Eosinophilic gastroenteritis: An unusual type of gastroenteritis

Clinical significance of direct fast scarlet staining on the diagnosis of eosinophilic colitis: A comparative study focusing on the eosinophil degranulation in colonic mucosal tissue

This study aimed to validate the DFS (direct fast scarlet) staining in the diagnosis of EC (eosinophilic colitis). The study included 50 patients with EC and 60 with control colons. Among the 60 control samples, 39 and 21 were collected from the ascending and descending colons, respectively. We compared the median number of eosinophils and frequency of eosinophil degranulation by HE (hematoxylin and eosin) and DFS staining between the EC and control groups. In the right hemi-colon, eosinophil count by HE was useful in distinguishing between EC and control (41.5 vs. 26.0 cells/HPF, p < 0.001), but the ideal cutoff value is 27.5 cells/HPF (high-power field). However, this method is not useful in the left hemi-colon (12.5 vs. 13.0 cells/HPF, p = 0.990). The presence of degranulation by DFS allows us to distinguish between the groups even in the left hemi-colon (58% vs. 5%, p < 0.001). DFS staining also enabled a more accurate determination of degranulation than HE. According to the current standard to diagnose EC (count by HE staining ≥20 cells/HPF), mucosal sampling from left hemi-colon is problematic since the number of eosinophils could not be increased even in EC. Determination of degranulated eosinophils by DFS may potentiate the diagnostic performance even in such conditions.

Eosinophilic Ascites: A Rare Diagnosis With an Even Rarer Etiology

Eosinophilic ascites (EA) is a rare and often challenging clinical manifestation of eosinophilic gastroenteritis (EGE), a condition characterized by eosinophilic infiltration in various layers of the gastrointestinal tract. EA specifically involves the abnormal accumulation of eosinophils in the peritoneal cavity, which can lead to significant abdominal distension and discomfort. EGE is an inflammatory disorder that can affect the mucosal, muscular, or serosal layers of the gastrointestinal tract, primarily resulting from a combination of genetic predisposition, environmental triggers, and immune responses. This case report discusses a 39-year-old male who presented with persistent abdominal distension, significant weight loss, vomiting, and chronic diarrhea. Clinical evaluation revealed marked eosinophilia and EA, prompting a series of diagnostic tests to differentiate it from other potential causes such as parasitic infections and malignancies. Imaging studies indicated moderate ascites and intestinal wall thickening. The patient was diagnosed with eosinophilic enteritis, and treatment with corticosteroids led to substantial clinical improvement. This case highlights the diagnostic challenges and management strategies associated with both EA and EGE, emphasizing the importance of recognizing these rare manifestations of eosinophilic gastrointestinal disorders.

A case of non-esophageal eosinophilic gastrointestinal disease diagnosed by mucosal incision-assisted biopsy

A 46-year-old woman presented at our hospital with anorexia, vomiting, and diarrhea. Blood tests indicated markedly increased eosinophil counts, and esophagogastroduodenoscopy revealed slight erythema in the gastric body. Computed tomography showed edematous thickening of the stomach and small intestinal walls and peritonitis. Thus, eosinophilic gastrointestinal disease was suspected. Endoscopic biopsies from the esophagus, stomach, and duodenum were collected, but no significant increases in eosinophil counts were observed. Little ascites effusion was detected and puncture cytology was difficult to perform. Thus, a sample of the muscularis propria layer was obtained by mucosal incision-assisted biopsy. Histopathological examination of the biopsy revealed significant eosinophilic infiltration within the muscularis propria layer of the stomach, confirming the diagnosis of non-eosinophilic esophagitis eosinophilic gastrointestinal disease. The patient was treated with a leukotriene receptor antagonist and prednisolone, and her clinical symptoms and gastrointestinal wall thickening rapidly improved. The Japanese diagnostic guideline for non-eosinophilic esophagitis eosinophilic gastrointestinal disease requires endoscopic biopsy or eosinophilic infiltration of ascites fluid. When diagnosis is difficult using conventional methods, as in this case, mucosal incision-assisted biopsy is useful as a next step.

A rare case of eosinophilic jejunitis: diagnosis and management strategies

Eosinophilic gastroenteritis is a rare disease with an unknown cause, which can manifest independently or as part of a hyper-eosinophilic syndrome. The severity of the condition depends on the extent of eosinophilic infiltration and damage to the digestive tract. Diagnosis relies on histological examination, which reveals a significant presence of eosinophilic polymorphonuclear leukocytes in the digestive wall. The authors present a new case of eosinophilic gastroenteritis in a 28-year-old patient who exhibited obstructive symptoms but lacked peripheral eosinophilia. Esophagogastroduodenoscopy showed no abnormalities, but barium transit imaging revealed gastro-duodeno-jejunal dilation upstream of a tight jejunal stenosis. Surgical examination of the affected area confirmed a diffuse and transparietal eosinophilic infiltrate, with no evidence of parasitic or granulomatous lesions. Fortunately, the patient had a swift recovery following surgery. Biopsies conducted at other locations, including the gastric, hepatic, and medullary levels, produced negative results, indicating the localized nature of the condition.

Joint ESPGHAN/NASPGHAN Guidelines on Childhood Eosinophilic Gastrointestinal Disorders Beyond Eosinophilic Esophagitis

INTRODUCTION

Eosinophilic gastrointestinal disorders beyond eosinophilic esophagitis (non-EoE EGIDs) are rare chronic inflammatory disorders of the gastrointestinal (GI) tract. Diagnosis is based on clinical symptoms and histologic findings of eosinophilic inflammation after exclusion of a secondary cause or systemic disease. Currently, no guidelines exist for the evaluation of non-EoE EGIDs. Therefore, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) formed a task force group to provide consensus guidelines for childhood non-EoE EGIDs.

METHODS

The working group was composed of pediatric gastroenterologists, adult gastroenterologists, allergists/immunologists, and pathologists. An extensive electronic literature search of the MEDLINE, EMBASE, and Cochrane databases was conducted up to February 2022. General methodology was used in the formulation of recommendations according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to meet current standards of evidence assessment.

RESULTS

The guidelines provide information on the current concept of non-EoE EGIDs, disease pathogenesis, epidemiology, clinical manifestations, diagnostic and disease surveillance procedures, and current treatment options. Thirty-four statements based on available evidence and 41 recommendations based on expert opinion and best clinical practices were developed.

