A case of early eosinophilic gastroenteritis with dramatic response to steroids.

Eosinophilic gastroenteritis is a rare disorder that can present with various gastrointestinal manifestations depending on the specific site and specific layer of the gastrointestinal tract involved. Majority of the cases involve stomach and proximal small bowel. The diagnostic criteria include demonstration of eosinophilic infiltration of bowel wall, lack of evidence of extra intestinal disease and exclusion of other causes of peripheral eosinophilia.1 The therapeutic role of steroids and antihelminthic drugs in the treatment of eosinophilic gastroenteritis is not established. In a few cases, steroids have produced symptomatic improvement in controlling malabsorption syndrome.2 We report a case, wherein mucosal eosinophilic gastroenteritis was confirmed on endoscopic biopsy and which responded dramatically to steroids thus preventing possible grave complications that could have developed in later stages of the disease like ascites and intestinal obstruction needing surgical intervention. A 21 year old female was admitted to Y. C. Rural Hospital, Latur with complaints of abdominal pain, dyspepsia, nausea, vomiting and diarrhea since 4 months. The case was previously diagnosed as chronic gastritis at another clinic and treated accordingly with antacids and antibiotics, in vain. After thorough clinical examination at our centre, she was advised routine hematological and serological investigations, stool examination, endoscopic examination and endoscopic biopsy of the gastrointestinal tract. Hemogram performed on an ADVIA-VX revealed a raised total WBC count of 30700/cmm with a differential count of P42%L20%M02%E36% B00%. The absolute eosinophil count was 11,052/cmm. There was no evidence of any parasite on peripheral blood smears. The stool examination was positive for occult blood. No parasite was detected. Stool culture was also sterile. On endoscopic examination of upper GI tract, the esophagus was normal. The pyloric end of stomach and duodenum showed small, superficial ulcers with inflammation (Fig. 1). The CT abdomen and chest X-ray were normal. A diagnosis of early eosinophilic gastroenteritis was made after excluding other causes of peripheral eosinophilia. The diagnosis was confirmed on histopathological examination of gastric and