S3588 Eosinophilic Gastroenteritis and Colitis After Intragastric Balloon Placement

Abstract

Introduction: Eosinophilic gastrointestinal diseases (EGIDs) are a group of rare disorders characterized by infiltration of eosinophils in the gastrointestinal tract. Hypersensitivity to food or environmental allergens is believed to play a pivotal role in the pathogenesis. Intragastric balloon (IGB) has been demonstrated as an effective and safe therapy for weight loss. Interestingly, a previous report described development of eosinophilic esophagitis (EoE) following IGB placement, suggesting a possible association between IGB and EGIDs. Case Description/Methods: A 61-year-old male underwent endoscopic placement of an Orbera® intragastric balloon for weight reduction. Forty days later, he presented with a 3-day history of watery and non-bloody diarrhea, abdominal pain, and nausea. Labs were notable for severe peripheral eosinophilia over 15,000/mL. Extensive infectious workup were unremarkable. His IGB was removed as he had reached his goal weight. Then, he underwent esophagogastroduodenoscopy and flexible sigmoidoscopy with biopsy. Endoscopic exam was notable for diffuse erythema in the stomach and duodenum, and congestion in the colon. Histologically, dense inflammatory infiltration of eosinophils and plasma cells in the lamina propria was found in the stomach, duodenum, and colon. After removal of the IGB, his symptoms and peripheral eosinophilia improved rapidly, and were resolved completely within 1 month without need for immunomodulatory therapies or diet modifications. Discussion: We describe a case of eosinophilic gastroenteritis and colitis with severe peripheral eosinophilia following IGB placement, in whom rapid resolution occurred after IGB removal without additional therapies. To our knowledge, this is the first case report that suggests a possible association between IGB and non-EoE EGIDs, which warrants clinicians' awareness and further studies.