S3146 Patients With Eosinophilic Esophagitis (EoE) and Persistent Extra-Esophageal GI Symptoms Should Be Evaluated for Eosinophilic Gastritis (EG) and Eosinophilic Duodenitis (EoD)

Abstract

INTRODUCTION: Eosinophilic gastrointestinal (GI) disorders (EGIDs) are chronic inflammatory conditions characterized by aberrant accumulation and activation of localized tissue eosinophils and mast cells. While Eosinophilic Esophagitis (EoE) is the best understood of the EGIDs, there is growing understanding of Eosinophilic Gastritis (EG) and Duodenitis (EoD) and evidence that they may be more prevalent than previous estimates. Though EoE is defined in part by esophageal dysfunction, patients with EoE often present with extra-esophageal symptoms which may not be attributable to isolated esophageal inflammation. EG/EoD may be underdiagnosed in these patients due to non-routine biopsy and histopathologic evaluation of gastric and duodenal mucosa. We reviewed gastric and duodenal biopsies in patients with known EoE and persistent non-esophageal symptoms to determine the frequency of EG/EoD in this population. METHODS: 27 patients at the University of Utah with a known history of EoE, persistent extra-esophageal symptoms, and a history of gastric and duodenal biopsies were identified, and retrospectively reviewed. Histopathologic evaluation was performed and eosinophil counts and chronic inflammation were assessed. Eosinophilic gastritis and duodenitis were defined as the presence of ≥30 eosinophils/high-powered field (hpf) in 5 and 3 hpfs in the stomach and duodenum, respectively. RESULTS: Of the 27 patients, 17 (63%) met histologic criteria for EG and/or EoD (4 combined EG/EoD, 13 EoD). The most common non-esophageal symptoms among these 17 patients were abdominal pain, nausea and bloating. 3 of the 17 patients had been diagnosed with irritable bowel syndrome in addition to EoE. Of the 10 patients not meeting histologic criteria for EG/EoD, 4 were subsequently found to have gastroparesis, 1 was on high dose NSAIDs and 1 was subsequently found to have mast cell activation syndrome. CONCLUSION: In this retrospective study, 63% of patients with EoE and chronic extra-esophageal GI symptoms were found to meet histologic criteria for EG/EoD. This high discovery rate suggests that gastric and duodenal biopsies should be performed and evaluated for eosinophils in patients with EoE and extra-esophageal symptoms, including those with persistent abdominal pain, nausea, bloating or a diagnosis of functional GI disease.