Eosinophilic Enteritis Research Articles

Concordance of the Histopathologic Diagnosis of Concurrent Duodenal and Ileal Biopsy Specimens in Dogs.

Simple SummaryCanine chronic inflammatory enteropathy (CIE) is a gastrointestinal (GI) inflammatory condition that requires histopathology of intestinal biopsies for definitive diagnosis. This can be performed endoscopically or surgically; with the former being more common as it is less invasive. In recent years, research has identified that different types of inflammatory disease and histologic severity can exist at different locations within the GI tract, known as discordance. There is a lack of understanding of the clinical impact of lesion oversight in dogs with discordant biopsies between locations. Therefore, current recommendations are to procure endoscopic biopsies from both the upper intestinal (stomach and duodenum) and lower small intestinal tract (ileum) when possible. The rate of discordance between different GI locations has not been assessed in dogs with non-inflammatory enteropathies, i.e., neoplastic etiology, nor compared between endoscopic and surgically collected biopsy specimens. Here, we report that the rate of discordance between the duodenum and ileum in CIE is similar between endoscopic biopsy and surgical biopsy specimens and confirm that discordance between upper and lower GI biopsies exist for small-cell lymphoma. There were no clinicopathologic variables that were correlated with discordance. We conclude that for all dogs with chronic GI signs, concurrent duodenal and ileal biopsies should be performed.Histopathologic discordance between gastrointestinal (GI) locations in canine chronic inflammatory enteropathy (CIE) has prompted recommendations to biopsy both the duodenum and ileum, while further evaluation is required for non-CIE. We aimed to determine the concordance of histopathologic diagnosis between duodenal and ileal endoscopic or full-thickness biopsy specimens for all dogs with CIE and GI neoplasia and to assess the association between histopathologic discordance between GI locations with clinicopathologic variables. Seventy-nine dogs were eligible, with endoscopic (74) or full-thickness (5) biopsy specimens. Clinicopathological data were recorded for all dogs. Concordance of histopathologic diagnosis was retrospectively assessed for concurrent duodenal and ileal biopsy specimens by a single board-certified veterinary pathologist using the modified World Small Animal Veterinary Association (WSAVA) Gastrointestinal Standardization Group guidelines. Sixty-seven dogs were diagnosed with CIE and 5 with enteric-associated T-cell lymphoma-2 (EATL-2). Concordance of histologic diagnosis between duodenal and ileal sites was similar between endoscopic (73.0%) and full-thickness (80.0%) biopsy groups. For the CIE cases, lymphoplasmacytic enteritis had the highest concordance (73.0%) and eosinophilic enteritis the least (16.7%). Of the 5 neoplastic cases, 5/5 (100%) were present at the duodenum but only 3/5 (60%) in the ileum. No clinicopathologic variables demonstrated a statistically significant association with discordance. We conclude that the level of discordance necessitates concurrent biopsy of both duodenum and ileum in all dogs with chronic GI signs. The rate of EATL-2 was lower than rates reported for cats.

S2961 Nivolumab-Induced Recurrence of Eosinophilic Enteritis and Esophagitis

S2961 Nivolumab-Induced Recurrence of Eosinophilic Enteritis and Esophagitis

English

BACKGROUND In a developing country like India, vast difference exists in people’s religion, culture, and socio-economic condition and along with it, there exists a significant difference in their dietary habits. This has led to an incidence of a large spectrum of gastrointestinal (GI) diseases which is different in different geographical locations. The study was undertaken for studying the spectrum of various histopathological lesions of gastrointestinal tract with the help of endoscopic biopsy. METHODS This cross-sectional study was carried out in a span of 2 years in the histopathology division. The study included 105 patients who had GI complains and underwent endoscopic biopsies for the same. RESULTS The present study included a total of 105 cases out of which there were 64 cases (61 %) of upper GI tract biopsies and remaining 41 cases (39 %) were of lower GI tract biopsies. Among 64 (100 %) cases of upper GI biopsies, reflux oesophagitis (4.67 %) was the most common in non-neoplastic lesions while well differentiated squamous cell carcinoma (20.31 %) was the most common neoplastic pathology. In gastric biopsies, chronic atrophic gastritis (3.12 %) was the most common condition in a non-neoplastic category, while gastric adenocarcinoma (15.61 %) was the malignant lesion which was found. Among duodenal biopsies, the most common lesion was eosinophilic enteritis / duodenitis (14.06 %). Among 41 (100 %) colonoscopic biopsies, the most common lesion was chronic non-specific inflammation (12.19 %) under non-neoplastic category, while well differentiated adenocarcinoma (46.34 %) was most common entity under malignant category in our study. Non-neoplastic lesions were more common in upper GI endoscopic biopsies whereas, neoplastic lesions were more frequently seen with lower GI endoscopic biopsies. CONCLUSIONS Performing endoscopy alone is an incomplete investigative modality for the diagnosis. While performing endoscopy and simultaneously taking biopsy for histopathological evaluation helps in giving an accurate diagnosis. KEY WORDS GIT, Endoscopy, Endoscopic Biopsy

