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 Table of Contents  
CASE REPORT
Year : 2012  |  Volume : 4  |  Issue : 8  |  Page : 367-368

Eosinophilic Gastroenteritis: A Rare Case Report


1 Department of Internal Medicine, Sakarya Education and Research Hospital, Sakarya, Turkey
2 Department of Pathology, Sakarya Education and Research Hospital, Sakarya, Turkey
3 Department of Gastroenterology, Sakarya Education and Research Hospital, Sakarya, Turkey

Date of Web Publication8-Aug-2012

Correspondence Address:
Selcuk Yaylaci
Department of Internal Medicine, Sakarya University Faculty of Medicine, 54100 Sakarya
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1947-2714.99522

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  Abstract 

Eosinophilic gastroenteritis (EGE) is a rare disease characterized by eosinophilic infiltration and peripheral eosinophilia. It can be seen anywhere in the gastrointestinal tract. It is diagnosed in the biopsies taken during endoscopic examination to the patients with abdominal pain and chronic diarrhea. A 40-year-old woman was admitted with abdominal pain and chronic diarrhea. She has not any disease, food, pollen, or drug allergy in her medical history. Leukocyte: 19,400/mm3 (neutrophil: 19.9%, eosinophil: 57.4%, lymphocyte: 16.5%), platelet: 281,000/ mm 3 , immunoglobulin E: 1721 IU/mL (normal range: 20-100 IU/mL) was counted in her blood examination. The duodenal biopsy was reported as EGE. We applied methylprednisolone 20 mg/day. With this treatment, the patient's symptoms regressed. In this article we present a case of chronic diarrhea diagnosed EGE. The first step in diagnosing is suspecting EGE. It should be borne in mind in patients with chronic diarrhea.

Keywords: Chronic diarrhea, Endoscopic examination, Eosinophilic gastroenteritis


How to cite this article:
Temiz T, Yaylaci S, Demir MV, Kahyaoglu Z, Tamer A, Uslan MI. Eosinophilic Gastroenteritis: A Rare Case Report. North Am J Med Sci 2012;4:367-8

How to cite this URL:
Temiz T, Yaylaci S, Demir MV, Kahyaoglu Z, Tamer A, Uslan MI. Eosinophilic Gastroenteritis: A Rare Case Report. North Am J Med Sci [serial online] 2012 [cited 2020 Feb 17];4:367-8. Available from: http://www.najms.org/text.asp?2012/4/8/367/99522


  Introduction Top


Eosinophilic gastroenteritis (EGE) is a rare disease characterized by eosinophilic infiltration and peripheral eosinophilia. It can be seen anywhere in the gastrointestinal tract. [1] The pathogenesis is not fully understood but hypersensitivity is a major factor. [2] Three different forms are defined: mucosal involvement, muscle involvement, and serosal involvement. [3] The first identification of EGE was made by Kaijser et al. in 1937. [3] It is diagnosed in the biopsies taken during endoscopic examination to the patients with abdominal pain and chronic diarrhea. [1],[2],[4] The number of diagnosed cases is increasing with the increase in endoscopic procedures. [4]

In this article we want to present a case of chronic diarrhea, which led to the diagnosis of EGE.


  Case Report Top


A 40-year-old woman was admitted with the complaints of abdominal pain and chronic diarrhea. She has diarrhea for 1 year. There was no fever, weight loss, or rash. She has no disease, food, pollen, or drug allergy in her medical history. There was no remarkable feature in her physical examination. Sedimentation: 23 mm/h, hematocrit: 35.5%, leukocyte: 19,400/mm 3 (neutrophil: 19.9%, eosinophil: 57.4%, lymphocyte: 16.5%), platelet: 281,000/mm 3 , immunoglobulin E (IgE): 1721 IU/mL (normal range: 20- 100 IU/mL) was counted in her blood examination. Liver and renal functions were in normal range. Parasitologic examination and bacterial culture of stool were normal. There was no remarkable feature in her abdominal ultrasonography and posterior-anterior lung radiography. Endoscopic examination was performed and multiple duodenal biopsies were taken. The duodenal biopsy was reported as EGE [Figure 1] and [Figure 2]. We applied methylprednisolone 20 mg/ day. With this treatment, the patient's symptoms regressed.
Figure 1: Microscopic appearance of duodenal biopsy (Hematoxylin and Eosin, ×100): common eosinophilic infiltrations in the duodenal mucosa