CONCLUSION

Non-EoE EGIDs literature is limited in scope and depth, making clear recommendations difficult. These consensus-based clinical practice guidelines are intended to assist clinicians caring for children affected by non-EoE EGIDs and to facilitate high-quality randomized controlled trials of various treatment modalities using standardized, uniform disease definitions.

Eosinophilic enteritis in a case of cystic fibrosis: an elusive diagnosis with an elementary cure

A late adolescent man diagnosed with cystic fibrosis and presenting with predominantly gastrointestinal symptoms, including chronic constipation, exocrine pancreatic insufficiency and gastro-oesophageal reflux disease, experienced recurrent episodes of nausea, vomiting and abdominal pain. CT of the abdomen unveiled the presence of chronic appendicitis, alongside constipation without evidence of distal intestinal obstruction syndrome. Endoscopic biopsies revealed small bowel eosinophilic infiltrates. Subsequently, the patient underwent an appendectomy, and a tailored regimen was established to address constipation, resulting in an initial alleviation of his symptoms. Three months later, a resurgence of symptoms occurred, coinciding with persistent intestinal eosinophilic infiltrates. A diagnosis of eosinophilic enteritis was rendered, and treatment commenced with an oral dosage of 40 mg of prednisone. Two weeks later, the patient experienced symptom resolution, corroborated by the findings of an endoscopic biopsy conducted 8 weeks later. During a follow-up examination 6 months later, the patient remained asymptomatic.

Non-esophageal eosinophilic gastrointestinal diseases: a narrative review

Eosinophilic gastrointestinal disorders are a group of rare diseases characterized by the infiltration of eosinophils in the gastrointestinal wall in a greater amount than in homeostatic conditions. 'Non-esophageal eosinophilic gastrointestinal disorders' is the umbrella term for all eosinophilic gastrointestinal disorders outside of the well known eosinophilic esophagitis. This includes eosinophilic gastritis, eosinophilic enteritis and eosinophilic colitis. The clinical presentation is atypical and not very different for the three disorders. The depth of infiltration has a bigger influence on the presenting symptoms than the disease location. Although the frequency of diagnosis and research in this subject is increasing over time, non-esophageal eosinophilic disorders are rare and high quality evidence is limited to date. In this narrative review, we provide an overview of the latest insights in the pathophysiology, diagnostic approach and available treatment options. Transcriptome studies have found the pathogenesis to be T helper type 2 driven. Various laboratory findings can be used to trigger raised suspicion and investigation with endoscopy. As the endoscopic appearance of the mucosa is normal in most cases, multiple biopsies in each segment are needed to quantify the amount of eosinophils in the tissue. Eosinophilic cut-offs for diagnosis are a controversial topic and a consensus is still lacking. A recently developed tissue based diagnostic platform which measures differentially expressed genes might be available in the future to classify patients with intermediate eosinophilic tissue levels under the cut-off. For the treatment, corticosteroids are still the cornerstone of treatment but promising research suggests a role of biologicals, such as Lirentelimab (anti-siglec 8) in particular.

Generalized Eosinophilia Following Moderna COVID-19 Vaccine Administration: A Case Report

Coronavirus disease 19 (COVID-19) vaccination is considered an important part in improving health outcomes globally. While various adverse events following vaccination against COVID-19 have been reported, eosinophilic diseases have rarely been documented in the literature and are poorly understood. Although vaccination is lauded as being “safe,” it has become apparent that adverse reactions related to the vaccines can have detrimental health effects for certain individuals. We present a case of a death related to multiple severe preexisting comorbidities, complicated by new-onset gastrointestinal complaints which were temporally associated with recent COVID-19 vaccination and did not subside, but worsened prior to death. Autopsy revealed evidence of eosinophilic enteritis, associated with ascites, as well as eosinophilic inflammation elsewhere, including the lungs and heart. Histological examination revealed abundant eosinophils in tissues, including the small intestines, epicardium, and lungs. Whether or not the eosinophilic inflammatory process was caused by the recent vaccination cannot be stated with certainty; however, the temporal association between vaccination, symptom onset/progression, and death, and the literature which suggests a possible association between coronavirus vaccination and eosinophilic reactions leads to the conclusion that this death might have been related to an adverse reaction to COVID-19 vaccination.

Eosinophilic enteritis requiring differentiation from chronic enteropathy associated with SLCO2A1 gene: A case report

BACKGROUND

Eosinophilic gastrointestinal disease (EGID) is a disorder characterized by infiltration of eosinophils causing mucosal damage and dysfunction of the gastrointestinal tract. The endoscopic findings of eosinophilic enteritis (EoN), an EGID variant, are nonspecific and occasionally difficult to diagnose. In contrast, chronic enteropathy associated with SLCO2A1 (CEAS) is a chronic persistent small intestinal disorder characterized by endoscopic findings such as multiple oblique and circular ulcers.

CASE SUMMARY

We report the case of a 10-year-old boy who had suffered abdominal pain and fatigue for the preceding 6 mo. He was referred to our institute for investigation of suspected gastrointestinal bleeding because of severe anemia with hypoproteinemia and positive fecal human hemoglobin. The upper and lower gastrointestinal endoscopic findings were normal; however, double-balloon small bowel endoscopy showed multiple oblique and circular ulcers with discrete margins and mild constriction of the intestinal lumen in the ileum. The findings were highly consistent with CEAS, but urine prostaglandin metabolites were within normal limits, and no previously reported mutations in the SLCO2A1 gene were identified. Histological evaluation demonstrated moderate to severe eosinophilic infiltration localized to the small intestine suggesting a diagnosis of EoN. Clinical remission was maintained with montelukast and a partial elemental diet, but emergent surgery for bowel obstruction due to small intestinal stenosis was performed two years after the initial treatment.

CONCLUSION

EoN should be considered in the differential diagnosis of CEAS-like small intestinal ulcerative lesions and normal urinary prostaglandin metabolite levels.

How We Manage Gastrointestinal Symptoms During Oral Immunotherapy Through a Shared Decision-Making Process-A Practical Guide for the Community Practitioner

Allergists addressing gastrointestinal (GI) symptoms during oral immunotherapy (OIT) may be biased toward diagnoses related to OIT; however, non-OIT causes may occur. Although there is currently a lack of robust data for evidence-based treatment recommendations, we provide 3 real-world illustrative cases along with a proposed management algorithm for GI symptoms encountered during OIT. This algorithm was developed because of a significant clinical need, given the number of new-to-OIT providers that include practicing allergists, trainees transitioning into practice, and allied health care providers who manage GI symptoms in OIT patients. We developed the algorithm based on the opinions of community and academic allergy clinics across Canada with significant clinical experience offering infant, preschool, and school-aged OIT patients, with gastroenterologist input. Further research is needed to fill the knowledge gaps in the management of GI symptoms during OIT before formal recommendations can be suggested.