Primary Eosinophilic Gastrointestinal Diseases Beyond Eosinophilic Esophagitis in Children.

There are many unknowns about primary eosinophilic gastrointestinal disease (EGID) in childhood. The aim of this study is to provide data about the frequency, management, control level, and prognosis of well documented primary EGID in childhood. This study was conducted in children who underwent endoscopy and/or colonoscopy at a single center over 10-year period up to August 2018. Primary EGID was diagnosed after exclusion of secondary EGID and classified as eosinophilic gastritis (EG), eosinophilic enteritis (EE), eosinophilic gastroenteritis (EGE: eosinophilic gastritis with eosinophilic enteritis) and eosinophilic colitis (EC) according to histopathological evaluation. The pathological number of eosinophil counts were accepted as >30 hpf for gastric mucosa in 5 hpf area, ≥20/hpf for duodenal, jejunal, and ileal mucosa, >50/hpf for right colonic mucosa, >35/hpf for transverse colonic mucosa, and >25/hpf for left colonic mucosa. Presenting symptoms, signs, management, follow-up, disease control level, and remission were analyzed. Remission is defined if the patient is controlled with all clinical, endoscopic/colonoscopic, and histopathologic parameters without any treatments or diet for at least a year. During the study period, 7457 biopsies were taken in 8262 endoscopy and/or colonoscopy procedures. Primary and secondary EGID frequencies were found 0.23% (n = 17 patients) and 0.1% (n =8 patients) per procedure with biopsy in children, respectively. Endoscopy/colonoscopy procedures were not able to performed in 9 patients because of short follow-up period (n = 6) or patients leaving follow-up (n = 3). Nine of the primary EGID patients had esophageal eosinophilia (EsE) at the time of diagnosis, 5 of them were previously managed as EoE. The median follow-up period of primary EGID patients excluding the ones without a control endoscopy/colonoscopy procedure was 3.35 years (min-max: 1.1-9.0 years). Proton pump inhibitors (PPI) were the most frequently used treatment alone or in combination with diet, systemic and/or topical corticosteroids. Disease control was evaluated in 8 of 17 patients and it was uncontrolled in 4, partially controlled in 1, and controlled in 3 patients. Remission was achieved in 2 patients. The frequency of primary EGID beyond eosinophilic esophagitis (EoE) in children is low. It may be difficult to achieve control in children with primary EGID in the long-term follow-up.

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.

Current Status of <i>Ancylostoma</i> Species in Domestic and Wild Animals and Their Zoonotic Implication: Review

Hookworm species are mainly an endo-parasite of cats and dogs and others animals including man. Next to roundworm (Ascaris suum) and whipworm (Trichuris trichuria) infections, hookworm infections ranked third in terms of disease load in humans. Among hookworms, Ancylostoma species are highly prevalent in various species of domestic and wild animals, including humans, and mostly found in Asia and tropical countries. People who live in poor resource countries are more vulnerable than in developed countries. Hookworms in children cause mental impairment that leads to cognitive impairment. Similarly, a disability-adjusted life year (DALY) occurs in hookworms, particularly Ancylostoma infects children due to physical impairment. In animals, hookworm may cause diarrhea, stunted growth, and anemia and even lead to death in young animals. Furthermore, Ancylostoma causes cutaneous larva migrans, eosinophilic enteritis, and anemia and finally may cause death in humans. As a result of urbanization, climate change, and land degradation, there are various Ancylostoma species which are newly emerging in animals. Currently, the Ancylostoma is a great concern both in humans and animals, particularly in resource poor countries. The Ancylostoma infection may require governmental and public attention. Therefore, a control and prevention strategy strongly requires integration between medical and veterinary communities to improve environmental and personal hygiene.

