A 66–year–old woman presented to the hospital for vomiting, diarrhea and abdominal pain since 10 days but persistent for many years. She had been diagnosed as Irritable Bowel Syndrome. Physical exam was unremarkable except generalized abdominal tenderness. Labs revealed leukocyte count 29,000/mm3 with 64% eosinophilia. Albumin was 2.9 g/dL. Renal and liver function tests were normal. Urease test for H.Pylori was negative. IgE levels were elevated at 1907 IU/ml (0–100 IU/ml). Stool for ova and parasites was negative. Computed Tomography (CT) abdomen/pelvis showed marked wall thickening of the stomach, small bowel and descending colon with infiltrative changes. EGD showed esophagitis, gastritis, duodenitis and edematous jejunal mucosa. Esophageal biopsy showed basal cell hyperplasia with intra epithelial lymphocytes and numerous eosinophils. Antral biopsy showed chronic gastritis with abundant submucosal eosinophils. Small bowel biopsy revealed chronic inflammation with numerous eosinophils in lamina propria. Bone marrow exam ruled out myeloproliferative disorder. Diagnosis of Eosinophilic gastroenteritis was established. Oral prednisone was started that led to gradual resolution of symptoms. Patient was discharged on maintenance low dose steroid and was asymptomatic on long term follow up.
Eosinophilic gastroenteritis (EG) is an uncommon disease characterized by diffuse or patchy eosinophilic infiltration in one or more areas of the gastrointestinal tract, associated with peripheral eosinophilia and high IgE levels. Clinical presentation depends on the extent of histologic involvement of the bowel wall. It often involves the stomach and small bowel and usually presents as vomiting, diarrhea, abdominal pain, anemia, weight loss or obstruction. It may mimic peptic ulcer disease, irritable bowel syndrome, inflammatory bowel disease, gastroenteritis or bowel obstruction. Diagnosis can be easily overlooked in early stages as endoscopic and CT scan findings are nonspecific until the disease is advanced when bowel wall thickening is seen. Definitive diagnosis is based on histology alone that is also easy to miss in initial stages due to patchy distribution. It is important to recognize EG early as treatment can prevent further mucosal damage and progresson of disease.
Eosinophilic Gastroenteritis should be a differential in patients with persistent gastrointestinal symptoms with relapsing and remitting disease course.