Published online Mar 21, 2023. doi: 10.3748/wjg.v29.i11.1757
Peer-review started: January 16, 2023
First decision: January 30, 2023
Revised: February 6, 2023
Accepted: February 27, 2023
Article in press: February 27, 2023
Published online: March 21, 2023
Eosinophilic gastrointestinal disease (EGID) is a disorder characterized by infiltration of eosinophils causing mucosal damage and dysfunction of the gas
We report the case of a 10-year-old boy who had suffered abdominal pain and fatigue for the preceding 6 mo. He was referred to our institute for investigation of suspected gastrointestinal bleeding because of severe anemia with hypoproteinemia and positive fecal human hemoglobin. The upper and lower gastrointestinal endoscopic findings were normal; however, double-balloon small bowel endoscopy showed multiple oblique and circular ulcers with discrete margins and mild constriction of the intestinal lumen in the ileum. The findings were highly consistent with CEAS, but urine prostaglandin metabolites were within normal limits, and no previously reported mutations in the SLCO2A1 gene were identified. Histological evaluation demonstrated moderate to severe eosinophilic infiltration localized to the small intestine suggesting a diagnosis of EoN. Clinical remission was maintained with montelukast and a partial elemental diet, but emergent surgery for bowel obstruction due to small intestinal stenosis was performed two years after the initial treatment.
EoN should be considered in the differential diagnosis of CEAS-like small intestinal ulcerative lesions and normal urinary prostaglandin metabolite levels.
Core Tip: Eosinophilic enteritis (EoN), a form of eosinophilic gastrointestinal disease localized to the small intestine, is extremely rare in children. The present pediatric case of EoN displayed multiple ulcerative lesions mimicking chronic enteropathy associated with SLCO2A1 and bowel obstruction due to small intestinal stenosis. The diagnosis was confirmed by small intestinal biopsy using double-balloon enteroscopy and analysis of urine prostaglandin metabolites.