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].

• Abdominal Pain

  EGE should be considered in the differential diagnosis of patients with chronic abdominal pain, vomiting, and hematemesis of unknown cause. The infant group may have a better prognosis than the child group if treated properly. [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]

  After an initial dose of steroids, she clinically improved significantly, her abdominal pain, nausea and vomiting improved, and she tolerated her diet. [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]

• Hyperactive Bowel Sounds

  A physical examination was unremarkable except for a hyperactive bowel sound and diffuse abdominal tenderness. [emj.bmj.com]

• Skin Patch

  No specific allergen was found from the multiple antigen simultaneous test and from the skin patch test. The parasitic immunodiagnosis was negative. [ncbi.nlm.nih.gov]

  Both a skin prick test and skin patch test are ordered, and possibly blood tests as well. [thebump.com]

  Both IgE dependent (specific IgE and skin prick) and non-IgE TH2 dependent (skin patch) allergy tests may aid in identification of the specific allergen related to a case. [wjgnet.com]

• Severe Osteoporosis

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

• Polymenorrhea

  She denied nausea, vomiting, menorrhagia, polymenorrhea, diarrhea, hematemesis, melena, or hematochezia. Her medical history was significant for allergic rhinitis, eczema, and asthma. Her surgical history was negative. [jabfm.org]

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]

Treatment with glucocorticoids is effective. [ncbi.nlm.nih.gov]

Frequency, prognosis and therapeutic implications must guide the diagnostic course. An acute eosinophilic gastroenteritis in a 78-year-old asthmatic woman receiving celecoxib is reported. [ncbi.nlm.nih.gov]

Prognosis With treatment, prognosis is good with full resolution of symptoms in spite of a possible relapsing course. [orpha.net]

This is <1.1, which suggests a peritoneal etiology for this ascitic fluid and rules out portal hypertension (SAAG >1.1). [the-rheumatologist.org]

Eosinophilic gastroenteritis (EGE) is an uncommon disease of unknown etiology reported in both adult and pediatric age group. [ncbi.nlm.nih.gov]

The epidemiology, pathophysiology, and treatment of EGE are also discussed, along with a review of the current literature. [ncbi.nlm.nih.gov]

Eosinophilic Colitis: Epidemiology, Clinical Features, and Current Management. Ther Adv Gastroenterol. 2011;4(5):301-309 [mulkiyedergi.org]

[…] etiology characterized by peripheral eosinophilia, eosinophilic invasion of the gastrointestinal tract, and clinical symptoms related to the site and tissue layer involved mostly involved stomach and proximal intestine 2 Eosinophilic Gastroenteritis Pathophysiology [powershow.com]

The pathophysiology is based on infiltration of the eosinophils involving various parts of gastrointestinal system, but also different layers of the wall. [ncbi.nlm.nih.gov]

Case reports may help to disseminate knowledge about the disease, thereby increasing the likelihood of early diagnosis and intervention to prevent complications. [ncbi.nlm.nih.gov]

Currently, no preventative measures are available for Eosinophilic Gastroenteritis Early detection and treatment of the disease are important to prevent the symptoms from becoming too severe/adverse What is the Prognosis of Eosinophilic Gastroenteritis [dovemed.com]

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.