Eosinophilic gastritis-a rare diagnosis

Introduction: Eosinophilic Gastritis (EG), one of the less common amongst Eosinophilic Gastrointestinal Disorders (EGID),with a prevalence of 6.3 cases/100.000, is an uncommon cause of unspecific abdominal symptoms, including epigastric pain.Case: A 23-year-old female, was admitted with recurrent episodes of nausea, vomiting, abdominal pain and weight loss. She was discharged one week previously after being treated for similar symptoms. The patient had failed an outpatient treatment with a Proton Pump Inhibitor (PPI). During her re-admission, Esophagogastroduodenoscopy (EGD) was performed, and results were significant for gastritis without ulcers or esophagitis. While awaiting biopsy results, the patient experienced a minimal improvement in her symptoms with intravenous fluids and PPI. Extensive workup remained negative except of eosinophilia in peripheral blood. Gastric mucosal biopsy revealed eosinophilic infiltrates in Lamina Propria, confirming the diagnosis of Eosinophilic Gastritis. Helicobacter pylori on immunohistochemistry was negative. The patient was counseled regarding the Six Food Elimination Diet for the management of this condition. Her symptoms began to improve under dietary restrictions. Repeated EGD with biopsy at 12 weeks showed resolved eosinophilic infiltrates.Discussion: EG remains a rare diagnosis, and it should be included as a differential diagnosis in every patient with refractory symptoms of nausea, vomiting, abdominal pain, and failure to thrive. Diagnosis of EGID is established after the exclusion of other causes of eosinophilia in the gastrointestinal tract.

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Eosinophilic enteritis – case report of a rare manifestation and review of updates

Gastroenterologie a hepatologie ◽

10.48095/ccgh2020492 ◽

2020 ◽

Vol 74 (6) ◽

pp. 492-496

Author(s):

Eliška Hloušková ◽

Kateřina Bajerová ◽

Jakub Pecl ◽

Petr Jabandžiev ◽

Marta Ježová ◽

...

Keyword(s):

Clinical Symptoms ◽

Histopathological Examination ◽

Corticosteroid Treatment ◽

Elimination Diet ◽

Eosinophilic Infiltration ◽

Duodenal Wall ◽

Dietary Restrictions ◽

Rare Manifestation ◽

Eosinophilic Gastrointestinal Disorders

Eosinophilic enteritis is one of the eosinophilic gastrointestinal disorders characterised by various clinical symptoms. Histopathologic proof of dense eosinophilic infiltration is the cornerstone for the diagnosis. There is no consensus on how dense the infiltration should be, and cut-off values of the eosinophilic count in HPF have not been defined yet. Therapy for eosinophilic enteritis is based on an elimination diet and corticosteroid treatment. Herein the authors report a case of 14-year-old boy who suffered from acute abdominal pain. Computer tomography of the abdomen revealed a thickening of the duodenal wall mimicking a tumour, which seemed to infiltrate the gallbladder and omentum. Histopathological examination of samples taken during laparoscopy showed eosinophilic infiltration and sclerotic changes of the gallbladder and duodenum. Follow-up endoscopy proved extensive eosinophilic infiltration of the gastrointestinal tract: eosinophilic esophagitis, duodenal ulcer with dense eosinophilic presence and eosinophilic proctitis. The patient recovered after dietary restrictions and prednisone.

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Diagnostic yield and appropriate indication of upper endoscopy in Jordanian children

BMC Pediatrics ◽

10.1186/s12887-020-02470-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Eyad Altamimi ◽

Yousef Odeh ◽

Tuka Al-quraan ◽

Elmi Mohamed ◽

Naif Rawabdeh

Keyword(s):

Abdominal Pain ◽

Diagnostic Yield ◽

Failure To Thrive ◽

University Hospital ◽

P Value ◽

Upper Endoscopy ◽

Detection Rates ◽

Common Indication ◽

Histopathological Findings ◽

Endoscopic Findings

Abstract Background Upper endoscopy is an essential tool for diagnosing pediatric gastrointestinal issues. This study aimed to assess the indications, diagnostic yields, concordance between histopathological and endoscopic findings and suitability of upper endoscopies performed at a tertiary university hospital in Jordan. Methods Hospital records of children who underwent upper endoscopy were retrospectively reviewed. Demographics, endoscopic details (e.g., indications, findings and any complications), and histopathological findings were collected. The relationship between endoscopic findings and histopathological abnormalities was reported. Results The study included 778 patients (age, 92.5 ± 54.5 months; 380 girls, 48.8%). The most common age group was children younger than 60 months (273 patients, 34.3%). The most common indication for endoscopy was abdominal pain, followed by vomiting and failure to thrive or weight loss. Normal upper endoscopy was reported in 411 patients (52.8%). Age below 60 months, abdominal pain, dysphagia/odynophagia, and heartburn were predictive of abnormal endoscopy in multivariate analysis with p-value 0.000, 0.048, 0.001 and 0.01 respectively. Abnormal endoscopy showed 67.3% sensitivity and 69.9% specificity to predict histopathological abnormalities. Of those performed, 13.6% endoscopies were described as inappropriate indication. The suitability of the procedure was a sensitive predictor for abnormal endoscopic and histopathological findings. Conclusions Abdominal pain is the most common indication for upper endoscopy in our population. It is associated with a higher chance of abnormal endoscopy. Concordance between endoscopic and histopathological findings is not high. Normal endoscopic findings shouldn`t discourage the endoscopist from obtaining tissue biopsies. Considering more biopsies may improve pathological detection rates. Compliance with established endoscopy guidelines may reduce unnecessary procedures.