The Economic Burden of Eosinophilic Gastritis and Eosinophilic Enteritis in the United States

INTRODUCTION

Eosinophilic gastritis and eosinophilic enteritis (EoG/EoN) are associated with a substantial clinical burden. However, limited information is available regarding the economic burden of EoG/EoN. This study was conducted to compare healthcare resource use (HRU) and costs among patients with EoG/EoN versus without EoG/EoN in the USA.

METHODS

Administrative claims data from the IBM MarketScan® Commercial Claims and Encounters (CCAE) and Medicare Supplemental and Coordination of Benefits Databases (2009-2019) was used to identify two cohorts of patients. Patients without EoG/EoN were matched 3:1 to patients with EoG/EoN on sex, year of birth, and healthcare plan type. Study measures included demographic characteristics, select comorbidities, all-cause HRU, and costs. Comparisons were made over a 1-year period following EoG/EoN diagnosis for patients with EoG/EoN and an eligible date for patients without EoG/EoN.

RESULTS

A total of 2219 patients with EoG/EoN and 6657 patients without EoG/EoN were analyzed. Significantly higher proportions of patients with EoG/EoN versus without EoG/EoN had comorbid conditions. Rates of all-cause HRU were significantly higher among patients with EoG/EoN versus patients without EoG/EoN (adjusted rate ratio [95% confidence interval]: inpatient visits, 6.26 [5.26, 7.46]; outpatient visits, 1.17 [1.16, 1.19]; emergency department visits, 2.11 [1.98, 2.25]; all p < 0.001). Patients with EoG/EoN incurred significantly higher costs versus patients without EoG/EoN (adjusted mean cost difference $31,180; p < 0.001). Cost differences were largely due to outpatient (adjusted mean cost difference $14,018; p < 0.001) and inpatient (adjusted mean cost difference $11,224; p < 0.001) costs.

CONCLUSION

The economic burden associated with EoG/EoN is substantial, with patients with EoG/EoN having a higher rate of HRU and incurring $31,180 more than patients without EoG/EoN on average. Most of the cost difference was attributable to outpatient and inpatient costs. Cost-saving strategies to lower the burden of illness in this patient population are needed.

Follow-Up of a Rare Case of Eosinophilic Gastroenteritis Associated with Persistent Blood Eosinophilia and Multiple Food Allergies

Eosinophilic gastroenteritis (EGE) is a subgroup of the eosinophilic gastro-intestinal disorders (EGIDs), characterized by eosinophilic infiltration and chronic inflammation of the gastrointestinal tract. These are rare diseases with still incompletely elucidated causes and mechanisms, with frequently delayed diagnosis and variable outcome. Despite increased interest in eosinophilic diseases in recent years, fewer data have been published on EGE and no standardized diagnostic and therapeutic approach exists. This paper reports the case of a young male patient diagnosed with EGE in 2017 based on clinical and histopathological criteria and constantly monitored during five years. Besides gastrointestinal eosinophilic infiltration, biopsies also revealed eosinophilic infiltration of the oesophagus, despite no declared characteristic oesophageal symptoms. We found increased specific IgE to multiple foods and progressive blood hypereosinophilia which preceded EGE diagnosis by three years. The EGE management included selective dietary restrictions and pharmacologic therapy based on daily budesonide non-enteric coated tablets, proton pumps inhibitors, antihistamines, cromoglycate, correction of iron, calcium and vitamin D deficiencies. The clinical outcome was good, while blood eosinophilia and endoscopic appearance remained almost unchanged. After one year the patient complained of respiratory symptoms suggesting asthma, needing continuous combined inhaled therapy. The reported case is illustrative for complex presentation, diagnosis and outcome of a rare case of mucosal chronic EGE associated with oesophageal involvement, peripheral eosinophilia, multiple food allergies and asthma.

Eosinophilic enteritis with enteroliths: A diagnostic dilemma

Introduction and importance

Eosinophilic gastroenteritis (EG) is a rare disease, characterized by eosinophilic infiltration of different layers of intestinal wall. Thus having a wide spectrum of presentation leading to diagnostic dilemma.

Case presentation

We report a case of 55 years old female who presented with pain in abdomen, constipation, vomiting off and on with passage of stools on alternate days since 6 months. Plain radiographs showed radio-opaque densities in abdomen. Contrast enhanced computed tomography (CECT) of abdomen showed Ileal stricture with dilated proximal bowel loops with enteroliths. Exploratory laparotomy confirmed ileal stricture with thickening of the mesentery and an ileal diverticulum. Resection of ileal stricture was performed. The resected segment contained seven hard, black enteroliths. Histopathology of the resected specimen confirmed EG. Stone analysis showed dense faecal matter with bile salts.

Clinical discussion

EG leads to symptoms ranging from vomiting, abdominal pain, diarrhoea, blood loss in stools, anaemia to malabsorption resulting in diagnostic dilemma. It may cause gastrointestinal obstructive symptoms secondary to stricture, depending upon the predominant layer involved.

Conclusion

The differential diagnosis of EG should always be considered when dealing with gastroenteritis presenting with radio-opaque densities in abdomen.

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Eosinophilic Gastroenteritis (EG) is a rare disease with a wide spectrum of clinical presentation.

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Diagnosis of EG is often missed or delayed due to its overlapping findings with other GI disorders.

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Presentation of Eosinophilic Gastroenteritis with Enterolith is rare.

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Eosinophilic Gastroenteritis once diagnosed can be treated medically.

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However, once stricture or enteroliths are formed or there is intestinal obstruction, surgery is the mainstay of treatment.

A Rare Case of Eosinophilic Gastroenteritis Isolated in the Muscularis Propria of the Small Bowel

Eosinophilic gastroenteritis (EG) is an autoimmune disorder that involves infiltration of eosinophils in the bowel wall of the stomach and/or intestine, resulting in various gastrointestinal symptoms. The majority of cases are diagnosed by findings of increased eosinophils on mucosal biopsies. We describe a rare type of eosinophilic gastroenteritis with eosinophilic infiltration involving only the muscularis propria layer. This elusive diagnosis was made after a full-thickness intestinal wall biopsy. This predominantly muscular type eosinophilic gastroenteritis can cause intestinal obstruction or perforation. Similar to the predominantly mucosal type eosinophilic gastroenteritis, this type of eosinophilic gastroenteritis responds to low-dose or topical corticosteroids.

