Case Report: Importance of dietary modification in successful management of eosinophilic gastroenteritis

Abstract

Introduction: Eosinophilic gastroenteritis (EGE) is an extremely rare inflammatory disorder with an estimated prevalence of 22-28/100 000. We herein, present a case of EGE in an elderly patient which was successfully managed with dietary restriction. Case report: A 70-year-old male with a history of gastroesophageal reflux disorder (GERD), atopic dermatitis and asthma presented with 2 weeks history of foul-smelling non-bloody diarrhea associated with nausea, vomiting and weight loss. Physical examination was significant for dry oral mucosa and loss of skin turgor. Lab findings were significant for a hemoglobin of 13.2 g/dl, hematocrit of 38.5%, mean corpuscular volume of 86.3%, white blood cell count of 24,200/mm3, albumin of 2.2 g/L, stool fat of 70g, stool osmolar gap of 115, C-reactive protein 1.47. Erythrocyte sedimentation rate, HIV test were unremarkable. Infectious stool work-up was negative. Computed tomography of the abdomen was unremarkable. The mucosa appeared mildly inflamed on upper endoscopy and colonoscopy, and biopsies showed eosinophilic infiltration of the mucosal and muscular layers. A diagnosis of eosinophilic gastroenteritis was made after other causes such as parasitic infection, drug use and malignancy were ruled out. The patient was counseled on a six-food elimination diet which successfully resolved his diarrhea. The patient did not have any relapses with dietary modification on follow-up. Discussion: The recurrence rate of EGE is 50%. Steroids improve symptoms in 90% of cases but the recurrence rates are high. The type, dose and duration of steroid therapy is unclear. Sodium cromoglicate, ketotifen, and Montelukast are other proposed treatments, the results being inconclusive. Bowel resection is performed in intestinal obstruction, but medical therapy is needed as recurrence in other segments in common. Dietary modification, a therapy with no side-effects should be the first line of treatment as it can result in resolution sparing the patient of steroid induced side effects.