Ishani Kale, BS1, Craig Rosenstengle, MD2, Hemangi Kale, MD3, Stuart Spechler, MD4 1McGovern Medical School at UTHealth, Houston, TX; 2Baylor Scott & White Medical Center, Fort Worth, TX; 3Baylor Scott & White Medical Center, Dallas, TX; 4Center for Esophageal Diseases, Baylor University Medical Center, Dallas, TX Introduction: Eosinophilic gastrointestinal diseases (EGIDs) are a rare group of disorders characterized by eosinophilic infiltration of the gastrointestinal (GI) tract, leading to chronic inflammation and GI dysfunction. While eosinophilic esophagitis (EoE) is well characterized, non-EoE EGIDs, such as eosinophilic duodenitis, remain underdiagnosed as duodenal ulcers are not routinely biopsied and due to their nonspecific symptoms.
Case Description/
Methods: A 25-year-old African American man with a history of EoE presented with recurrent abdominal pain, nausea, vomiting, and weight loss. Multiple prior endoscopies showed duodenal ulcers, which were attributed to H. pylori and NSAID use. Despite H. pylori eradication and NSAID avoidance, he developed recurrent ulcerations and eventually, symptoms suggestive of gastric outlet obstruction. An esophagogastroduodenoscopy (EGD) with ulcer base biopsy revealed eosinophil-rich duodenitis, confirming an EGID-related duodenal ulcer. He was treated with budesonide slurry and proton pump inhibitors (PPIs), leading to complete resolution of symptoms. Discussion: Non-EoE EGIDs can present with nonspecific symptoms, often leading to misdiagnosis or delayed diagnosis. After common etiologies such as H. pylori and NSAID use are excluded, a high index of suspicion and biopsy from the duodenal ulcer base is crucial. This case underscores the importance of obtaining biopsies from the ulcer base, which directly led to the correct diagnosis. This case highlights the diagnostic challenges of eosinophilic duodenitis presenting as recurrent duodenal ulcers. Increased clinical suspicion and comprehensive histologic evaluation, including ulcer base biopsies, are essential for timely diagnosis and appropriate management.
Disclosures: Ishani Kale indicated no relevant financial relationships. Craig Rosenstengle indicated no relevant financial relationships. Hemangi Kale indicated no relevant financial relationships. Stuart Spechler indicated no relevant financial relationships.
Ishani Kale, BS1, Craig Rosenstengle, MD2, Hemangi Kale, MD3, Stuart Spechler, MD4. P1984 - Eosinophilic Gastrointestinal Disease Presenting as Recurrent Duodenal Ulcers: A Case Report, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
