Clinical Presentation of Eosinophilic Gastroenteritis
Eosinophilic gastroenteritis (EGE) presents with nonspecific gastrointestinal symptoms including abdominal pain (62% of cases), vomiting (71%), diarrhea, and weight loss, often in patients with a history of atopy. 1, 2
Core Symptom Complex
The most common presenting symptoms are:
- Abdominal pain occurs in approximately 62% of patients and is typically crampy in nature 1, 2, 3
- Vomiting is the most frequent symptom, present in 71% of cases, and may be recurrent or cyclical 4, 2
- Diarrhea is a common manifestation, often accompanied by malabsorption 1, 5
- Weight loss occurs frequently due to chronic symptoms and malabsorption 1, 3
- Nausea is reported in the majority of patients 5, 3
Less Common but Important Presentations
Additional clinical features to recognize include:
- Ascites can develop, particularly in serosal-predominant disease 1, 5
- Gastrointestinal bleeding may occur, though less commonly 3
- Acute pancreatitis has been reported as a concurrent presentation, especially with duodenal involvement 5
- Peripheral eosinophilia is typically present on laboratory evaluation 5, 4
Pattern Recognition by Disease Extent
The clinical presentation varies based on which layer of the gastrointestinal wall is predominantly affected:
- Mucosal disease presents primarily with abdominal pain, vomiting, diarrhea, and malabsorption 1
- Muscular layer involvement may cause obstructive symptoms 1
- Serosal disease characteristically presents with ascites and peripheral eosinophilia 1, 5
Distribution Beyond Stomach and Small Bowel
While EGE classically affects the stomach and duodenum, recognize that:
- Esophageal involvement occurs in approximately 30% of cases 2
- Colonic involvement is present in 28% of patients 2
- The disease can be focal or diffuse throughout the gastrointestinal tract 1, 5
Key Diagnostic Clues
Important clinical context that should raise suspicion:
- History of atopy is common, including food allergies, asthma, eczema, or allergic rhinitis 4, 3
- Recurrent or cyclical pattern of symptoms occurring every 7-10 days has been described 4
- Peripheral eosinophilia on complete blood count is a critical laboratory finding 5, 4
- Symptoms are typically unresponsive to standard acid suppression therapy 1
Common Pitfalls to Avoid
The nonspecific nature of symptoms creates diagnostic challenges:
- Do not dismiss patients with vague gastrointestinal complaints and peripheral eosinophilia—obtain endoscopy with biopsies 5, 2
- Consider EGE in unexplained acute pancreatitis, particularly when duodenal edema is present on imaging 5
- Recognize that symptoms may present as a single episode, recurrent course, or chronic disease pattern 1
- The diagnosis requires histologic confirmation showing >30 eosinophils per high-power field in at least five fields, with eosinophilic degranulation extending to the muscularis mucosa or submucosa 1