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Figure 2: Microscopic appearance of duodenal biopsy (Hematoxylin and Eosin, ×200): common eosinophilic infiltrations in the duodenal mucosa

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  Discussion Top


EGE is a rare disease characterized by eosinophilic infiltration and peripheral eosinophilia. It is difficult to diagnose because of nonspecific symptoms. Gastric or duodenal biopsies are required for confirming diagnosis. The macroscopic appearance is nonspecific. More than 20 eosinophils were determined in each magnification field histologically. [3],[4] Reasons (parasites, drug use, malignancy) leading to eosinophilia must be excluded. EGE can be seen anywhere in the gastrointestinal tract. [1],[5]

Because of nonspecific symptoms, the first step in diagnosing is suspecting EGE. Peripheral eosinophilia is seen in two-thirds of patients. [6] Eosinophilic infiltrations in the biopsy anywhere in the gastrointestinal tract is diagnostic if the other reasons (parasites, drug use, malignancy) are excluded. Because of diffuse involvement, multiple biopsy should be taken from different places. [1],[2],[4],[7] High serum level of IgE is common in these patients. Eczema, atopic diseases, such as asthma, may be accompanied. EGE affects both sexes and all age groups but most of the cases are older than 30 years. It is difficult to determine the actual frequency or prevalence of EGE. Number of diagnosed cases is increasing with the increase in endoscopic procedures but the actual frequency of EGE is not known. [8]

There is no consensus about the treatment of EGE. There are not enough studies on this. The treatment should be individualized according to the patient's age and the severity of the symptoms. The steroids are the main drug in the treatment. Antihistamines (ketotifen), mast cell stabilizer (oral chromoglycate), and leukotriene antagonists (montelukast) are other drugs that can be used in the treatment of EGE. [1],[8],[9]

The first step in diagnosing is suspecting EGE. It should be borne in mind in patients with chronic diarrhea.

 
  References Top

1.Chen MJ, Chu CH, Lin SC, Shih SC, Wang TE. Eosinophilic gastroenteritis: Clinical experience with 15 patients. World J Gastroenterol 2003;9:2813-6.  Back to cited text no. 1
[PUBMED]    
2.Kelly KJ. Eosinophilic gastroenteritis. J Pediatr Gastroenterol Nutr 2000;30:28-35.  Back to cited text no. 2
    
3.Talley NJ, Shorter RG, Phillips SF, Zinsmeister AR. Eosinophilic gastroenteritis: A clinicopathological study of patients with disease of the mucosa, muscle layer and subserosal tissues. Gut 1990;31:54-5.  Back to cited text no. 3
[PUBMED]    
4.Baig MA, Qadir A, Rasheed J. A review of eosinophilic gastroenteritis. J Natl Med Assoc 2006;98:1616-9.  Back to cited text no. 4
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5.Rothenberg ME. Eosinophilic gastrointestinal disorders (EGID). J Allergy Clin Immunol 2004;113:11-28.  Back to cited text no. 5
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6.Straumann A, Simon HU. The physiological and pathophysiological roles of eosinophils in the gastrointestinal tract. Al­lergy 2004;59:15-25.  Back to cited text no. 6
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7.Fleischer DM, Atkins D. Evaluation of the patient with sus­pected eosinophilic gastrointestinal disease. Immunol Al­lergy Clin North Am 2009;29:53-63.  Back to cited text no. 7
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8.Khan S. Eosinophilic gastroenteritis. Gastroenterol Clin North Am 2008;37:333-48.  Back to cited text no. 8
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9.Furuta GT, Liacouras CA, Collins MH, Gupta SK, Justinich C, Putnam PE, et al. Eosinophilic esophagitis in children and adults: A systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology 2007;133:1342-63.  Back to cited text no. 9
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    Figures

  [Figure 1], [Figure 2]


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