Case Of Eosinophilic Gastroenteritis Research Articles

S3631 March of the Eosinophils: A Case of Eosinophilic Gastroenteritis, Immune Thrombocytopenia, and Iron Deficiency Anemia

Introduction: Eosinophilic gastrointestinal disorders (EGIDs) refer to eosinophilic infiltration of the gastrointestinal tract in the absence of secondary causes. Here, we present a case of a young male with immune thrombocytopenia (ITP) and biopsy-proven eosinophilic gastroenteritis that developed iron-deficiency anemia. Case Description/Methods: A 16-year old male with a past medical history significant for autism, ITP, melanoma, allergic rhinitis, and eosinophilic esophagitis presented for evaluation of chronic abdominal pain. He had an EGD in April 2018 that revealed white exudates at the gastroesophageal junction, scattered erosions in the gastric body and fundus, severe antral gastritis, and scattered erosions noted throughout the duodenal bulb. Biopsies were taken and revealed distal eosinophilic esophagitis (greater than 50/HPF), eosinophilic gastritis, and chronic inflammation of the duodenal bulb with Brunner gland hyperplasia and villous blunting. Absolute eosinophil count was higher than 2,000/uL. Given findings of persistent inflammation despite a six-food elimination diet, the patient was started on oral Budesonide, a proton-pump inhibitor, and an H2 receptor blocker. In March 2020, a repeat surveillance EGD with biopsy revealed the duodenum was free of inflammation or other diagnostic abnormalities. Roughly 28 eosinophils/HPF were present in the gastric cardia near the GEJ, and numerous eosinophils remained in the other gastric tissues sampled. B udesonide was discontinued due to patient intolerance. In early 2021, the patient was found to have microcytic anemia. Further Hematologic evaluation revealed low folate and iron levels. He was started on supplemental iron and folic acid, leading to resolution of the anemia. Iron and folate deficiency was believed to be secondary to malabsorption caused by EGE. (Figure) Discussion: Eosinophilic gastrointestinal diseases remain a rare and underexplored clinical entity. While its pathophysiology is not fully understood at this time, TH2 mediated activation of B-cells and subsequent stimulation of eosinophils locally appears to be at play. Given ITP has a TH1 predominant cytokine profile, it is unclear if there is a causal association between the two. Diagnosis of EGID necessitates histological evidence of eosinophilic infiltration of the GI tract in the absence of secondary causes or infiltration elsewhere. Dietary modification to eliminate food allergens is a reasonable initial treatment, glucocorticoids remain the mainstay of pharmacotherapy at this time.Figure 1.: Cross-section of gastric tissue stained with hematoxylin and eosin demonstrating prominent eosinophils (greater than 100 per high-power field) within the lamina propria and gastric epithelium with associated epithelial injury.

Eosinophilic gastrointestinal disorders presenting with multiple gastric and colonic ulcerative lesions: a case report

Eosinophilic gastrointestinal disorders are rare inflammatory conditions marked by eosinophilic infiltration of the gastrointestinal tract. Endoscopic manifestations vary from patient to patient. However, ulcerative lesion is a rare occurence. A 57-year-old patient presented with chronic diarrhea and significant peripheral blood eosinophilia. During endoscopy, multiple ulcers were discovered throughout the stomach, duodenum, and colon. Biopsies showed excess tissue eosinophilia suggestive of eosinophilic gastroenteritis and colitis. The patient responded dramatically with corticosteroid. However, he developed steroid dependency necessitating the use of azathioprine. In conclusion, a rare case of eosinophilic gastroenteritis and colitis presented with multiple ulcerative lesions was described. Physicians should be aware that eosinophilic gastroenteritis and colitis may be a cause of chronic diarrhea, particularly, in patients presented with peripheral blood eosinophilia. Corticosteroid is the mainstay of treatment. In steroid dependency case, azathioprine may be an option.

Eosinophilic Gastroenteritis in Tropical Area: about 6 Cases from Senegal

The aetiologies of hypereosinophilia are dominated by digestive parasitosis and drug intake. In the tropics, because of the frequency of parasitosis, eosinophilic digestive pathologies of primary origin, which are rare, may be overlooked. We report 6 cases of eosinophilic gastroenteritis with polymorphic digestive manifestations testifying to the different locations of eosinophilic infiltration in the digestive parietal layer. Three patients had ascites rich in eosinophils, indicative of serous involvement, while the other two had a muscular form, and the last a mucosal involvement. The evolution was favourable in all cases with corticosteroid therapy, but a recurrence was noted in 4 cases when treatment was stopped.

