Abstract
Eosinophilic Gastrointestinal Disease involving Multiple Segments of the GI Tract with Ascites: A Case Report
Jobel Feliz Castillo-Coranez, MD; Eulenia R. Nolasco, MD
Manila Doctors Hospital
Background: Eosinophilic gastrointestinal disease (EGID) is a rare inflammatory condition characterized by eosinophilic infiltration of specific segments and layer of the gastrointestinal tract, leading to diverse symptoms. In our patient, multiple GI segments were involved which is a rare and complex presentation of EGID, leading to her varied symptoms. Likewise, the presence of ascites suggests deep eosinophilic infiltration to the serosal layer, which is the least common layer affected, further adding to the unusual presentation of the case.
Clinical Presentation: The patient is a 53 year old female who presented with reflux, heartburn, bloating, epigastric pain, vomiting, and loose watery stools. Her symptoms affected both the upper and lower gastrointestinal tracts. These symptoms persisted despite initial treatment for GERD and infectious diarrhea. Investigations revealed significant eosinophilia in peripheral blood and whole abdominal ultrasound showed ascites. Analysis of the ascitic fluid also revealed significant eosinophilia. This suggests deep eosinophilic infiltration to the serosal layer, which is the least common layer affected. Endoscopy and colonoscopy were done with multiple biopsies, and eosinophilic infiltration was confirmed in the esophagus, stomach, small intestine, and colon. She was managed as a case of EGID after initial poor response with treatment for GERD and infectious diarrhea. Investigations revealing eosinophilia in the mucosa of various different segments of her GI tract as well as ascitic fluid confirmed the diagnosis. After establishing the diagnosis, she was treated with montelukast and corticosteroids, which resulted in rapid and marked improvement of all her symptoms.
Conclusion: This case contributes knowledge to the literature that despite multiple segments and bowel wall layer involvement, the condition is very responsive to therapy, emphasizing the importance of awareness of this condition among clinicians for early diagnosis and appropriate treatment.
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
| Resumption of face-to-face Evidence-Based Medicine Workshop Venue to be announced once finalized. |
July 21, 2023 (Friday), 1-5pm |
| Monthly Critical Appraisal of Topics Conferences to be gaciliated by Research Coordinators per Institution | Monthly Critical Appraisal of Topics Conferences per Institution |
| CAT Plenary/Liver Con Dates: September 23, 2023 December 16, 2023 March 2024 (During the JAC) Resumption of face-to-face Quarterly Critical Appraisal of Topics facilitated by the JRRE |
2 Clinical scenarios and articles are to be sent to institutions each on August 2023, November 2023, and February 2024; |
| Hybrid Research Workshop 4 week asynchronous via Moodle, followed by a 1 day on-site Onsite Workshop Research Protocol Presentation for Level I GI Fellows-In-Training - Research Protocol Presentation: August 12, 2023 - Research Forums of the Tripartite Societies |
Week 1: July 15-21, 2023 Week 2: July 22-28, 2023 Week 3: July 29-August 4, 2023 Week 4: August 5-11, 2023 |
| Research Manuscript Workshop for level II GI Fellows-In-Training | January 6, 2024 |