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Combined and Alternating Topical Corticosteroids and Food-Elimination Diet May Reduce Steroid Burden while Maintaining Efficacy of Treatment: A Retrospective Cohort Study of a Clinical Care Protocol in Eosinophilic Esophagitis

Gastroenterology ◽

10.1016/s0016-5085(17)32972-4 ◽

2017 ◽

Vol 152 (5) ◽

pp. S865-S866

Author(s):

Craig C. Reed ◽

Anca Safta ◽

Shadi Qasem ◽

Angie Almond ◽

Evan S. Dellon ◽

...

Keyword(s):

Cohort Study ◽

Eosinophilic Esophagitis ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Clinical Care ◽

Elimination Diet ◽

Topical Corticosteroids ◽

Care Protocol ◽

Food Elimination ◽

Efficacy Of Treatment

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Food Elimination Diet and Nutritional Deficiency in Patients with Inflammatory Bowel Disease

Clinical Nutrition Research ◽

10.7762/cnr.2018.7.1.48 ◽

2018 ◽

Vol 7 (1) ◽

pp. 48 ◽

Cited By ~ 16

Author(s):

Hee-Sook Lim ◽

Soon-Kyung Kim ◽

Su-Jin Hong

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Elimination Diet ◽

Nutritional Deficiency ◽

Inflammatory Bowel ◽

Food Elimination

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620 GASTRODUODENAL EOSINOPHILIA IS UNDER-APPRECIATED IN EOSINOPHILIC ESOPHAGITIS (EOE) PATIENTS WITH FUNCTIONAL BOWEL SYMPTOMS: A REAL LIFE EXPERIENCE

Diseases of the Esophagus ◽

10.1093/dote/doab052.620 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Kathryn Peterson ◽

Robert Genta ◽

Henrik Rasmussen ◽

Bradford Youngblood ◽

Amol Kamboj

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Eosinophilic Esophagitis ◽

Life Experience ◽

Real Life ◽

Gastrointestinal Disorder ◽

Control Group ◽

Abdominal Symptoms ◽

Gi Symptoms ◽

Initial Work

Abstract Eosinophilic esophagitis (EoE) is currently thought to be the most common Eosinophilic Gastrointestinal Disorder. EoE patients often present with non-esophageal GI symptoms. Presence of EoE increases one’s risk of developing distal eosinophilia, including eosinophilic gastritis (EG) and duodenitis (EoD). A diagnosis of EG/EoD often takes years due to lack of provider awareness and absence of consensus diagnostic guidelines. The aim was to evaluate the prevalence of EG/EoD in patients with EoE and functional abdominal symptoms. Methods 52 EoE patients with extra-esophageal GI symptoms (i.e. abdominal pain, nausea, bloating, irritable bowel) who had stomach and small bowel biopsies interpreted as non-specific inflammation or normal were identified (‘EoE + S’). 15 EoE patients without extra-esophageal complaints who had routine screening stomach and small bowel biopsies at their initial endoscopies were included as a control group (‘EoE-S’). Biopsies taken at initial work up were identified and blocks were cut for H&E staining and assessment by an independent, blinded GI pathologist skilled in eosinophil (eos) assessment. Results 45 EoE + S and 12 EoE-S patients were evaluated (Table 1). Common symptoms were abdominal pain, bloating and nausea. All prior pathology reports were consistent with non-specific inflammation or normal tissue. Upon blinded re-assessment, 8/45 (17.8%) EoE + S patients met criteria for EG (≥30 eos/hpf in ≥5 gastric hpfs). None of the EoE-S patients met criteria for EG. 24/45 (53%) EoE + S patients met criteria for EoD (≥30 eos/hpf in ≥3 duodenal hpfs). 7 patients had concomitant EG + EoD. 3/12 EoE-S patients met criteria for EoD. Peak gastric and duodenal eos counts for the EoE + S group were higher than for the EoE-S group. Conclusion In patients with EoE and extra-esophageal GI complaints, review of gastric and duodenal biopsies previously reported as normal or ‘non-specific inflammation’ demonstrated a high discovery rate of gastroduodenal eosinophilia. These findings suggest that intentional evaluation of gastric and duodenal eos is indicated in patients with EoE and persistent non-esophageal GI symptoms. Increased awareness of EG/EoD and consensus diagnostic criteria may lead to the identification of currently undiagnosed patients with EG/EoD.