S3495 A Case of Eosinophilic Gastroenteritis in Disguise as a Parasitic Infection

Introduction: Eosinophilic gastroenteritis (EGE) is a rare inflammatory disorder that can involve any part of the gastrointestinal (GI) tract affecting around 22 per 100000 people. It classically presents with GI symptoms and peripheral eosinophilia. Our case highlights a clinical overlap between eosinophilic gastroenteritis (EGE) and parasitic infection. Case Description/Methods: A 41-year-old man presented with 2 weeks of watery diarrhea and emesis, after a 2-month trip to Latin America. His symptoms started a few days before his return. He reported 10-14 episodes of watery, non-bloody diarrhea daily with intermittent epigastric pain, night sweats, anorexia, nausea, and weight loss. He was given amoxicillin by a relative without avail in addition to taking penicillin two days before presentation for a tooth infection. On his trip, he occasionally drank tap water, had raw vegetables and raw milk but denied having raw meat or fish. He also reported walking barefooted in jungle areas and swimming in lakes, but denied any foot/skin trauma. His medical history is non-contributory. On exam, blood pressure was 99/62 mmHg, with an otherwise normal full exam. Labs showed normal hemoglobin, WBC of 11.4k/ml with eosinophilia, and a Creatinine of 1.35 mg/dl. Abdominal CT with contrast showed colitis of the ascending and proximal transverse colon. He was empirically given ivermectin for Strongyloides with no improvement. Further infectious workup was negative. Endoscopy findings suggested eosinophilic esophagitis, gastritis, erythematous duodenopathy, and an erythematous mucosa in the terminal ileum (Figure 1). Pathology showed active esophagitis, inflammation in the gastric antrum, duodenum, terminal ileum, colon, and markedly increased eosinophils and plasma cells in all locations. He was discharged on albendazole but with no response. He was readmitted and started on a 10-day prednisone 40mg course with improvement leading to discharge. Discussion: The presentation of GI symptoms and peripheral eosinophilia carries a broad list of differential diagnoses including parasitic infections, inflammatory bowel disease, hyper-eosinophilic syndrome, malignancy, and eosinophilic gastroenteritis. This can be challenging at times as it can represent an overlap between multiple etiologies. We decided to treat empirically for Strongyloides given the suspicious travel history and the risk of hyperinfection syndrome, but the lack of response led to a more confident diagnosis of EGE as evident by response to corticosteroids.

S2982 A Case of Eosinophilic Gastroenteritis and Eosinophilic Dermatitis in a Patient: Two Sides of the Same Coin?

S2982 A Case of Eosinophilic Gastroenteritis and Eosinophilic Dermatitis in a Patient: Two Sides of the Same Coin?

Successful use of montelukast in eosinophilic gastroenteritis: a case report and a literature review

BackgroundEosinophilic gastrointestinal disorders, also known as eosinophilic gastroenteritis, are rare inflammatory conditions characterized by eosinophilic infiltration of different parts of the gastrointestinal tract, along with peripheral eosinophilia in most cases. Other known causes for gut eosinophilic infiltration must be excluded to confirm the diagnosis of eosinophilic gastroenteritis. Symptoms of the disorder depend on the affected gastrointestinal tract segment and depth of involvement. Treatment includes systemic glucocorticoids and/or dietary therapy with an empiric elimination diet. Second line therapies include the leukotriene receptor antagonist montelukast, and other anti-allergy drugs such as mast cell stabilizers (including cromolyn and the H1-antihistamine ketotifen), suplatast tosilate which is a selective Th-2 cytokines (IL-4 and IL-5) inhibitor, and the monoclonal anti-IgE antibody omalizumab. We report a case of eosinophilic gastroenteritis who was successfully treated and achieved remission with montelukast as an initial monotherapy. Upon extensive literature review, this represents the second reported adult case of eosinophilic gastroenteritis who responds to montelukast alone as a first line therapy.Case presentationA 49-year-old female presented with recurrent abdominal pain, vomiting, diarrhea and unexplained eosinophilia. She was diagnosed with eosinophilic gastroenteritis and was successfully treated with montelukast monotherapy. After 7 days of therapy, the patient responded well and had complete resolution of her gastrointestinal symptoms and peripheral eosinophilia. Patient remained in remission on follow-up after 12 months. We reviewed the literature for leukotriene antagonist use in the treatment of eosinophilic gastroenteritis and included the cases treated with the leukotriene antagonist montelukast as an initial therapy or as a second line therapy for refractory disease.ConclusionMontelukast may be an effective treatment for eosinophilic gastroenteritis, either alone or in combination with systemic steroids or ketotifen. Our patient is the second reported adult case of eosinophilic gastroenteritis who responded to montelukast alone as a first line therapy. Further studies and clinical trials are required to confirm efficacy compared to standard therapy.

