S6348 Clinical Dilemma in Eosinophilic Gastritis: A Case Report

Introduction: Eosinophilic gastrointestinal disease (EGID) is a condition characterized by an abnormal presence of eosinophils in the gastrointestinal tract, without identifiable secondary causes, affecting approximately 6.3 out of 100,000 people in the U.S., mostly women with atopic conditions. Diagnosis typically occurs when biopsies show 20 or more eosinophils per high-power field (HPF) alongside gastrointestinal symptoms. The 2022 consensus introduced a classification system: eosinophilic gastritis (EoG) affects the stomach, eosinophilic enteritis (EoN) targets the small intestine, and eosinophilic colitis (EoC) impacts the colon. The mechanisms are still being studied, but immune responses to allergens are believed to play a significant role. Case Description/Methods: A 69-year-old woman with a history of asthma with recent exacerbations on oral steroids, type 2 diabetes mellitus, and hypothyroidism presented with 3 weeks of nausea, vomiting, diarrhea, and poor oral intake. Imaging studies revealed a large hiatal hernia, while other diagnostic evaluations were negative. An initial esophagogastroduodenoscopy (EGD) with stomach biopsy showed eosinophilia, revealing 60-90 eosinophils per high power field (HPF) infiltrating the lamina propria and muscularis mucosa. Following the initiation of high-dose steroid treatment, the patient exhibited marked clinical improvement. Follow up EGD confirmed the resolution of eosinophilic infiltration, and was subsequently discharged with a steroid taper. Discussion: The patient’s case raises questions about the interplay between the hiatal hernia and eosinophilic gastritis, in light of her history of oral steroid use due to recent asthma exacerbations and ongoing symptoms. Hiatal hernia may weaken the lower esophageal sphincter, which can lead to reflux of stomach acid and contents into the esophagus and, potentially, the stomach. Prolonged exposure to stomach acid could irritate the stomach lining and exacerbate the inflammatory response characteristic of eosinophilic gastritis (EoG). This cumulative pathological burden could potentially lead to complications related to EoG. Furthermore, the absence of established treatment guidelines for eosinophilic gastritis—where systemic corticosteroids are typically the standard treatment—highlights the urgent need for additional research to identify optimal therapeutic options for managing this condition.