Sequential therapy was significantly better than standard therapy for eradicating H. pylori infection.

Common variable immunodeficiency (CVID) is a rare primary immunodeficiency disease characterized by hypogammaglobulinemia and recurrent bacterial infections especially in respiratory and gastrointestinal systems. The authors present here a case of CVID with uncommon gastrointestinal manifestation in the form of CVID enteropathy. Based upon the clinical presentation and histopatholic findings the patient was diagnosed as CVID enteropathy and treated with intravenous antibiotics and 3-4 wkly intravenous immunoglobulin infusion and he had responded poorly to gastrointestinal symptoms but the frequency of respiratory and skin infection reduced. CVID has heterogenous gastrointestinal manifestations; among them the CVID enteropathy is an uncommon presentation which responds poorly to the mainstay therapy of intravenous immunoglobulin infusion and represents a diagnostic as well as therapeutic challenge for treating physician.

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Eosinophilic gastroenteritis is characterized histologically by eosinophilic infiltration of the gut wall and clinically manifests by gastrointestinal (GI) symptoms. A high index of suspicion is required for the early diagnosis of this uncommon disease in patients who have concomitant GI symptoms and peripheral eosinophilia. This unusual case who initially had duodenal ulcer with duodenal stenosis, responded to Helicobacter pylori treatment and dilatation. He was symptom free for 2 years. Subsequently, developed evanescent eosinophilic gastritis and recurrent H. pylori infection with refractory prepyloric ulceration, but no duodenal stenosis. Eosinophilic gastritis and H. pylori infection initially responded to treatment, but subsequently the patient developed nonhealing prepyloric ulcer and refractory H. pylori infection and had persistent symptoms; all these necessitated surgical intervention consisting of antrectomy with gastrojejunostomy.