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Clinicopathologic Findings in Eosinophilic Gastroenteritis: A German Case Series

Michaela Müller, Klaus-Michael Keller, Sonja Stallmann and Alexander J Eckardt

Eosinophilic gastroenteritis (EG) is a rare disease that includes a spectrum of clinical presentations, characterized by eosinophilic gastrointestinal infiltration in the absence of other causes of eosinophilia. The clinical presentation varies according to the intestinal wall layer and the localization within the gastrointestinal tract.

The aim of this pilot study was to assess clinical, imaging and histopathological features of a case series and to develop a questionnaire for prospective follow-up.

The diagnosis was established in 6 patients by endoscopic biopsies and in one case by sonographic imaging in the presence of peripheral eosinophilia and symptomatic response to therapy. Charts were reviewed and patients were contacted.

Since 2010, 7 patients (3 men, 4 women, mean age 44 ± 20 years) were diagnosed with EG. The most common symptom was abdominal pain, followed by bloating, intermittent nausea and diarrhea, but symptoms did not correlate well with disease location. All patients with endoscopic biopsies showed involvement of the mucosa, even in case of normal endoscopic appearance. Two had additional involvement of the muscularis and serosa. A history of allergy was reported in 43%. Peripheral eosinophilia was absent in 43%. Five patients were treated with oral prednisolone and improved within two to four weeks. In two patients no further therapy was necessary. One patient showed recurrence after 2 years and received a second successful treatment. Maintenance therapy was necessary with prednisolon in one and montelukast in another. One patient improved spontaneously and another received budesonide 9mg and an elimination diet with partial improvement.

In summary, clinicians should think of EG in patients with common gastrointestinal symptoms. Biopsies from normal appearing mucosa might increase the diagnostic yield. Most patients had good response to steroid therapy often followed by longer lasting symptom-free periods. However, long-term follow-up is necessary, because relapse frequently occurs and maintenance therapy may become necessary.