Eosinophilic Gastroenteritis Causing Small Bowel Diverticulosis and Volvulus: A Case Report

Patient: Female, 83-year-old

Final Diagnosis: Eosinophilic gastroentritis • jejunal diverticulosis

Symptoms: Abdominal pain • obstruction

Medication: —

Clinical Procedure: —

Specialty: Surgery

A case report about eosinophilic enteritis presenting as abdominal pain

RATIONALE

Eosinophilic enteritis (EE) is an immune-mediated antigen-driven disease that may lead to clinical symptoms and organ dysfunction and characterized by the presence of extensive eosinophilic infiltrates on histopathological examination of the intestinal mucosa.

PATIENT CONCERNS

A 29-year-old man presented with a half-month duration of paroxysmal upper abdominal pain that gradually evolved into continuous pain accompanied by the urge to defecate.

DIAGNOSES

Pathological findings of enteroscopy showed acute and chronic inflammation accompanied by eosinophilic infiltration (>20/ high-power field).

INTERVENTIONS

The patient was initially treated with IV infusion of dexamethasone 10 mg per day for 3 days, which was reduced to 7.5 mg per day for 2 days once pain relief was achieved. Upon discharged from our hospital, the patient was prescribed with oral prednisolone 30 mg per day, which was reduced by 5 mg per week for 6 weeks until discontinuation.

OUTCOMES

The patient was relieved from the pain after receiving dexamethasone for 5 days, and he was maintained on oral prednisolone 30 mg per day upon discharge from the hospital. On the day of discharge, the eosinophil count and derived ratios were normal.

LESSONS

In patients with EE, the dynamic changes of the eosinophil count should be monitored. Clinicians must be aware that not all patients with EE have a history of allergies. In the management and treatment of the disease, multisite biopsies should be carried out if EE is suspected, and EE is responsive to steroid therapy.

An Unusual Case of Eosinophilic Ascites with Pleural Effusion - A Rare Manifestation of Eosinophilic Gastroenteritis (EGE)

Eosinophilic gastroenteritis (EGE) is a rare disease characterized by tissue eosinophilia and can affect any part of gastrointestinal (GI) tract from the esophagus to the rectum, although stomach and small intestine are sites most frequently involved. We hereby describe an unusual case of eosinophilic gastroenteritis affecting the stomach, small intestine, colon and rectum involving the mucosa and serosa. A twenty-oneyearold student presented with fever, diarrhea, ascites and right pleural effusion. Total leucocyte count was high with marked eosinophilia. Ascitic and pleural fluid were exudates with low adenosine deaminase (ADA) level and predominant eosinophils. Biopsy specimens of the stomach, duodenum, ileum, colon and rectum showed dense eosinophilic infiltration of lamina propria. Based on the constellation of clinical features and investigations, a diagnosis of EGE was made, and therapy with prednisone was started. Symptoms and peripheral eosinophilia rapidly resolved. It is thus imperative to diagnose this disease early and institute the necessary treatment.

A case of eosinophilic gastroenteritis with high PET-CT accumulation treated by P-CAB

Eosinophilic gastroenteritis (EGE) can present findings on computed tomography (CT) images that resemble malignant tumors. EGE is generally treated with systemic oral steroid administration, which is reportedly effective in relieving symptoms at least temporarily. Here, we report a case of EGE that mimicked malignant lymphoma in a gastroduodenal lesion, in which treatment with a potassium-competitive acid blocker without systemic oral steroid administration relieved the symptoms and reversed the initial image findings. A 56-year-old woman became aware of discomfort in her epigastric region, which gradually worsened. This case showed antroduodenal wall thickness, which mimicked a malignant lymphoma with increased F-18 fluorodeoxyglucose (FDG) uptake by positron emission tomography/computed tomography (PET/CT). An upper gastrointestinal endoscopy revealed protruding erosions in the antrum and severe edematous changes in the duodenum. Extensibility of the normal gastric wall by insufflation also occurred. However, an abdominal ultrasound indicated wall thickening with a preserved wall structure. Histological examinations showed a large amount of eosinophil infiltration, mainly in the gastroduodenal mucosa, without malignant cells. Thus, we made a final diagnosis of EGE. The patient was then administered 20 mg vonoprazan fumarate per day because she refused steroid treatment and because the pathological lesion was also localized from the duodenum to the antrum. After 3 weeks of potassium-competitive acid blocker treatment, her symptoms were alleviated, and the degree and extent of thickening of the gastroduodenal wall in upper gastrointestinal endoscopy and ultrasonographic image findings had remarkably improved.

Lymphoplasmacytic and eosinophilic enteritis with or without globule leukocyte hyperplasia in 4 goats

Four, mature, client-owned goats were presented to referral hospitals for recurrent diarrhea despite treatment for intestinal parasitism. Common clinical findings included diarrhea, poor condition, neutrophilia, and hypoalbuminemia. Testing for common infectious causes of diarrhea in goats was negative. Ultrasonography and computed tomography in 2 cases was suggestive of enteritis, including thickened intestinal walls and fluid filled, dilated small intestines, respectively. Lymphoplasmacytic and eosinophilic enteritis (LEE) was ultimately diagnosed on intestinal biopsy histopathology based on the presence of small intestinal villous blunting and increased numbers of lymphocytes and eosinophils predominantly within the lamina propria. Numerous globule leukocytes were also noted on histopathology in 3 cases. All goats responded favorably to corticosteroid treatment with weight gain and resolution of diarrhea and clinicopathologic abnormalities. Relapses occurred, and complete cure was difficult to achieve. Reported in other species, this series describes the clinical presentation, diagnosis, and treatment of LEE in adult goats.

Rare case of rapidly reaccumulating ascites

Eosinophilic ascites is a rare type of exudative ascites most commonly caused by eosinophilic gastroenteritis. Here, a 57-year-old man presents with sudden-onset abdominal distension associated with nausea, vomiting and decreased appetite for 10 days. Physical examination revealed significant abdominal distention and fluid wave. Initial labs showed leucocytosis and mild peripheral eosinophilia. Imaging of his abdomen revealed severe ascites, no features of cirrhosis and diffuse inflammatory changes involving the jejunum and ileum. Diagnostic paracentesis showed exudative, ascitic fluid with predominant eosinophilia. Cytology of the ascitic fluid and blind biopsies taken during oesophagogastroduodenoscopy and enteroscopy were both negative for malignancy. The ascites reaccumulated rapidly, requiring five rounds of large-volume paracentesis during hospitalisation. Empiric treatment for suspected eosinophilic gastroenteritis with intravenous steroids improved and stabilised the patient's ascites for discharge. Parasitic workup resulted positively for Toxocara antibodies on ELISA. On 2-week outpatient follow-up, a course of albendazole resolved all gastrointestinal symptoms.