Poisoning by Megathyrsus maximus (Sin. Panicum maximum) cv. Colonião in horses in the state of Rio de Janeiro

ABSTRACT: Colic outbreaks in horses have been associated with the grazing of several Megathyrsus maximus (Sin. Panicum maximum) cultivars in the North and Central-West regions of Brazil. In this paper, we report a horse colic outbreak in the Southeast region of Brazil caused by ingestion of the “Colonião” cultivar of M. maximus, which has not previously been considered as toxic. The five affected horses belonged to the Veterinary Platoon based at the Central Ammunition Deposit of the Brazilian Army in the city of Paracambi, Rio de Janeiro state, Brazil. The horses had access to treated water and commercial concentrate, and were located in a field of M. maximus at the time of the outbreak. All horses exhibited clinical signs of colic and bloat, and three of them died. The extend of the clinical course ranged from four to five days in the three animals that died; in the two animals that recovered from the colic episodes, the extend of the clinical courses were 10 and 15 days. Necropsy findings revealed intestinal and gastric bloating and hemorrhages involving the intestinal wall. Light microscopy showed moderate diffuse lymphoplasmacytic and eosinophilic enteritis with multifocal erosions, in addition to submucosal edema associated with multifocal vasculitis. The pathogenesis of colic caused by M. maximus ingestion in horses has not yet been elucidated. Some authors have suggested that higher starch concentrations in M. maximus during the rainy season may be responsible for the toxicity of this plant. However, the findings of this study do not support this hypothesis. As a prophylactic measure, it is suggested that horses do not graze exclusively M. maximus at the beginning of rainy periods, in which regrowth of this grass occurs. In Brazil, outbreaks of horse colic associated with ingestion of varieties of Megathyrsus can also occur outside the North and Midwest regions, under specific climate conditions.

Eozinofilní enteritida – kazuistika vzácné manifestace onemocnění a stručný přehled novinek

Eosinophilic enteritis is one of the eosinophilic gastrointestinal disorders characterised by various clinical symptoms. Histopathologic proof of dense eosinophilic infiltration is the cornerstone for the diagnosis. There is no consensus on how dense the infiltration should be, and cut-off values of the eosinophilic count in HPF have not been defined yet. Therapy for eosinophilic enteritis is based on an elimination diet and corticosteroid treatment. Herein the authors report a case of 14-year-old boy who suffered from acute abdominal pain. Computer tomography of the abdomen revealed a thickening of the duodenal wall mimicking a tumour, which seemed to infiltrate the gallbladder and omentum. Histopathological examination of samples taken during laparoscopy showed eosinophilic infiltration and sclerotic changes of the gallbladder and duodenum. Follow-up endoscopy proved extensive eosinophilic infiltration of the gastrointestinal tract: eosinophilic esophagitis, duodenal ulcer with dense eosinophilic presence and eosinophilic proctitis. The patient recovered after dietary restrictions and prednisone.

Etiological spectrum of adults presesenting with malabsorption: Experience at a tertiary centre

Introduction: Malabsorption occurs due to different causes and the clinical presentation varies with the underling etiology. Very few studies have been done to determine the etiological spectrum of malabsorption in northern India. Aim: To assess the etiology in patients presenting with malabsorption and to study clinical, haematological, biochemical, serological, endoscopic and histological features of these patients. Materials and Methods: Clinical assessment of 91 cases presenting with malabsorption complains in the gastro OPD was done along with vitamin B12 and fecal fat estimation. Relevant haematological, serological investigations, endoscopy was done. Duodenal biopsy was taken. Data was obtained and analysed. All patients clinically presenting with malabsorption were included in the study. The patients excluded were those, who refused for endoscopy or participation in the study. Results: The most common causes of malabsorption were non-specific duodenitis(42.8%), celiac disease (CD)(18.7%), tropical sprue (TS) (8.8%), giardiasis(3.3%), eosinophilic enteritis (2.2%), lymphangiectasia(1.1%), abetalipoproteinemia(1.1%) and 22% cases were normal histologically. The principal features differentiating celiac disease and tropical sprue were also noted. Patients with CD more often had anemia, scalloping of folds on endoscopy, moderate or severe villous atrophy and increased intraepithelial lymphocytes, in comparison to patients with TS. Conclusion: CD is commoner than TS. Though histology is gold standard for the diagnosis of CD, TS and other intestinal mucosal diseases, correlation of histological findings with clinical, hematological, endoscopic and serological findings is important as subtle histological changes may be missed depriving the patient of proper treatment. Keywords: Celiac disease, Diarrhea, Malabsorption, Tropical sprue, Villous atrophy, IELs.

