Published online Sep 27, 2016. doi: 10.4240/wjgs.v8.i9.656
Peer-review started: May 25, 2016
First decision: July 6, 2016
Revised: July 12, 2016
Accepted: July 29, 2016
Article in press: August 1, 2016
Published online: September 27, 2016
Processing time: 124 Days and 10.9 Hours
Eosinophilic gastroenteritis (EGE) is a rare condition characterized by eosinophilic infiltration of the gastrointestinal tract. Depending on the dominant layer of infiltration it is classified into three types namely, mucosal, muscularis and subserosal. The most uncommon variant is the subserosal type characterized by primarily subserosal disease, eosinophilic ascites and peripheral hypereosinophilia. The clinical features are non-specific with history of atopic predisposition and allergy. Endoscopic biopsy is frequently non-diagnostic due to an uninvolved gastrointestinal mucosa rendering its diagnosis a challenge. The mainstay of diagnosis is peripheral hypereosinophilia and eosinophil-rich ascitic fluid on diagnostic paracentesis. Oral steroid therapy is usually the first line of treatment with dramatic response. Due to a propensity for relapse, steroid-sparing therapy should be considered for relapses of EGE. We report a case of subserosal EGE with diagnostic clinical features and treatment response and review the current strategy in the management of eosinophilic ascites.
Core tip: Eosinophilic gastroenteritis (EGE) is a rare condition and the diagnosis of subserosal EGE is challenging due to its nonspecific symptoms and signs and frequently non-diagnostic biopsy on gastrointestinal endoscopy. This review describes a patient with typical findings of peripheral hypereosinophilia and eosinophilic ascites and outlines the current strategy in the diagnosis and treatment of subserosal EGE.