Alhareth Al Juboori, MD1, Gavin Levinthal, MD2, Shradha Gupta, MD3 1HonorHealth, Phoenix, AZ; 2Honor Health Gastroenterology - SCOTTSDALE, AZ, Scottsdale, AZ; 3HonorHealth, Chandler, AZ Introduction: Eosinophilic gastrointestinal disorders (EGID) is a group of diseases that can affect any segments of the gastrointestinal (GI) tract. This is marked by eosinophilic inflammation of the esophagus, stomach, small intestine, or colon, leading to organ dysfunction and clinical symptoms. (1,2) These disorders include eosinophilic esophagitis (EoE), eosinophilic gastritis (EG), eosinophilic gastroenteritis (EGE), eosinophilic enteritis (EE), and eosinophilic colitis (EC). The presentation depends on the location and extent of invasion of eosinophils in the bowel wall. We present a case of EGID with esophageal and gastric involvement.
Case Description/
Methods: A 44-year-old male with history of food impaction requiring urgent endoscopy fifteen years ago presented with food impaction. He reports that he was eating steak and felt that it got stuck in his esophagus. Carbonated drinks or water were unable to push the food down. On initial evaluation, he was able to speak full sentences but unable to tolerate secretions. He was hemodynamically stable. Blood test was significant for leukocytosis of 16.7 10³/uL, absolute eosinophils 5.3(normal < 0.62 10³/uL).
He underwent an Esophagogastroduodenoscopy (EGD) which showed food in the mid esophagus was removed with a Raptor grasping device. LA Grade C esophagitis with no bleeding was noted in the mid esophagus. A moderate Schatzki ring was also found. The EoE Reference Score (EREFS) score was 7. Extensive diffuse erythematous nodular mucosa was found in the stomach with multiple erosions. The severity of EoE was moderate on the Index of Severity for Eosinophilic Esophagitis (I-SEE).
Gastric biopsy showed prominent eosinophilic infiltration in the lamina propria (up to 93 per high power field). The esophageal biopsy showed squamous mucosa with numerous intraepithelial eosinophils (up to 53 per high power field) Discussion: EGE is an uncommon and heterogeneous gastrointestinal disease that is often underdiagnosed. In recent years, the prevalence of EGE has increased. EoE is more prevalent and presents dysphagia, reflux, and food impaction. Involvement of other sites is rare and often missed or diagnosed late.
Proton pump inhibitor, topical steroids and elimination diet are mainstay treatments for eosinophilic esophagitis. Dupilumab, a monoclonal antibody against interleukin (IL)-4 receptor alpha (IL-4rα), is used for severe cases. EGE is treated with diet therapy and corticosteroids. Recently biologic agents have been used for the treatment of EGE.
Figure: Eosinophilic gastritis (low power, high power and CD117 stain showing increased mast cells. Eosinophilic esophagitis with increased eosinophils in the esophagus.
Figure: Eosinophilic gastritis (low power, high power and CD117 stain showing increased mast cells. Eosinophilic esophagitis with increased eosinophils in the esophagus.
Disclosures: Alhareth Al Juboori indicated no relevant financial relationships. Gavin Levinthal indicated no relevant financial relationships. Shradha Gupta indicated no relevant financial relationships.
Alhareth Al Juboori, MD1, Gavin Levinthal, MD2, Shradha Gupta, MD3. P2906 - Beyond Food Impaction: Unraveling the Clinical Spectrum of Eosinophilic Gastrointestinal Disease: A Case Report, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