Histomorphological spectrum of colonic biopsies: A two year study

Introduction: Colonoscopy and accompanying mucosal biopsy is the diagnostic tool of choice in the evaluation of patients with colo rectal pathologies. The objectives of this study were to study the histo morphological spectrum of colonoscopic biopsies, to find age, gender, site distribution of these lesions and to correlate them with clinical presentation and colonoscopic diagnosis. Materials and Methods: The study included all the colonoscopic biopsies received at Department of Pathology, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad from January 2015 to December 2016, over a period of two years. Results: There were 198 colonoscopic biopsies during this period. Two biopsies were inadequate for opinion and were excluded from the study. All the colorectal resection specimens, anal lesion were excluded from the study. Out of total 196 biopsies, 104 were non-neoplastic lesions, 92 were neoplastic lesions. Mean age of patients was 49.7 years with a male to female ratio of 1.6:1. Most common location of the lesion was rectum. The most common presenting complaint for both non-neoplastic and neoplastic lesions was bleeding per rectum. Non-specific colitis was commonest non-neoplastic lesion followed by ulcerative colitis. In the neoplastic lesions, adenocarcinoma was the commonest subtype followed by adenomatous polyps. Conclusion: Both neoplastic and non-neoplastic lesions equally affect colon. Non-specific colitis, ulcerative colitis, Crohns disease, tuberculosis, amoebic colitis, eosinophilic enteritis, hamartomatous and hyperplastic polyps were the various non neoplastic lesions encountered in our study. Adenocarcinoma was the most common malignancy on colonic biopsies. Carcinomas occurred at a later age than adenomas. Colonscopic diagnosis correlated well with histopathology diagnosis in carcinomas. Keywords: Colonoscopy, Mucosal biopsy, Non-neoplastic lesions, Neoplastic lesions, Rectum, Non-specific colitis, Adenocarcinoma.

Analysis and Follow up of Endoscopy Results in 1099 Patients with Terminal Ileum Lesions.

Objective We aim to analyze the diagnostic yield, diagnostic accuracy, and delayed diagnosis of patients with terminal ileum lesions, providing follow-up suggestions for suspected patients. Methods We carried out an analysis of 1099 patients who had terminal ileum lesions in our hospital from 2009 to 2019. The endoscopy reports and histopathology reports of terminal ileal biopsies were recorded. Clinical diagnosis and management were reviewed to determine whether there was a need to correct after a follow-up endoscopy result. Results A total of 1099 patients were found to have terminal ileum lesions, among which 959 in 1099 patients (87.26%) were diagnosed as benign, 17 in 1099 patients (1.55%) were diagnosed as malignant, and 123 in 1099 patients (11.19%) were diagnosed as suspected. The diagnostic accuracies of terminal ileal polyp, cyst, cancer, eosinophilic enteritis, parasite, lymphofollicular hyperplasia, and amyloidosis were 100%. The diagnosis was delayed in 9.93% of Crohn's disease (CD) and 12.5% of lymphoma. Among the definite cases, the diagnosis was corrected during the follow-up in 12.5% of the patients, while the clinical treatment was corrected during the follow-up in 17.86% of the patients. Among the suspected cases, the diagnosis and treatment was corrected in 61.11% of the patients during the follow-up. Conclusion Coincident diagnosis of ileitis and ileum ulcer is low. Delayed diagnosis of Crohn's disease and lymphoma were observed in a certain proportion of patients with terminal ileum lesions. A follow-up endoscopy was strongly recommended for these suspected patients with terminal ileum lesions.

