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Year : 2014 | Volume : 2 | Issue : 1 | Page : 62 - 63  


Letter to the Editor
Eosinophilic Gastroenteritis with Duodenal Involvement: A Rare Case.

Sudhir Kumar Vujhini1 Indira Velagandla2, Hari Shanker Vallakati3, Mahesh Kumar Kandukuri4, Kishori D5, Swetha6

1Assosciate professor, 2Professor and Head, 3Professor, 4Asst. Professor, 5Asst. Professor, 6Asst. Professor, Dept. of Pathology, Malla Reddy Institute of Medical Sciences, Suraram, Hyderabad, Andhra Pradesh.

 

Dear Sir,

Eosinophilic Gastroenteritis (EG) is a rare inflammatory disorder of gastrointestinal tract of unknown etiology. It is characterized by eosinophilic infiltration of bowel wall from esophagus to rectum, most commonly, the stomach and duodenum, peripheral eosinophilia and various gastrointestinal manifestations. Diagnosis requires a high index of suspicion and exclusion of various disorders that are associated with peripheral eosinophilia.

We report a rare case of a 36-year-old man presented with mild upper abdominal pain, tenesmus and frequency of bowel motion. The patient had no past history of ulcer pain and had not had any abdominal operations. There was no history of recent weight loss and any blood or mucus in the stools. The patient is neither an alcoholic nor a smoker. There was no history of allergy, asthma or skin eczema. Abdominal examination showed a soft and tender abdomen. Routine hematological investigations revealed peripheral eosinophilia (30%) with total count of 14,300 cells/cu.mm (Figure 1) and raised ESR (48 mm/ 1st hr). Ultrasonography of abdomen was a normal. Upper G.I. endoscopy showed mild gastritis and duodenitis without any gastric or duodenal ulcers. Mucosal biopsy was done from third part of duodenum and sent for histological examination.

Histology showed two tiny mucosal biopsy bits comprising of mucosal villi lined by columnar epithelium with sub epithelial infiltration of plenty of eosinophils up to muscularis propria (Figure 2). Based on these findings a diagnosis eosinophilic duodenitis was offered. The patient was put on low dose steroid therapy and there was a dramatic improvement. Steroid treatment was gradually reduced and eventually terminated after one month. On regular follow-up, the patient improved.

Eosinophilic   gastroenteritis is a rare, benign inflammatory disorder of the gastrointestinal tract, characterized by eosinophilic infiltration of the layers of the bowel wall, in the absence of known causes of eosinophilia, including drug reaction, parasitic infections and malignancy. [1 – 3] EG affects all ages of both genders and diagnosed most commonly in the third decade of life. It mainly involves stomach and duodenum. [4] The etio-pathology remains unknown, but a personal or a family history of allergic disorders is noted in 70% of patients with this disorder. [5]

EG should be considered in the differential diagnosis of unexplained gastrointestinal symptoms, especially in the presence of peripheral eosinophilia. The main diagnostic criteria are: 1) the presence of gastrointestinal symptoms, 2) biopsies showing eosinophilic infiltration of one or more areas of the gastrointestinal tract (more than 20 eosinophils per high power field) and 3) no evidence of parasitic or extra-intestinal disease. [1 – 3] Histopathology is the gold standard for diagnosis. [2]

Various gastrointestinal manifestations are abdominal pain, vomitings, diarrhea, weight loss, malabsorption, intestinal obstruction, eosinophilic ascites and intense peripheral eosinophilia. [4]

Peripheral eosinophilia is seen in up to 80% of cases of EG. Raised serum IGE levels are seen in children with EG.

Ninety percent of the cases of EG respond to steroid therapy. The duration of therapy varies from patient to patient. Surgical intervention may be required for cases with intestinal obstruction or perforation.

In summary, we present a rare case of eosinophilic gastroenteritis diagnosed on histology and responded to steroid therapy. Clinicians should be aware of this rare entity as it can mimic several other gastrointestinal disorders.

References:

  1. Khan S, Orenstein SR. Eosinophilic gastroenteritis. Gastroenterol Clin North Am 2008;37(2):333-48.
  2. 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(1):54-8.
  3. Chen MJ, Chu CH, Lin SC, Shih SC, Wang TE. Eosinophilic gastroenteritis: clinical experience with 15 patients. World J Gastroenterol 2003;9(12):2813-6.
  4. Lim KC, Tan HK, Rajnakova A, Venkatesh SK. Eosinophilic gastroenteritis presenting with duodenal obstruction and ascites. Ann Acad Med Singapore. 2011 Aug;40(8):379-81.
  5. Rothenberg ME. Eosinophilic gastrointestinal disorders (EGID). J Allergy Clin Immunol 2004;113(1):11-28.

Corresponding Author:

Dr. Sudhir Kumar Vujhini,

Dept. of Pathology,

MallaReddy Institute of Medical Sciences, Suraram Hyderabad, Andhra Pradesh

E-mail: vujhini07@yahoo.com

 

FOR FIGURES PLEASE REFER PDF FILE

 

Source of Support: Nil. Conflict of Interest: None.

 





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