Vitamin D deficiency causing eosinophilic esophagogastroenteritis and ascites: a rare association

A 54-year-old Chinese man presented with ascites for 2 weeks. He had a preceding 2-year history of intermittent dysphagia, lethargy and general malaise. Blood investigations revealed leucocytosis with eosinophilia of 26.5%, whereas paracentesis showed turbid fluid with high protein content (45 g/L) and a high white blood cell count of 5580/µL, predominantly eosinophils (90%). An incidental assay of vitamin D showed a very low level of 13.5 ng/mL. No other cause of ascites was found. Gastroscopy was normal except for duodenitis. However, biopsies from lower oesophagus confirmed the presence of eosinophilic infiltration. Following vitamin D replacement, the patient experienced marked improvement in symptoms of dysphagia within 2 weeks and no recurrence of ascites after 3 months. The reason for the patient's vitamin D deficiency remains unclear. The marked improvement in the patient's health indicates a causative role of vitamin D deficiency in causing eosinophilic esophagogastroenteritis and associated eosinophilic ascites.

Two Cases of Eosinophilic Gastroenteritis With Rare Manifestations Revealed in Medical Checkup Findings

Eosinophilic gastroenteritis (EGE) is characterized by dense infiltration of eosinophils in gastrointestinal tissues, resulting in morphological and functional abnormalities of the gastrointestinal tract. EGE susceptibility is most common among individuals aged 40-50 years old, and hence it is likely that affected patients will be encountered at the time of a medical checkup. In this report, we present two rare cases of EGE that presented interesting manifestations in findings obtained in a fluoroscopic examination performed at an annual medical checkup. Accumulation of case reports is important to provide information to pathologists to enable them to make correct early diagnosis and begin effective treatment at the earliest.

Eosinophilic colitis in adults

Eosinophilic colitis (EoC) is a pathological entity associated with abnormal infiltration of colonic mucosa by eosinophilic polynuclear cells (Eo). This is a relatively common pathology in infants and children under 2 years old, but is more rare and has been less studied in adults. EoC can be classified as primary or secondary. Primary EoC is, in the majority of cases, related to an allergic reaction, either IgE-mediated and capable of causing an anaphylactic-type food allergy, or not mediated by IgE and capable of giving rise to food enteropathy. The symptoms for adults with EoC are variable and non-specific, diarrhoea and abdominal pain being the most common signs. There is no histological consensus for the diagnosis of EoC. The presence of over 40 Eo per high-power field (×400) in at least two different colonic segments could be suggested as the criterion for the diagnosis. In adults with primary EoC, skin tests are of limited value and the response to a restrictive diet is less effective than in young children, given that IgE or non-IgE-mediated allergic reactions are rarely identified and EoC generally require medical treatment. There is no consensus on the treatment of EoC, but the potential efficacy of corticosteroids and budesonide has been demonstrated in the vast majority of cases studied.

Eosinophilic gastroenteritis in small intestine in a child in a remote medical centre required surgery

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Eosinophilic gastroenteritis in small intestine in a child which was treated with surgery.

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First study in a child in the Middle East and Levantine.

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Was diagnosed in a remote centre which emphasise the importance of communication between centres.

Introduction

Eosinophilic gastroenteritis (EGE) is an extremely rare disease of unknown aetiology that can occur at any age, but rarely in children. It usually presents with ambiguous abdominal pain and the symptoms can occur for years before diagnosis. It needs a high suspicion and therefore misdiagnosis can occur.

Presentation of case

We present a case of three-and-a-half year old girl who had a complicated EGE but was misdiagnosed as no proper consult was available as she presented in a remote medical centre. She had 50 cm from her small intestine dissected as micro abscesses and a necrotic mass of 3.5*2.5 cm were observed.

Discussion

EGE is usually managed medically. However, the patient’s condition was complicated and surgery was indicated. However, if proper diagnosis was made, conservative surgery would be the proper management as this case tends to improve with steroids.

Conclusions

Medical centres in remote areas should have a way to discuss atypical cases with a skilled consultant even when urgent as surgery indication can completely differ. This is the first case reported in the region with EGE in a child which can justify the difficulty in diagnosis as it is quite rare and have not been reported previously in the region which can lead to futuristic misdiagnosis.

Upper Gastrointestinal Bleed in a Young Male- A Rare Presentation of Eosinophilic Gastroenteritis

Eosinophilic gastroenteritis (EGE) is a rare idiopathic disease affecting multiple organs (stomach and small intestine) of the digestive tract. It is characterized by eosinophilic infiltration of the bowel wall to a variable depth and symptoms associated with gastrointestinal tract disease. The prevalence of this condition is ranging from 8 and 28 per 100,000. We present a rare presentation of EGE manifesting as upper GI bleeding.  A 28-year-old male with PMH of EGE, duodenal ulcers, and stricture presented to the hospital with the chief complaints of three episodes of dizziness and melena over one day. His home medications included prednisone, montelukast, and pantoprazole. On admission, he was found to be tachycardic (150) while other vital signs were stable. Physical examination revealed cold, pale and clammy skin but was otherwise normal on examination. Initial labs showed hemoglobin (hgb) of 9.3. His hospital course was complicated with 1 episode of large volume hematemesis >1.5 L and brief loss of consciousness for which a code rapid response was called. On day 2, the hgb dropped to 5.7 and the patient received a blood transfusion. Emergent endoscopy (EGD) revealed high-grade duodenal stenosis, severe pyloroduodenal deformity and a duodenal ulcer with the visible vessel. Two clips were deployed blindly. Epinephrine could not be injected due to hard and fibrotic tissue around duodenal stenosis. The Interventional Radiology team was consulted and emergent angiography was done which revealed active bleeding from a branch of the gastric artery. Embolization was done and hemostasis was achieved successfully. He needed 5 units of PRBC transfusion in total. He was treated with pantoprazole twice a day intravenously since admission. For his known duodenal stricture, the surgical team was consulted. No acute surgical intervention was recommended. On discharge, he was sent home with pantoprazole 40 mg twice a day, slow tapering of prednisone and close follow up with gastroenterology, surgery, and primary care doctor within 1 week. The purpose of this case report is to increase awareness about this clinical condition among medical professionals.