S1992 Immune Checkpoint Inhibitor-Mediated Eosinophilic Esophagitis and Gastroenteritis

INTRODUCTION: Immune checkpoint inhibitors (ICPI) are immunomodulatory antibodies that enhance the immune system in the management of malignancies resulting in significantly improved prognosis especially in melanoma treatment. They are often associated with immune mediated side effects affecting multiple organ systems. The most common gastrointestinal side effect is colitis resulting in diarrhea, however eosinophilic esophagitis (EoE) and gastroenteritis is rarely reported. CASE DESCRIPTION/METHODS: A 50 year old female with history of stage IIIB melanoma managed with resection and 12 months of adjuvant nivolumab presented after immunotherapy completion with severe pruritis, dysphagia, and epigastric pain. Laboratory workup was notable for 19.9% eosinophilia with an absolute count of 1,700 cells/µL. Esophagogastroduodenoscopy (EGD) revealed ringed esophagus, white plaques and edema in the entire esophagus as well as edema and friability in the stomach and duodenal bulb. Biopsies showed increased intraepithelial eosinophils (eos), greater than 50 per high power field (hpf) in the proximal and distal esophagus. Gastric and duodenal biopsies revealed increased eos in the lamina propria with villous blunting. Her abdominal pain improved with a prednisone taper but she then developed severe heartburn and worsening dysphagia. Repeat EGD showed longitudinal furrows, edema, rings, and exudates consistent with EoE and normal stomach and duodenum. Pathology showed up to 80 eos/hpf in the esophagus, with resolution of the gastric and duodenal eosinophilia. Her symptoms resolved with a course of omeprazole and viscous budesonide slurry. DISCUSSION: Nivolumab is associated with several immune mediated toxicities including pneumonitis, colitis, endocrine and dermatological side effects. Eosinophilia may be seen following treatment with ICPIs and is potentially associated with improved prognosis. Eosinophilic tissue inflammation, particularly involving the GI tract is uncommon. A prior case report described eosinophilic enteritis following combination ICPIs ipilumab and nivolumab. A French case series reported 37 patients with hypereosinophilia following ICPI therapy; 57% had organ involvement, none with esophagitis or gastroenteritis. Most patients responded well to ICPI discontinuation and/or corticosteroids. This is the first report of eosinophilic esophagitis and gastroduodenitis following completion of 1 year of nivolumab therapy. There appears to be resolution with systemic and topical corticosteroid therapy.

Halo sign and araneid limb-like sign in eosinophilic enteritis

Halo sign and araneid limb-like sign in eosinophilic enteritis

Serum Interleukin-17 Evaluation in Patients With Eosinophilic Gastrointestinal Disease

Background: Eosinophilic gastrointestinal disorders or diseases (EGIDs) may result from an abnormal immune-mediated response to food antigens. Activated eosinophils release various mediators with inflammatory properties which may result in tissue and subsequently organ damage. The cytokine milieu of these patients has revealed increased levels of pro-inflammatory cytokines, including interleukin (IL)-17. This study aims to evaluate the potential role of this cytokine in the pathogenesis of EGID.Materials and Methods: This prospective study was conducted at the Allergy Outpatient Clinic, Mofid Children Hospital, Tehran, Iran from January 2016 to January 2017. In this study, Serum IL-17 was determined in all the patients referred to the Allergy Clinic with a pathologic diagnosis of EGID. Results: The median (minimum and maximum) serum IL-17 level in patients with EGID, gastroesophageal reflux disorder (GERD), and healthy controls were 4.32 (0.00-6.383), 2.82 (0.00-3.231), and 3.6 (0.00-7.165) pg/mL, respectively. The results of the non-parametric analysis revealed no significant difference between the three groups regarding IL-17 (P=0.16). However, by classifying EGID in two separate groups with the involvement of upper (eosinophilic esophagitis and eosinophilic gastritis) and lower (eosinophilic enteritis, eosinophilic colitis) gastrointestinal (GI) tracts, a significant difference in serum IL-17 level became evident (P=0.004). Conclusion: We found a significant relationship between IL-17 and upper GI involvement in EGID.

Eosinophilic enteritis presenting as an acute small bowel obstruction.

Eosinophilic enteritis presenting as an acute small bowel obstruction.

Клініко-морфологічна діагностика еозинофільного гастроентериту (огляд літератури)

Клініко-морфологічна діагностика еозинофільного гастроентериту (огляд літератури)

MON-693 Strongyloides Stercoralis Hyper Infestation Syndrome in Type 2 Diabetes: An ANCA Positive Case Report from India