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Sphincter of Oddi Dysfunction: A Perplexing Presentation

Case Reports in Gastroenterology ◽

10.1159/000452736 ◽

2016 ◽

Vol 10 (3) ◽

pp. 714-719 ◽

Cited By ~ 3

Author(s):

Sana Ahmad Din ◽

Iman Naimi ◽

Mirza Beg

Keyword(s):

Abdominal Pain ◽

Magnetic Resonance Cholangiopancreatography ◽

Sphincter Of Oddi ◽

Abdominal Ultrasound ◽

Sphincter Of Oddi Dysfunction ◽

Sphincter Pressure ◽

Abdominal Symptoms ◽

Biliary Sphincterotomy ◽

Bile Drainage ◽

Oddi Dysfunction

Sphincter of Oddi dysfunction is caused by stenosis or dyskinesia of the sphincter of Oddi, leading to blockage of bile drainage from the common bile duct. We present the case of a 16-year-old female with chronic abdominal pain who underwent laparoscopic cholecystectomy for cholelithiasis but continued to experience abdominal pain, nausea, and vomiting along with persistently elevated ALT and AST levels. Postoperative abdominal ultrasound was nondiagnostic. Esophagogastroduodenoscopy showed mild reflux esophagitis and mild chronic Helicobacter pylori-negative gastritis. Omeprazole was started, but it did not decrease the frequency and severity of the abdominal symptoms. Magnetic resonance cholangiopancreatography did not reveal any pathology. Endoscopic retrograde cholangiopancreatography with manometry confirmed an elevated biliary sphincter pressure. Biliary sphincterotomy was performed, and the symptoms improved.

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Idiopathic Sclerosing Encapsulating Peritonitis in a Patient with Atypical Symptoms and Imaging Findings

Case Reports in Gastrointestinal Medicine ◽

10.1155/2021/6695806 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Joseph Wetherell ◽

Katherine Woolley ◽

Rishi Chadha ◽

Julia Kostka ◽

Edin Adilovic ◽

...

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Respiratory Distress ◽

Clinical Symptoms ◽

Failure To Thrive ◽

Rare Condition ◽

Imaging Findings ◽

Atypical Symptoms ◽

Sclerosing Encapsulating Peritonitis ◽

Encapsulating Peritonitis

Sclerosing encapsulating peritonitis is a rare condition caused by a fibrotic membrane covering the small bowel which may lead to abdominal pain or obstruction. The cause may be primary and idiopathic or secondary to several diseases, treatments, and/or medications. The condition typically presents with bowel obstruction, and only one previous case has described ascites as the presenting sign. Sclerosing encapsulating peritonitis is typically diagnosed intraoperatively. We present a case of a patient who presented with atypical clinical symptoms including respiratory distress, recurrent abdominal ascites, and failure to thrive who was diagnosed nonoperatively.

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Superior Mesenteric Venous Thrombosis after Laparoscopic Exploration for Small Bowel Obstruction

Case Reports in Surgery ◽

10.1155/2013/952383 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Hideki Katagiri ◽

Shozo Kunizaki ◽

Mayu Shimaguchi ◽

Yasuo Yoshinaga ◽

Yukihiro Kanda ◽

...

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Abdominal Surgery ◽

Venous Thrombosis ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Anticoagulation Therapy ◽

Mesenteric Venous Thrombosis ◽

Laparoscopic Exploration ◽

Abdominal Symptoms

Mesenteric venous thrombosis is a rare cause of intestinal ischemia which is potentially life-threatening because it can lead to intestinal infarction. Mesenteric venous thrombosis rarely develops after abdominal surgery and is usually associated with coagulation disorders. Associated symptoms are generally subtle or nonspecific, often resulting in delayed diagnosis. A 68-year-old woman underwent laparoscopic exploration for small bowel obstruction, secondary to adhesions. During the procedure, an intestinal perforation was identified and repaired. Postoperatively, the abdominal pain persisted and repeat exploration was undertaken. At repeat exploration, a perforation was identified in the small bowel with a surrounding abscess. After the second operation, the abdominal pain improved but anorexia persisted. Contrast enhanced abdominal computed tomography was performed which revealed superior mesenteric venous thrombosis. Anticoagulation therapy with heparin was started immediately and the thrombus resolved over the next 6 days. Although rare, this complication must be considered in patients after abdominal surgery with unexplained abdominal symptoms.

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