Clozapine-Related Diarrhea and Colitis: Report of 4 Cases

BACKGROUND

During clozapine treatment, diarrhea is a rare but clinically relevant adverse effect. Cases of microscopic colitis and eosinophilic colitis have been previously reported.

PROCEDURES

We present 4 patients who developed severe diarrhea in early weeks of clozapine therapy.

FINDINGS

Two patients had significant peripheral eosinophilia 1 week after diarrhea symptoms. One of these patients also had Charcot-Leyden crystals in stool afterward, confirming the presence of eosinophils in the gut lumen. One of our patients had a confirmed microscopic colitis and later also neutropenia, which required treatment.

CONCLUSIONS

Charcot-Leyden crystals in stool may be associated with concurrent diarrhea and eosinophilia during clozapine treatment, which is a previously unreported finding. Occurrence of blood dyscrasias with diarrhea symptoms during clozapine treatment needs further investigation to understand the possible shared mechanisms.

Eosinophilic esophagitis, gastroenteritis, and colitis in a patient with prior parasite exposure

Eosinophilic gastrointestinal disorders (EGID) comprise a spectrum of inflammatory diseases that can affect any segment of the gastrointestinal tract. The pathogenesis of these conditions is complex; differentiating between primary and secondary forms of these disorders can be clinically challenging. We report a case of primary EGID in a patient with remote parasite exposure, whose symptoms were initially attributed to irritable bowel syndrome. Endoscopy revealed the rare finding of EGID involving the entire gastrointestinal tract; symptoms improved with an elimination diet. This case raises the possibility of a link between prior parasite exposure and development of EGID, and underscores the necessity of exploring alternative diagnoses in patients with presumed IBS who present with severe symptoms.

Retrospective study of budesonide in children with eosinophilic gastroenteritis

BACKGROUND

The effectiveness of budesonide (BUD), a locally active steroid, on eosinophilic gastroenteritis (EGE) is not well understood. This study is to retrospectively evaluate the efficacy of BUD in children with EGE.

METHODS

Forty-four children, diagnosed with EGE, were enrolled from 2013 to 2017 in our center. According to patients' preference, all the patients were treated with dietary elimination (DE) and montelukast therapy, or combined with prednisone (PRED)/BUD. Patients' clinical manifestations, treatments, and outcomes were reviewed from the medical records. Twenty-four patients (7 PRED, 7 BUD, 10 DE) received therapy for ≥8 weeks, followed by repeat endoscopy and biopsies. Histological response was defined as <20 eos/hpf (eosinophils per high-power field).

RESULTS

Significant number of patients in DE+PRED (6/7, 85.7%) and DE+BUD (6/7, 85.7%) groups achieved histological response than in the DE group (3/10.30%) (p = 0.024). Mean post-treatment peak eos/hpf in the DE+PRED group was 16.57 ± 6.85 vs. 10.00 ± 5.07 in the DE+BUD group vs. 36.60 ± 24.57 in the DE group (p = 0.009). Change of eos/hpf from pre- to post-treatment was -49.86 ± 45.02 vs. -34.29 ± 23.44 in the BUD group vs. -0.3 ± 23.95 in the DE group (p = 0.011). There were no significant differences between DE+PRED and DE+BUD groups (p = 0.470, p = 0.363, respectively).

CONCLUSION

BUD is effective in the treatment of EGE and has similar effectiveness with PRED.

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.

Synergy of Interleukin (IL)-5 and IL-18 in eosinophil mediated pathogenesis of allergic diseases

Eosinophils are circulating granulocytes that have pleiotropic effects in response to inflammatory signals in the body. In response to allergens or pathogens, exposure eosinophils are recruited in various organs that execute pathological immune responses. IL-5 plays a key role in the differentiation, development, and survival of eosinophils. Eosinophils are involved in a variety of allergic diseases including asthma, dermatitis and various gastrointestinal disorders (EGID). IL-5 signal transduction involves JAK-STAT-p38MAPK-NFκB activation and executes extracellular matrix remodeling, EMT transition and immune responses in allergic diseases. IL-18 is a classical cytokine also involved in immune responses and has a critical role in inflammasome pathway. We recently identified the IL-18 role in the generation, transformation, and maturation of (CD101+CD274+) pathogenic eosinophils. In, addition, several other cytokines like IL-2, IL-4, IL-13, IL-21, and IL-33 also contribute in advancing eosinophils associated immune responses in innate and adaptive immunity. This review discusses with a major focus (1) Eosinophils and its constituents, (2) Role of IL-5 and IL-18 in eosinophils development, transformation, maturation, signal transduction of IL-5 and IL-18, (3) The role of eosinophils in allergic disorders and (4) The role of several other associated cytokines in promoting eosinophils mediated allergic diseases.

Involvement of the anti-inflammatory, anti-apoptotic, and anti-secretory activity of bee venom in its therapeutic effects on acetylsalicylic acid-induced gastric ulceration in rats

Acetylsalicylic acid (ASA) is the most highly consumed pharmaceutical product worldwide. Importantly, gastrointestinal ulceration due to ASA is a major complication. Hence, the present work aimed to examine, for the first time, the healing properties of bee venom (BV) in acute gastric ulceration induced by ASA. Forty adult male Sprague-Dawley rats were divided into four groups that received distilled water only, ASA (500 mg/kg BW) twice daily for 3 days, ASA for 3 days followed by BV (2 mg/kg BW) for 7 days, or ASA for 3 days followed by ranitidine hydrochloride (50 mg/kg BW) for 7 days. Haematological analysis, haemostatic evaluation, and inflammatory marker estimation were performed. Rat stomachs were collected for ulcer scoring, gene expression analysis, oxidative stress assays, histopathological and immunohistochemical examinations, and tissue eosinophil scoring. The results revealed that BV markedly decreased the ulcer index, pro-inflammatory cytokine levels, malondialdehyde levels, BAX distribution, caspase-3 expression, and tissue eosinophil levels. Additionally, significant increases in antioxidant enzymes and heat shock protein 70 localization in gastric tissue were evident following BV treatment after ASA exposure. Also, BV has been found to attenuate the haematological, haemostatic, and histopathological alterations induced by ASA. Our findings collectively indicate that the gastroprotective effect of BV against ASA-induced ulceration in rats is mediated by its antioxidant, anti-inflammatory, anti-apoptotic, and anti-secretory properties.