A 53-year old male patient with T2D and hypertension for 13 years, presented to Apollo Sugar Clinic, Raipur with recurrent abdomen pain, but no vomiting, constipation, diarrhea or fever. The patient has a past history of asthmatic bronchitis, recurrent eosinophilia, and one month prior to hospitalization, recovered from erythematous maculopapular serpentine rash measuring 6.0 x 1.5 cm over the abdomen post anti-allergic treatment. The patient was neither suffering from immunosuppressive condition nor was on immunosuppressant therapy, had normal vitals but the laboratory findings revealed high total leukocyte count and raised absolute eosinophil count (52%). The provisional diagnosis was made as hypereosinophilic enteritis in a long-standing T2D and hypertension. Immunological tests antinuclear antibody (ANA) and antineutrophil cytoplasmic antibodies (ANCA) resulted in positive ruling out vasculitis. Stool examination detected rhabditiform larvae of S Stercoralis and diagnosed as Strongyloides hyper infestation syndrome. The patient was managed with IV antibiotics, IV fluids, IV insulin and when abdomen pain reduced started with the oral diet. To remove larvae load, unlike routine treatment, the patient was put on albendazole and ivermectin for three consecutive days. After 15 days follow-up patient was completely asymptomatic; at 6 weeks TLC, stool test, ANCA and ANA titer were negative indicating no parasite load. These antibodies detected could be due to molecular mimicry triggered by parasite antigens which may help in diagnosing and monitoring the disease course. ANA and ANCA positive results have been rarely reported in the past for S stercoralis. This unique case of S stercoralis infestation in T2D may enlighten the health care physicians to investigate for this infestation in immunocompromised T2D patients with pain abdomen. Precise diagnosis with timely management can prevent steroid therapy due to eosinophilic enteritis which can be harmful to the patients.

Pathological findings in North Sea and Baltic grey seal and harbour seal intestines associated with acanthocephalan infections.

Grey seals Halichoerus grypus and harbour seals Phoca vitulina are common seal species in the North and Baltic seas and final hosts of Corynosoma acanthocephalans. C. strumosum and C. magdaleni infect the small intestines of both seal species. In contrast to harbour seals, Baltic grey seals in the past have regularly displayed severe C. semerme infections in the caecum and colon, with associated tunica muscularis hypertrophy, inflammation and ulcerations as part of the Baltic seal disease complex (BSDC). Pathogenesis and correlation of acanthocephalan infections with these lesions are still unknown. This study describes the intestinal pathology and parasitic distribution in each seal species. Grey seal (n = 83) and harbour seal (n = 1156) intestines of all age groups and sexes, collected in Poland, Germany and Estonia from 1998 to 2017, were investigated. Most harbour seals came from the North Sea, whereas grey seals were predominantly derived from the Baltic Sea. Both species featured mild to moderate small intestinal infections. Grey seals showed colonic infections not found in harbour seals and featured a chronic erosive to ulcerative, eosinophilic or lympho-plasmacytic colitis with tunica muscularis hypertrophy, indicating still prevailing clinical signs of the BSDC. Harbour seals displayed granulomatous, eosinophilic, lympho-plasmacytic or catarrhal enteritis. The prevalence of acanthocephalan infections in harbour seals increased from 2012 onwards. Furthermore, significant associations between acanthocephalan infection and the presence of intestinal inflammation were found for both seal species. This study suggests that the level of acanthocephalan infection and associated lesions are suitable seal population health indicators, with the colon being a specific target organ for Baltic grey seal health monitoring.

Dual checkpoint inhibitor-associated eosinophilic enteritis

BackgroundEosinophilia has been reported as a rare, new biological effect of immune checkpoint inhibition that may be associated with improved treatment response and the development of immune-related adverse events.Case presentationWe report a case of dual checkpoint inhibitor-associated hypereosinophilia and eosinophilic enteritis in a patient with advanced cutaneous melanoma. Rapid resolution of peripheral eosinophilia and associated symptoms was achieved with steroids alone.ConclusionsImmune checkpoint inhibition can trigger inflammation in virtually any organ in the body, leading to diverse clinical manifestations. To our knowledge, this is the first case report of eosinophilic enteritis due to ipilimumab plus nivolumab.

P310 TIME TO EOSINOPHILIC GASTRITIS/ENTERITIS DIAGNOSIS IMPROVES WHEN PATIENTS ARE CO-MANAGED BY AN ALLERGIST AND GASTROENTEROLOGIST

Eosinophilic gastritis (EG) and eosinophilic enteritis (EE) are chronic diseases characterized by persistent gastrointestinal (GI) symptoms and elevated eosinophils in GI biopsies. Diagnosis is often delayed due to a low clinical suspicion for EG/EE. Here we utilize a large claims database to characterize the real-world diagnosis of EG/EE.