Eosinophilic Gastroenteritis: Case Report and Review in Search for Diagnostic Key Points

Abstract

Eosinophilic gastroenteritis is considered an uncommon disease with a low incidence rate that remains as a diagnostic challenge for the clinician, in spite of the fact that seventy years have passed since its original description. Hereby we present the case of a 29-year-old male without history of allergies who was evaluated for unspecific gastrointestinal symptoms, without relevant findings on physical examination and presenting an initial complete blood count (CBC) with severe eosinophilia. The patient was evaluated and the diagnosis of eosinophilic gastroenteritis was confirmed by histopathological findings. The relevance of the case resides in highlighting the lack of guidelines or consensus for histological diagnosis being virtually the only one available. To a similar extent, treatment evidence is based on case series with a reasonable number of patients and case reports.

A Case of Eosinophilic Gastroenteritis Associated with Eosinophilic Ascites Diagnosed by Full-Thickness Biopsy of the Small Intestine

“…The recently reported incidence of eosinophilic gastroenteritis is estimated to be 28 per 100,000 per year, and studies have shown an increased prevalence during the past 16 years [3]. The pathogenesis of eosinophilic gastroenteritis involves a Type 1 hypersensitivity reaction, and many patients will have a history of atopy [8]. The associated allergic disorders, including asthma, allergic rhinitis, and atopic eczema are present in between 54–63% of reported cases of eosinophilic gastroenteritis [7].…”

“…The diagnosis of eosinophilic gastroenteritis requires the presence of three main features that include gastrointestinal symptoms, eosinophilia of one or more areas of the gastrointestinal tract on histology, and the exclusion of other causes of tissue eosinophilia, including intestinal tuberculosis, parasitosis, and malignancy [5,7]. Although the clinical history and physical examination are important, the definitive diagnosis of eosinophilic gastroenteritis is made histologically, which requires gastrointestinal biopsy [8]. To confirm the histological diagnosis, at least 15–20 eosinophils per high power microscopic field are required [5].…”

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

“…[4] Eosinophilic gastrointestinal disorders affect all ethnic groups between 20 and 50 years of age but more commonly around the third decade of life. [5] Unlike in the esophagus, baseline eosinophils are detected in the stomach and intestine under healthy conditions as a part of the host-defense mechanism. [15] However, their infiltration to the deeper layers is considered abnormal.…”

“…[5] Unlike in the esophagus, baseline eosinophils are detected in the stomach and intestine under healthy conditions as a part of the host-defense mechanism. [15] However, their infiltration to the deeper layers is considered abnormal. Eosinophilia in the intestinal mucosa is not seen with infections caused by common bacteria, viruses, and fungus.…”

Abdominal Pain and Ascites: Not Always Related to Portal Hypertension

“…The diagnosis is based on a high index of suspicion when patients present with GI symptoms along with laboratory and pathological findings suggestive of GI tract infiltration by eosinophils [5]. …”