Eosinophilic Gastrointestinal Diseases in Childhood

Eosinophilic gastrointestinal diseases (EGIDs) comprise a group of chronic, inflammatory diseases of the gastrointestinal (GI) tract, that are characterized, clinically, by symptoms related to the dysfunction of the involved segment(s) of the GI tract, and histologically, by dense eosinophilic inflammation, in the absence of an identifiable secondary cause. The group of EGIDs comprises eosinophilic esophagitis (EoE), eosinophilic gastritis (EG), eosinophilic gastroenteritis (EGE), and eosinophilic colitis (EC). EoE is the most common and the best described EGID compared to EG, EGE, and EC. The clinical presentation of the EGIDs differs depending on the location and the extent of the eosinophilic infiltration in the GI tract, as well as its depth through the bowel wall. In the absence of biological markers, the diagnosis is based on the combination of clinical symptoms with the histological features of EGIDs, after the exclusion of secondary causes of eosinophilic inflammation of the GI tract. Treatment is individualized and includes elimination diets (mainly empiric or elemental) and/or drugs, according to the involved GI segment: proton pump inhibitors or local steroids in EoE; local or oral systemic steroids in EG/EGE limited to the duodenum; oral systemic steroids in EGE with lower small intestine and/or colon involvement. In patients with EoE, maintenance treatment with lower doses may be considered following histological remission with the means of drugs. In patients treated with elimination diets, disease food triggers identified during food reintroduction need to be further eliminated. Esophageal stenosis despite medical treatment requires endoscopic dilation, while the use of thiopurines or anti-TNF drugs may be considered in refractory or steroid-dependent EGID (other than EoE). The aim of this review is to provide the available evidence on each of the above disorders, to aid clinicians to interpret the clinical manifestations and the laboratory findings and choose the best available treatment option.

Eosinophilic gastroenteritis: Atypical cause for chronic diarrhea in human immunodeficiency virus-associated immunosuppression

Eosinophilic gastroenteritis (EGE) is an uncommon disease in both immunocompetent and immunocompromised. We describe a 57-year-old male with human immunodeficiency virus who presented to us with chronic diarrhea. He had no history of allergies and had significant weight loss, normal systemic examination, and a complete blood count showing no eosinophilia. After an esophagogastroduodenoscopy, the diagnosis of EGE was made by histopathological findings. The symptoms started improving with the initiation of treatment with oral prednisolone.

Evaluation of gene expression change in eosinophilic gastroenteritis

AIM

Screening differentially expressed genes (DEGs) related to Eosinophilic gastroenteritis (EG) to introduce possible biomarkers.

BACKGROUND

EG as a rare gastrointestinal disorder is characterized with gastrointestinal bleeding, crampy generalized abdominal pain, diarrhea, nausea, vomiting, and weight loss. In this study gene expression profile of patients is analysis via protein-protein interaction (PPI) analysis to reveal new prospective of disease.

METHODS

Top significant genes of gene expression profiles of 5 gastric antrum EG patients and 5gastric antrum control from GEO which were matched via boxplot analysis were screened via PPI network by using Cytoscape software and STRING database. Numbers of 20 top nodes of query DEGs based on degree value were introduced as central nodes which 7 critical central genes among them were identified. Gene ontology enrichment for the 20 central genes was done by using CluGO. Action map for the central genes was performed by applying CluePedia.

RESULTS

Among 20 central nodes, TXN, PRDX2, NR3C1, GRB2, PIK3C3, AP2B1 and REPS1 were recognized as critical central genes. Nine biological terms were determined that most of them were involved in the transport processes.

CONCLUSION

The introduced possible biomarkers can be used in the differential diagnosis of the disease and also in treatment of disorder.

Massive hemorrhagic ascites: A rare presentation of eosinophilic gastroenteritis

According to Klein’s classification system, the symptomatology of eosinophilic gastroenteritis (EG), a rare disease, differs based on the affected tissue layer. Patients with subserosal EG often have peritoneal effusion. Hemorrhagic ascites due to EG is extremely rare and has not been reported in the literature. Here, we report a 57-year-old woman with EG and massive hemorrhagic ascites. Laboratory investigations showed elevated peripheral eosinophils with significant eosinophilia (65.6%). Ultrasonography showed massive abdominal ascites. Abdominal paracentesis revealed hemorrhagic peritoneal fluid and microscopy showed predominant eosinophils. Upper gastrointestinal endoscopy revealed erosions, exudates, and mucosal rings in the duodenal mucosa; histological examination indicated eosinophilic infiltration. EG presenting with hemorrhagic ascites was diagnosed by histologic examination of eosinophilic infiltration. She was empirically treated with ketotifen 1 mg bid po with rapid resolution of ascites and a remarkable decline in peripheral eosinophil counts. Clinicians should consider the differential diagnosis of unexplained hemorrhagic ascites.

Diagnosis, Natural History and Treatment of Eosinophilic Enteritis: a Review

PURPOSE OF REVIEW

To review recent findings regarding eosinophilic enteritis, including epidemiology, pathogenesis, natural history, and treatment.

RECENT FINDINGS

A 2017 population-based study using a US healthcare system database identified 1820 patients with a diagnosis of eosinophilic enteritis among 35,826,830 individuals. The majority of patients with eosinophilic enteritis in this study were women (57.7%), Caucasian (77.5%), and adults (> 18 years of age) (83.5%). The overall prevalence of eosinophilic enteritis was estimated at 5.1/100,000 persons. Eosinophilic enteritis, also known as eosinophilic gastroenteritis, is a rare primary eosinophilic gastrointestinal disorder (EGID) of unknown etiology characterized by the presence of an intense eosinophilic infiltrate on histopathological examination of the intestinal mucosa. The etiology of eosinophilic enteritis remains unknown. However, there is evidence to support the role of allergens in the pathogenesis of this disorder, as children and adults with EGIDs often have positive skin testing to food allergens and a family history of allergic diseases. Recent studies unraveling the role of IgE-mediated but also delayed Th2-type responses have provided insight into the pathogenesis of this disease. Eosinophilic enteritis causes a wide array of gastrointestinal symptoms such as abdominal pain, diarrhea, nausea, vomiting, bloating, or ascites, and its diagnosis requires a high degree of clinical likelihood, given the nonspecific clinical presentation and physical examination findings. Oral corticosteroids are considered to be the mainstay of treatment and are generally used for a short period with good response rates. Antihistamine drugs and sodium cromoglycate have also been used to treat patients with eosinophilic enteritis. Preliminary studies have demonstrated the potential benefit of biological therapies targeting the eosinophilic pathway such as mepolizumab, an anti-IL5 antibody, or omalizumab, an anti-IgE monoclonal antibody. Eosinophilic enteritis is generally considered to be a benign disease without relapse, but up to 50% of patients may present a more complex natural history characterized by unpredictable relapses and a chronic course.

