Abstract

Eosinophilic gastroenteritis is not only easy to ignore in clinical practice, but also easy to miss in the process of pathological diagnosis. It is considered an uncommon disease with a low incidence rate that remains as a diagnostic challenge for the clinician, in spite of the fact that seventy years have passed since its original description. It is characterized by focal or diffuse infiltration of eosinophils in the gastrointestinal tract in the absence of secondary causes. The pathogenesis of this condition is not well understood and its clinical presentation depends on the segment and layer of the gastrointestinal tract affected. Hereby we present the case of a 45-year-old female without history of allergies who was evaluated for unspecific gastrointestinal symptoms, without relevant findings on physical examination. Subsequently she received repeated courses of helicobacter pylori eradication therapy, anti-helminthes therapy and eventually underwent cholecystectomy for cholelithiasis without any improvement of her symptoms postoperatively. Later she was treated by psychiatrists and gastroenterologist as non ulcer dyspepsia for years. On Complete Blood Count (CBC) she had persistent severe eosinophilia. The patient was evaluated and the diagnosis of eosinophilic esophagitis and gastritis was confirmed by histopathological findings. Her symptoms as well as complete blood count improved dramatically within two weeks with oral steroid and montelukast therapy. The relevance of the case resides in highlighting the lack of guidelines or consensus for histological diagnosis being virtually the only one available. To a similar extent, treatment evidence is based on case series with a reasonable number of patients and case reports..

Keywords: Eosinophilic gastroenteritis; Eosinophilia; Cholecystectomy; Oral steroid