousness followed up by a rapid response. Between day 1 and 2, hgb dropped to 5.7; patient received blood transfusion and managed conservatively with continuous vital monitoring in ICU. Emergent endoscopy (EGD) revealed high grade duodenal stenosis, severe pyloric-duodenal deformity with duodenal ulcer with visible vessel and 2 clips were deployed blindly. Epinephrine could not be injected due to hard and fibrotic tissue around duodenal stenosis. IR was consulted; angiography revealed active bleeding from gastric artery. Cool in and with a subsequent embolization was done. He received 5 unit RBCs total and continued on pantoprazole. For his known duodenal stricture, surgery was consulted with recommendation of no acute surgical intervention in the hospital. On discharge he was sent home with PO PPI, prednisone 40 daily, liquid diet, hydration and close follow up with GI, Surgery and PCP as soon as possible. DISCUSSION: EGE is more common in pediatric population and affects adults between the 3rd and 5th decade of life with a female predominance in USA. The risk factors include: genetic factors observed in familial cases, higher socioeconomic status, Caucasian race and excess weight. EGE is seen in patients with various allergies, asthma and elevated serum IgE levels, suggesting an association with hypersensitivity involved in the pathophysiology of EGE. 3 clinical criteria used to diagnose EGE: Presence of gastrointestinal symptoms; Gastrointestinal eosinophilic infiltrates; Exclusion of causes of tissue eosinophilia such as drug reactions or parasitic infections.