Eosinophil Counts in the Small Intestine and Colon of Children Without Apparent Gastrointestinal Disease: A Meta-analysis

The aim of the current study was to review the available data regarding eosinophil density in healthy tissue specimen originating from lower gastrointestinal segments to support suggested diagnostic cutoffs widely used in clinical practice. A systematic search was performed in 3 different databases. Calculations were made with Comprehensive MetaAnalysis software using random-effects model. Cell number measurements were pooled using the random-effects model and displayed on forest plots. Summary point estimations, 95% confidence intervals (CIs), and 95% prediction intervals (PIs) were calculated. The cumulative mean cell numbers were 8.26 (95% CI 4.71-11.80) with PI of 0-25.32 for the duodenum, 11.52 (95% CI 7.21-15.83) with PI 0-60.64 for the terminal ileum, and 11.10/ high-power field (HPF) (95% CI 9.11-13.09) with PI of 0.96 to 21.23 in the large intestine and the rectum (HPF area = 0.2 mm). Previous studies included control patients with irritable bowel syndrome and functional gastrointestinal disorders. As mucosal eosinophils have a role in their pathomechanism, those patients should have been excluded. A critical point of interpreting reported data is that HPF is relative to the technical parameters of the microscopes; therefore, it is important to report findings in cell/mm. The present meta-analysis does not support the higher (>20) or lower (<10) cutoff values for healthy tissue eosinophil number. In contrast to the esophagus, there is no normal cutoff eosinophil density in the small intestine and the colon. A prospective, multicenter study to establish normal mucosal eosinophil density is clearly needed.

Acute eosinophilic appendicitis: a radiologic-pathologic correlation

Inflammation of the appendix is one of the most common conditions requiring emergent surgical intervention. Computed tomography commonly demonstrates a dilated appendix with adjacent inflammation. Traditionally, luminal obstruction of the appendix has been thought to be the primary etiology of appendicitis. However, current evidence suggests that etiology of appendicitis is multifactorial and can involve a number of different pathogenic pathways. Here we present a case of acute eosinophilic appendicitis with radiologic-pathologic correlation from a hypersensitivity reaction pathway. Acute eosinophilic appendicitis may represent an early precursor to conventional acute suppurative (phlegmonous) appendicitis, or a variant form of acute appendicitis.

Prevalence of Eosinophilic Gastroenteritis and Colitis in a Population-Based Study, From 2012 to 2017

BACKGROUND & AIMS

Although eosinophilic esophagitis (EoE) has been extensively studied, there have been few epidemiology studies of other eosinophilic gastrointestinal disorders (EGIDs). Using a large, population-based database, we investigated epidemiologic features of eosinophilic gastroenteritis (EoGE) and eosinophilic colitis (EoC) in the United State.

METHODS

We collected data from a commercial database (Explorys Inc, Cleveland, OH) that provided electronic health records from 26 major integrated U.S. healthcare systems from 1999 to March 2017. We identified a cohort of adult and pediatric patients with EoGE and EoC from March 2012 to March 2017, based on the Systematized Nomenclature of Medicine Clinical Terms. We calculated the overall prevalence of EoGE and EoC among different patient groups, and performed age- and gender-adjusted analyses to assess for differences in the prevalence of associated medical conditions in patients with EoGE and EoC and control patients (patients in the database between March 2012 and March 2017 without EGID-associated diagnoses).

RESULTS

Of the 35,826,830 individuals in the database, we identified 1820 patients with EoGE and 770 with EoC. The overall prevalence rate of EoGE was 5.1/100,000 persons; the overall prevalence rate of EoC was 2.1/100,000 persons. Each of the non-EoE EGIDs was more prevalent in Caucasians than in African-Americans and Asians, and in female patients than male patients. Although EoGE was more prevalent in children (under 18 years of age) than in adults, EoC was more prevalent in adults (older than 18 years of age). Compared with control patients, individuals with non-EoE EGIDs were more likely to have been diagnosed with other gastrointestinal or allergic disorders.

CONCLUSIONS

In a population-based study in the United States, using the Explorys database, we found the overall prevalence rate of EoGE to be 5.1/100,000 persons and the prevalence rate of EoC to be 2.1/100,000; these values are at the lower end of prevalence rates previously reported in the United States.

Eosinophilic Enteritis: A Delayed Diagnosis

Eosinophilic gastrointestinal disorders are a rare and complex group of disorders that are characterized by eosinophilic infiltration of the gastrointestinal tract. Patients often present with a wide range of signs and symptoms as any length or layer of the GI tract can be involved such as mucosal, muscular, or serosal. As a part of the workup, patients frequently undergo computed tomography scans and multiple endoscopies before the diagnosis is finally made as was true in our case of a 59-year-old male patient presenting with 2 months of nausea, abdominal pain, and weight loss. He underwent esophagogastroduodenoscopies, colonoscopies, video capsule study, and balloon enteroscopy before the diagnosis was confirmed histologically. Endoscopic and radiographic findings can be variable and are usually unpredictable. The diagnosis is confirmed on histopathological examination of biopsies that must show >15-50 eosinophils/high-power field based on the location in the GI tract. In our patient, erythema, scalloping, whitish exudate, and patches of villous blunting were noted in the duodenum to proximal ileum endoscopically with >50 eosinophils/high-power field confirming the diagnosis of eosinophilic enteritis. This class of diseases is often found in patients with a history of allergic disorders suggestive of hypersensitivity in the etiology of the disease although our patient had no such known history. Elimination diets and steroids are the mainstay of therapy and often lead to complete resolution of symptoms as well as endoscopic and radiographic findings in up to 90% of patients as was seen in our patient, although some patients have a chronic remitting course.

Subserous Eosinophilic Gastroenteritis: A Rare Cause of Ascites

Eosinophilic gastroenteritis is an inflammatory gastrointestinal disease characterized by eosinophilic infiltration of the digestive tract. The subserous type is the rarest form and diagnosis is challenging because the symptoms are heterogeneous and endoscopy may be non-diagnostic. The authors describe the clinical case of a 41-year-old female patient who was diagnosed with subserous eosinophilic gastroenteritis. This case highlights the importance of clinical suspicion of eosinophilic gastroenteritis in patients in the third to fifth decades of life with gastrointestinal symptoms, ascites and eosinophilia.