Case Report
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 7, 2009; 15(17): 2156-2161
Published online May 7, 2009. doi: 10.3748/wjg.15.2156
Unusual presentations of eosinophilic gastroenteritis: Case series and review of literature
Rafiq A Sheikh, Thomas P Prindiville, R Erick Pecha, Boris H Ruebner
Rafiq A Sheikh, Department of Gastroenterology, Kaiser Permanente Medical Center, 6600 Bruceville Road, Sacramento, CA 95823, United States
Thomas P Prindiville, Department of Gastroenterology, University of California Davis, 4150 V Street, Sacramento, CA 95917, United States
R Erick Pecha, Department of Gastroenterology, Marshall Medical Center, 1100 Marshall Way, Placerville, CA 95667, United States
Boris H Ruebner, Department of Pathology, University of California Davis, 4150 V Street, Sacramento, CA 95917, United States
Author contributions: Sheikh RA, Prindiville TP and Pecha RE performed endoscopic evaluations; Ruebner BH performed the pathology evaluations; All authors contributed to writing and reviewing the manuscript.
Correspondence to: Rafiq A Sheikh, MBBS, MD, MRCP (UK), FACP, FACG, Department of Gastroenterology, Kaiser Permanente Medical Center, 6600 Bruceville Road, Sacramento, CA 95823, United States. rafiq.a.sheikh@kp.org
Telephone: +1-916-6886858  
Fax: +1-916-6886315
Received: November 14, 2008
Revised: March 24, 2009
Accepted: March 31, 2009
Published online: May 7, 2009
Abstract

Eosinophilic gastroenteritis (EG) is an uncommon disease characterized by focal or diffuse eosinophilic infiltration of the gastrointestinal tract, and is usually associated with dyspepsia, diarrhea and peripheral eosinophilia. Diffuse gastrointestinal tract and colonic involvement are uncommon. The endoscopic appearance may vary from normal to mucosal nodularity and ulceration. Gastrointestinal obstruction is unusual and is associated with predominantly muscular disease. We present five unusual cases of EG associated with gastric outlet and duodenal obstruction. Two cases presented with acute pancreatitis and one had a history of pancreatitis. Four cases responded well to medical therapy and one had recurrent gastric outlet obstruction that required surgery. Four out of the five cases had endoscopic and histological evidence of esophagitis and two had colitis. Two patients had ascites. These cases reaffirm that EG is a disorder with protean manifestations and may involve the entire gastrointestinal tract. Gastric outlet and/or small bowel obstruction is an important though uncommon presentation of EG. It may also present as esophagitis, gastritis with polypoid lesions, ulcers or erosions, colitis and pancreatitis and may mimic malignancy.

Keywords: Gastroenteritis; Eosinophilic; Gastrointestinal obstruction; Eosinophilic esophagitis; Eosinophilic colitis; Eosinophilic pancreatitis