Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2023; 29(11): 1757-1764
Published online Mar 21, 2023. doi: 10.3748/wjg.v29.i11.1757
Eosinophilic enteritis requiring differentiation from chronic enteropathy associated with SLCO2A1 gene: A case report
Kantaro Kimura, Keisuke Jimbo, Nobuyasu Arai, Masamichi Sato, Mitsuyoshi Suzuki, Takahiro Kudo, Tomonori Yano, Toshiaki Shimizu
Kantaro Kimura, Keisuke Jimbo, Nobuyasu Arai, Masamichi Sato, Mitsuyoshi Suzuki, Takahiro Kudo, Toshiaki Shimizu, Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
Tomonori Yano, Department of Medicine, Jichi Medical University, Tochigi 329-0498, Japan
Author contributions: Kimura K, Jimbo K, and Arai N contributed to manuscript writing and editing, and data collection; Jimbo K, Sato M, and Suzuki M contributed to data analysis; Kudo T, Yano T, and Shimizu T contributed to conceptualization and supervision; all authors have read and approved the final manuscript.
Supported by a Japan Society for the Promotion of Science KAKENHI Grant-in-Aid for Young Scientists, No. 20K16905.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Keisuke Jimbo, MD, PhD, Assistant Professor, Department of Pediatrics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
Received: January 16, 2023
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
Processing time: 59 Days and 19.5 Hours

Eosinophilic gastrointestinal disease (EGID) is a disorder characterized by infiltration of eosinophils causing mucosal damage and dysfunction of the gastrointestinal tract. The endoscopic findings of eosinophilic enteritis (EoN), an EGID variant, are nonspecific and occasionally difficult to diagnose. In contrast, chronic enteropathy associated with SLCO2A1 (CEAS) is a chronic persistent small intestinal disorder characterized by endoscopic findings such as multiple oblique and circular ulcers.


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.

Keywords: Anemia, Chronic enteropathy associated with SLCO2A1, Double-balloon endoscopy, Eosinophilic gastrointestinal disease, Hypoproteinemia, Case report

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.