The features of eosinophilic gastroenteritis stem from the invasion of eosinophils and a subsequent inflammatory reaction involving the intestinal epithelium [1] [2] [3] [4]. Although virtually any part of the gastrointestinal tract can be affected, the stomach and the proximal small intestine seem to be the most common sites [1] [2]. The severity of symptoms somewhat depends on the depth of inflammation, but the non-specific complaints dominate the clinical presentation - abdominal pain (frequently accompanied by cramping), diarrhea, nausea with vomiting, and dysphagia [1] [2]. Because the mucosal layer is universally affected, malabsorptive syndromes, particularly protein-losing enteropathy and iron deficiency, are a common finding, which often results in weight loss and anemia, respectively [1] [5]. Lower gastrointestinal bleeding is present when eosinophilic gastroenteritis affects the colon [1] [6]. A delayed onset of puberty, amenorrhea, failure to thrive, and growth retardation are notable manifestations in children and adolescents [1] [5] [6]. Ascites with very high peripheral eosinophilia are hallmarks of more severe forms of eosinophilic gastroenteritis in which subserosal layers of the intestinal wall are affected [1]. In rare cases, accompanying disorders may include pancreatitis, acute appendicitis, and duodenal ulcers [1].

• Pseudotumor

  Inflammatory pseudotumor of the small intestine. Am J Roentgenol Radium Ther Nucl Med. 1974 Jun; 121 (2):305–311. [ PubMed ] [ Google Scholar ] LiVolsi VA, Perzin KH. Inflammatory pseudotumors (inflammatory fibrous polyps) of the esophagus. [ncbi.nlm.nih.gov]

  P J Male, F de Toledo, S Widgren, R de Peyer and S Berthoud, Pseudotumoral enterocolitis and massive eosinophilia., Gut, 10.1136/gut.24.4.345, 24, 4, (345-350), (1983). G. N. J. Tytgat and E. M. H. [oadoi.org]

  Grossly, both of these groups had characteristic circumscribed pseudotumors. In group A, the lesions were found throughout the gastrointestinal tract; in group B, the lesion was confined to the pyloric antrum. [journals.lww.com]

• Abdominal Pain

  In the hEGE group (n 13), initial symptoms included hematemesis, abdominal pain, and vomiting. Three of the subjects had normal endoscopic findings. Eight patients were categorized into the infant group and 5 into the child group. [ncbi.nlm.nih.gov]

• Nausea

  A 68-year-old woman was admitted with abdominal pain, nausea, vomiting, and watery diarrhea. Laboratory findings revealed elevated serum titers of amylase, lipase, and peripheral blood eosinophil count. [ncbi.nlm.nih.gov]

• Delayed Gastric Emptying

  The disease has the signs of delayed gastric emptying, vomiting, weight loss, and substantial thickening of the gastric antrum. Histopathology established the diagnosis of eosinophilic gastroenteritis of panmural type. [ncbi.nlm.nih.gov]

  Gastroenterology was consulted and she underwent abdominal CT, MRCP, upper gastrointestinal series and gastric emptying study, which were all unremarkable except for mild delayed gastric emptying. [karger.com]

• Recurrent Epigastric Pain

  We report the case of an adolescent boy with recurrent epigastric pain, nausea and vomiting, in whom sonographic features and eosinophilia of the peripheral blood suggested the diagnosis of EG. [ncbi.nlm.nih.gov]

  He had no fever or recent weight loss, but he had experienced recurrent epigastric pain, nausea and episodic diarrhea for about one year. As a teenager, he had had tuberculous lymphadenitis. [cmaj.ca]

• Severe Osteoporosis

  Oral administration of ketotifen in a patient with eosinophilic colitis and severe osteoporosis. [ncbi.nlm.nih.gov]

Because of the rare occurrence of eosinophilic gastroenteritis in clinical practice, the diagnosis may not be an easy one to make. In fact, studies show that up to 80% of patients experience symptoms for several years before the condition is recognized [1] [4]. For this reason, it is necessary to perform a thorough workup in patients who report nonspecific gastrointestinal complaints, starting with a detailed patient history and a full physical examination. After the course of symptoms and their progression is noted, laboratory studies should be employed, revealing abundant peripheral eosinophilia with average counts of 2000/μL [1]. Additional findings include anemia, hypoalbuminemia (as a result of fecal protein loss that can be tested through a 24h collection of alpha1-antitrypsin), steatorrhea, and high serum immunoglobulin E (IgE) levels [1]. The differential diagnosis of peripheral eosinophilia is broad, which is why stool cultures (to rule out parasitic infections) and skin prick tests (to exclude allergies) are vital constituents of the workup [1]. Computed tomography and ultrasonography are useful imaging studies (ascites and thickening of gastric folds are typically identified), but the nonspecific findings revealed during these procedures necessitates the use of endoscopy and subsequent histopathological examination [1] [5]. Eosinophilic gastroenteritis is confirmed when eosinophils are visualized in the gastrointestinal tract and when all other possible causes of eosinophilia are excluded [1] [5] [6].

• Lymphocytic Infiltrate

  In celiac disease, biopsy of small bowel shows blunting of villi, crypt hyperplasia, and predominantly lymphocyte infiltration of crypts. [wjgnet.com]

• Ischemic Changes

  A barium study of the small intestine showed thickening of the duodenal wall in 1 patient with subserosal disease and ischemic changes in the proximal ileum in 1 patient with muscular disease. [doi.org]

1. Ingle SB, Hinge (Ingle) CR. Eosinophilic gastroenteritis: An unusual type of gastroenteritis. World J Gastroenterol. 2013;19(31):5061-5066.
2. Chen MJ, Chu CH, Lin SC, Shih SC, Wang TE. Eosinophilic gastroenteritis: clinical experience with 15 patients. World J Gastroenterol. 2003;9:2813–2816.
3. Hsu YQ, Lo CY. A case of eosinophilic gastroenteritis. Hong Kong Med J. 1998;4:226–228.
4. Christopher V, Thompson MH, Hughes S. Eosinophilic gastroenteritis mimicking pancreatic cancer. Postgrad Med J. 2002;78:498–499.
5. Freeman HJ. Adult eosinophilic gastroenteritis and hypereosinophilic syndromes. World J Gastroenterol. 2008;14(44):6771-6773.
6. Baig MA, Qadir A, Rasheed J. A review of eosinophilic gastroenteritis. J Natl Med Assoc. 2006;98:1616–1619.