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

Abstract

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 Gastroenteritis in the Small Intestine Mimicking Eosinophilic Granulomatosis With Polyangiitis in a Young Male Patient

“…EGPA is a systemic vasculitis that causes continual inflammation in systemic organs; therefore, an inflammatory reaction can be detected using clinical symptoms and laboratory data [8]. On the other hand, EGE is based on the allergic reaction triggered by eosinophilia and elevated immunoglobulin E levels [8,9]. Transient inflammation can appear but disappear during the clinical course.…”

Abdominal Pain Due to Eosinophilic Gastroenteritis Diagnosed in 25-Year-Old and 27-Year-Old Sisters with a Family History of Asthma

“…Diagnosis is commonly described in the White population but is reported to occur in all races and ethnic backgrounds; up to 70% of patients with EGID have a personal or family history of atopic disorders (asthma, eczema, or hay fever) [8], and more than 50% of patients have blood eosinophilia [9]. It also predominantly affects female more than male patients [8].…”

“…Some cases present diverse abdominal manifestations, such as abdominal pain, dyspepsia, bloating, and chronic diarrhea, that did not improve with conventional pharmacological therapy for dyspepsia after advanced examination using biopsy revealed eosinophil infiltration with varying degrees of densities [12]. In the end, therapy with anti-inflammatory and anti-allergic agents gave more satisfactory results [9], especially with a combination of elimination diets according to allergy test results [9,12]. Some patients could also develop hypereosinophilia [9], but others can have a normal range of eosinophil serum [7].…”

“…In the end, therapy with anti-inflammatory and anti-allergic agents gave more satisfactory results [9], especially with a combination of elimination diets according to allergy test results [9,12]. Some patients could also develop hypereosinophilia [9], but others can have a normal range of eosinophil serum [7]. Hypereosinophilia can be associated with the severity of the disease and the presence of atopic disease [9,23].…”

“…Some patients could also develop hypereosinophilia [9], but others can have a normal range of eosinophil serum [7]. Hypereosinophilia can be associated with the severity of the disease and the presence of atopic disease [9,23]. Although there are no specific guidelines for EoG, EG, and eosinophilic colitis yet, a review of the literature showed that the presence of eosinophil sheets in expanded lamina propria, excessive intraepithelial eosinophils, eosinophil cryptitis/abscess, and eosinophils in the muscularis mucosa and submucosa are all required histological diagnostic criteria for EoG.…”