Eosinophilic gastroenteritis in a young man

• Published in: Canadian Medical Association journal (CMAJ) 2011-01, Vol.183 (1), p.E65-E67
• Main Authors: Famularo, Giuseppe, Prantera, Cosimo, Nunnari, Josè, Gasbarrone, Laura
• Format: Article
• Language: English
• Subjects: Adult; Care and treatment; Development and progression; Diagnosis; Enteritis - diagnosis; Enteritis - etiology; Enteritis - therapy; Eosinophilia - diagnosis; Eosinophilia - etiology; Eosinophilia - therapy; Gastritis - diagnosis; Gastritis - etiology; Gastritis - therapy; Gastroenteritis; Gastroenterology; Gastrointestinal diseases; Humans; Male; Medical diagnosis; Patient outcomes; Practice; Studies
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.091467

Our patient had peripheral eosinophilia and eosinophilic ascites, which are the hallmarks of the serosal type of eosinophilic gastroenteritis.1 Our patient had no malabsorption, bowel obstruction or bleeding, which are typical features of the mucosal and muscular types. These findings highlight the point that only the peritoneum and the serosal layer of the gut may be involved, while both the mucosal and muscular layers are spared. We had to obtain full-thickness biopsy specimens for accurate diagnosis because the eosinophilic infiltrate was confined to the peritoneum and subserosal layer. Patients with drug hypersensitivity, infection by a virus, Helicobacter pylori or a parasite, vasculitis (e.g., Churg- Strauss syndrome, polyarteritis nodosa), connective tissue disease (e.g., systemic sclerosis), celiac disease, Crohn disease, eosinophilic leukemia or hypereosinophilic syndrome may have eosinophilic infiltration of the gastrointestinal tract that could mimic the cardinal feature of primary eosinophilic gastroenteritis.1 These disorders should be ruled out before a firm diagnosis of primary eosinophilic gastroenteritis is established. Furthermore, involvement of organs other than the gastrointestinal tract usually points to systemic hypereosinophilic syndromes such as eosinophilic leukemia, hypereosinophilic syndrome and Churg-Strauss syndrome. The association between eosinophilic gastroenteritis and other idiopathic eosinophilic disorders of the gastrointestinal tract, such as eosinophilic esophagitis and eosinophilic colitis, is unclear. These disorders likely represent a continuum of pathologically and mechanistically related disorders that have in common the involvement and activation of eosino - phils as the ultimate effector of injury to the gastrointestinal tract.4 This hypothesis is still unproven and requires further investigation.