Peripheral eosinophilia and hypoalbuminemia are associated with a higher biopsy diagnostic yield for eosinophilic gastroenteritis

BackgroundGastric and duodenal mucosa may appear normal in eosinophilic gastroenteritis (EGE). Adult gastroenterologists typically biopsy only in the setting of mucosal abnormalities or symptoms, while pediatric providers biopsy all patients. The biopsy yield of EGE has not been adequately evaluated. AimsTo evaluate the biopsy yield of EGE in a pediatric cohort and assess predictors of increased biopsy yield. MethodsWe identified patients age 0-18 who underwent upper endoscopy. We recorded endoscopic findings, pathology, demographics, and clinical and laboratory characteristics. We identified EGE cases (>20 eosinophils per high-power field on stomach and/or duodenum biopsy). We compared characteristics between EGE and non-EGE cases, calculated biopsy diagnostic yield, and performed multivariate analysis for predictors of increased biopsy yield. ResultsIn 509 patients (55.6% female, mean age 10.3 years, 69.7% white, 58.7% atopic), biopsy diagnostic yield for EGE was 1.2% (6/509) among all subjects, 7.7% (3/39) for those with peripheral eosinophilia (≥500 eos/uL), 9.1% (3/33) for those with hypoalbuminemia (<3.5 g/dL), and 25.0% (3/12) for those with peripheral eosinophilia and hypoalbuminemia. The odds of EGE were 27.8 (95% CI 3.3–231.8) times greater among those with peripheral eosinophilia. The mean total biopsy surface area and number of fragments was similar between patients with and without EGE. The area under the ROC curve for blood eosinophil counts and albumin level for predicting EGE was 0.926. ConclusionsThe biopsy diagnostic yield for EGE is low but increases with peripheral eosinophilia and hypoalbuminemia. Patients with these features should have biopsies obtained, regardless of endoscopic appearance.

Abdominal pain and mass caused by subserosal eosinophilic enteritis

Abstract Eosinophilic gastroenteritis (EGE) causes acute abdomen, which is not diagnosed preoperatively and sometimes requires emergency surgery. Here we report a case of EGE, in which laparoscopy was performed to reveal the cause of recurrent abdominal pain, and a mass lesion was detected. Moreover, we finally diagnosed subserosal layer type of EGE based on the pathological results.

Eozinofilni gastroenteritis sa akutnim abdomenom - prikaz slučaja

Eosinophilic gastroenteritis (EGE) as a rare inflammatory gastrointestinal (GI) disorder is primarily characterized by long-term or recurrent abdominal pain. Peripheral eosinophilia is usually caused by eosinophilic infiltrations into the multiple layers of the GI tract. In this report, a case of EGE with an acute abdomen is presented. A 14-year-old female experienced severe abdominal pain and hypereosinophilia. She underwent appendectomy due to severe abdominal pain approximately one week before readmission. Because of the persistence of pain, the upper GI endoscopy and biopsy were performed and the result of the pathological examination was eosinophilic gastroenteritis. Due to the nonspecificity of EGE symptoms, it is recommended that clinicians study pathology in atypical and nonresponsive GI diseases; biopsy should be performed as well.

A Case of Eosinophilic Gastroenteritis with Small Bowel Perforation

A Case of Eosinophilic Gastroenteritis with Small Bowel Perforation

Clinical Characteristics and Treatment Outcomes of Patients with Eosinophilic Esophagitis and Eosinophilic Gastroenteritis

