S6033 Eosinophilic Gastrointestinal Disease Presenting as Recurrent Duodenal Ulcers: A Case Report

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 nonsteroidal anti-inflammatory drug use. Despite H. pylori eradication and nonsteroidal anti-inflammatory drug 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 nonsteroidal anti-inflammatory drug 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.