S4370 Beyond Food Impaction: Unraveling the Clinical Spectrum of Eosinophilic Gastrointestinal Disease: A Case Report

Introduction: Eosinophilic gastrointestinal disorders is a group of diseases that can affect any segments of the gastrointestinal tract. This is marked by eosinophilic inflammation of the esophagus, stomach, small intestine, or colon, leading to organ dysfunction and clinical symptoms. These disorders include eosinophilic esophagitis (EoE), eosinophilic gastritis, eosinophilic gastroenteritis (EGE), eosinophilic enteritis, and eosinophilic colitis. The presentation depends on the location and extent of invasion of eosinophils in the bowel wall. We present a case of eosinophilic gastrointestinal disorder with esophageal and gastric involvement. Case Description/Methods: A 44-year-old man with history of food impaction requiring urgent endoscopy 15 years ago presented with food impaction. He reports that he was eating steak and felt that it got stuck in his esophagus. Carbonated drinks or water were unable to push the food down. On initial evaluation, he was able to speak full sentences but unable to tolerate secretions. He was hemodynamically stable. Blood test was significant for leukocytosis of 16.7 10³/uL, absolute eosinophils 5.3 (normal <0.62 10³/uL). He underwent an Esophagogastroduodenoscopy which showed food in the mid esophagus was removed with a Raptor grasping device. LA Grade C esophagitis with no bleeding was noted in the mid esophagus. A moderate Schatzki ring was also found. The EoE Reference Score score was 7. Extensive diffuse erythematous nodular mucosa was found in the stomach with multiple erosions. The severity of EoE was moderate on the Index of Severity for Eosinophilic Esophagitis (I-SEE). Gastric biopsy showed prominent eosinophilic infiltration in the lamina propria (up to 93 per high power field). The esophageal biopsy showed squamous mucosa with numerous intraepithelial eosinophils (up to 53 per high power field). Discussion: EGE is an uncommon and heterogeneous gastrointestinal disease that is often underdiagnosed. In recent years, the prevalence of EGE has increased. EoE is more prevalent and presents dysphagia, reflux, and food impaction. Involvement of other sites is rare and often missed or diagnosed late. Proton pump inhibitor, topical steroids and elimination diet are mainstay treatments for eosinophilic esophagitis. Dupilumab, a monoclonal antibody against interleukin (IL)-4 receptor alpha (IL-4rα), is used for severe cases. EGE is treated with diet therapy and corticosteroids. Recently biologic agents have been used for the treatment of EGE.