Background: Eosinophilic esophagitis (EoE) and eosinophilic gastroenteritis (EGE), part of the spectrum of eosinophilic gastrointestinal disorders (EGID), share pathogenic similarities. We examined differences regarding clinical characteristics and treatment outcomes between EoE and EGE cases. Methods: Two-hundred fifteen EGID patients, including 181 with EoE and 34 with EGE, diagnosed at Shimane University Hospital between February 2011 and March 2019 were enrolled. Information regarding clinical parameters and treatment outcomes was reviewed. Results: EoE showed significant male predominance (82.3%) as compared with EGE (50.0%) (p < 0.001). Furthermore, patients with EoE were significantly older and had a higher body mass index (24.8 ± 4.0 vs. 22.2 ± 4.3, p < 0.05). Over 90% of the EoE patients were initially given proton pump inhibitor (PPI) treatment, of whom 73.2% showed clinical and histological remission. Vonoprazan, a more potent acid inhibitor than PPI, was effective in two-thirds of the nonresponsive EoE patients initially treated with a PPI. In contrast, oral glucocorticoid administration was mainly given to patients with EGE (58.8%). Of 13 EGE patients treated with a food-elimination diet, responsible foods were successfully identified in 9, with 7 controlled in a state of remission without glucocorticoid therapy. Conclusions: We found different clinical characteristics and treatment strategies in the present EoE and EGE cases. Most of the EoE patients responded to and were maintained by acid suppressive therapy, using PPI or vonoprazan. For EGE patients, glucocorticoid administration was mainly used though food-elimination diet therapy also showed beneficial effects.

S3378 A Case of Eosinophilic Gastroenteritis in Disguise as a Parasitic Infection

S3378 A Case of Eosinophilic Gastroenteritis in Disguise as a Parasitic Infection

S2959 Eosinophilic Gastritis: An Imposter of Gastric Malignancy

INTRODUCTION: Eosinophilic gastroenteritis (EGE) is an uncommon condition characterized by eosinophilic infiltration into the lining of the GI tract with a predilection for the stomach and proximal small bowel. Symptoms are non-specific, and the disease is known to take a chronic, relapsing/remitting course. To date, approximately 300 cases are described in literature. Here, we present a case of EGE closely mimicking gastric malignancy. CASE DESCRIPTION/METHODS: A 57-year-old male with a past medical history of DM II, HTN, GERD, and ESRD was admitted to the hospital with 30 lbs weight loss, postprandial fullness, and intractable vomiting. Physical examination showed moderate tenderness to deep palpation in the upper abdomen. CT scan revealed gastric outlet obstruction from an incidental finding of gastric antrum mass. An EGD was performed and revealed a malignant appearing mass in the pre-pyloric region of the stomach. Biopsies showed peptic duodenitis without any evidence of malignancy or H. Pylori infection. Given high suspicion for malignancy, an endoscopic ultrasound was performed to evaluate the deeper layers and obtain snare mucosal biopsies. EUS showed a 12mm diffuse wall thickening of the pylorus with distortion of the gastric wall layer architecture. FNA of the deep gastric layers was performed using a 22G needle. FNA and repeat mucosal biopsies were negative for malignancy and showed reactive epithelial cells and non-specific inflammation. After a multi-disciplinary discussion, the decision was made to perform diagnostic laparoscopy, followed by gastro-jejunostomy, for the gastric outlet obstruction. Intra-operative findings did not show any evidence of peritoneal disease or lymphadenopathy. Pathology showed diffuse eosinophilic infiltration of the mucosa and muscularis propria, consistent with eosinophilic gastritis. He recovered well from his surgery and tolerated solid food prior to discharge. DISCUSSION: The pathogenesis of EGE is not well understood. Available evidence suggests that it is a hypersensitivity reaction. Histopathological analysis can confirm the diagnosis. Eosinophilic infiltration can involve any layer of the stomach (mucosa, muscularis propria, or serosa), which impacts clinical presentation. The treatment is primarily based on dietary modifications and systemic steroids. In conclusion, eosinophilic gastroenteritis should remain on the differential diagnosis in appropriate clinical cases where the diagnosis of cancer is unclear.Figure 1.: Endoscopic visualization of mass in the gastric antrum. The mass extended into the pylorus.Figure 2.: Hematoxylin and eosin stain of superficial pylorus biopsy taken during EGD. This largely shows inflammation, with mildly increased eosinophils. This image was taken at 20x magnificationFigure 3.: Hematoxylin and eosin stain of full-thickness antral tissue taken during exploratory laparotomy. This shows focally increased mucosal eosinophils. This image was taken at 40x magnification.

THREE CASE REPORTS OF EOSINOPHILIC GASTROENTERITIS WITH MILK, WHEAT, AND PEANUT FOOD ALLERGY

Eosinophilic gastroenteritis (EGE) is an uncommon disease that can affect one or more organs of the digestive tract. EGE has a very low incidence rate and its diagnosis is challenging for any clinician. We report a case series of three cases of EGE who were evaluated for non-specific gastrointestinal symptoms and presented with an increase in eosinophils and total immunoglobulin E. The diagnosis of EGE was confirmed by histopathological findings. The causative food allergens were identified by provocation and elimination tests. The relevance of our case series lies in concomitant food allergy with the atopic constitution and the improvement of symptoms after the elimination of specific food is the mainstay for the management of EGE.

Case Report: Importance of dietary modification in successful management of eosinophilic gastroenteritis

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. Case report: A 70-year-old male with a history of gastroesophageal reflux disorder (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 hemoglobin of 13.2 g/dl, hematocrit of 38.5%, mean corpuscular volume of 86.3%, white blood cell count of 24,200/mm3, albumin of 2.2 g/L, stool fat of 70g, stool osmolar gap of 115, C-reactive protein 1.47. Erythrocyte sedimentation rate, HIV test were unremarkable. Infectious stool work-up was negative. Computed tomography of the 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 eosinophilic gastroenteritis was made after other causes such as parasitic infection, drug use and malignancy were ruled out. The patient was counseled on 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 recurrence rate of EGE is 50%. 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. Dietary modification, a therapy with no side-effects should be the first line of treatment as it can result in resolution sparing the patient of steroid induced side effects.

1727 Importance of DIETARY Modification in Successful Management of Eosinophilic Gastroenteritis

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.

Eosinophilic gastroenteritis: diagnosis and clinical perspectives.

Eosinophilic gastroenteritis (EGE) is a digestive disorder in children and adults that is characterized by eosinophilic infiltration in the stomach and intestine. The underlying molecular mechanisms predisposing to this disease are unknown, but it seems that hypersensitivity response plays a major role in its pathogenesis, as many patients have a history of seasonal allergies, food sensitivities, asthma, and eczema. Symptoms and clinical presentations vary, depending on the site and layer of the gastrointestinal wall infiltrated by eosinophils. Laboratory results, radiological findings, and endoscopy can provide important diagnostic evidence for EGE; however, the cornerstone of the diagnosis remains the histological examination of gastric and duodenal specimens for evidence of eosinophilic infiltration (>20 eosinophils per high-power field), and finally clinicians make the diagnosis in correlation with and by exclusion of other disorders associated with eosinophilic infiltration. Although spontaneous remission is reported in around 30%–40% of EGE cases, most patients require ongoing treatment. The management options for this disorder include both dietary and pharmacological approaches, with corticosteroids being the mainstay of therapy and highly effective. The subsequent course is quite variable. Some patients have no recurrences, while a few experience recurrent symptoms during or immediately after corticosteroid interruption. An alternative therapeutic armamentarium includes mast-cell stabilizers, leukotriene antagonists, antihistamines, immunomodulators, and biological agents. In this review, we provide a summary of the different diagnostic tools utilized in practice, as well as the different therapeutic approaches available for EGE management.

Eosinophilic Ascites, A Challenging Diagnosis

Eosinophilic ascites is a rare presentation of eosinophilic gastroenteritis (EGE), a rare condition first described by Kaijser, in 1937; Hundreds of cases have been reported. EGE affects both adults and children. EGE was defined by the presence of gastrointestinal symptoms with an abnormal eosinophilic infiltrate of the intestine wall and exclusion of other causes of secondary eosinophilic infiltration; EGE has 3 clinical presentations depending on the depth of eosinophilic infiltration of the bowel wall. The mucosal form (44% of EGE cases) is associated with diarrhoea, malabsorption, protein-losing enteropathy or bleeding. The muscular form (12% of cases) corresponds to eosinophilic infiltration of the muscular layer and may result in acute obstruction. The serosal form (39% of EGE cases) and may result in eosinophilic ascites (21%).

Eosinophilic Gastroenteritis: 3 Cases and Review of Literature

Eosinophilic Gastroenteritis: Eosinophilic Gastroenteritis (EGE) is a rare disease affecting one or more segments of gastrointestinal tract, mainly stomach and small bowel with dense eosinophilic infiltration in gastrointestinal tract. It has a chronic clinical course. The patients may or may not have peripheral eosinophilia. The treatment of choice is a short course of corticosteroids. We present three cases of eosinophilic gastroenteritis with review of literature

Clinical characteristics, diagnosis, and treatment of 98 cases of eosinophilic gastroenteritis

Clinical characteristics, diagnosis, and treatment of 98 cases of eosinophilic gastroenteritis