Clinical Endoscopy

Eosinophilic Gastritis Presenting as Tissue Necrosis: Yong Min Jo, Jin Seok Jang, Seung Hee Han, Sang Hyun Kang, Woo Jae Kim, Jin Sook Jeong; Clin Endosc 2015;48(6):558-562. Published online November 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.6.558

Abstract PDF PubReader ePub: Eosinophilic gastroenteritis is very rare disorder that is characterized by eosinophilic infiltration of the gastrointestinal tract in the absence of any definite causes of eosinophilia. It is associated with various clinical gastrointestinal manifestations, and depends on the involved layer and site. We report a case of eosinophilic gastritis presenting with severe necrosis. The symptoms disappeared immediately after beginning steroid treatment, and the eosinophil count decreased to the reference range. The patient showed eosinophilic gastritis characterized by necrotic change such as necrotizing gastritis. It is a unique presentation of eosinophilic gastritis. To the best of our knowledge, no case of eosinophilic gastritis characterized by necrotic change such as necrotizing gastritis has been previously reported in Korea.

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Eosinophilic Esophagitis: Yun Ju Jo, M.D.; Korean J Gastrointest Endosc 2009;39(6):329-337. Published online December 30, 2009

Abstract PDF: Eosinophilic esophagitis, as a new emerging disease during the last decade, is a clinicopathologic disorder of the esophagus, and it is characterized by dense esophageal eosinophilic infiltrations and typical esophageal symptoms. These patients usually present with dysphagia, food impaction or refractory reflux symptoms, and biopsy of the esophagus shows more than 15 eosinophils per high-power field. The typical findings on endoscopy are linear furrows, ringed esophagus, mucosal nodularities, whitish plaques and/or stricture. It is essential to exclude the known causes of tissue eosinophilia such as gastroesophageal reflux disease, eosinophilic gastroenteritis, infections, drug, hypersensitivity, Crohn's disease or malignancy. The majority of these patients have an atopy or allergic disorders, so other causes of eosinphilia should be evaluated. The therapeutic options include acid suppression, steroids, dietary modification, endoscopic dilatation, etc. Eosinophilic esopahgitis has recently been reported in Korea. Future schematic studies about this new disease are needed. (Korean J Gastrointest Endosc 2009;39:329-337)

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A Case of Eosinophilic Esophagogastroenteritis with Transmural Involvement: Jong Dae Kim, M.D., Euyi Hyeog Im, M.D., Jung Ho Lee, M.D., Tae Hee Lee, M.D., Sun Moon Kim, M.D., Young Woo Choi, M.D. and Young Woo Kang, M.D.; Korean J Gastrointest Endosc 2007;35(6):404-409. Published online December 30, 2007

Abstract PDF: Eosinophilic gastroenteritis is an uncommon disorder characterized by eosinophilic inflammation of the gastrointestinal tract that can present with various gastrointestinal manifestations, depending on the specific site of the affected gastrointestinal tract and the specific layer of the affected gastrointestinal wall. The depth of infiltration is the basis for a proposed classification as mucosal, muscular and serosal subtypes. Diagnostic criteria include the demonstration of eosinophilic infiltration of the bowel wall and lack of evidence of extra-intestinal disease. We experienced a 56-year-old woman that presented with postprandial epigastric pain and, 3 weeks later, with low abdominal pain. An abdominal examination showed tenderness and rebound tenderness in the whole abdomen and a hypoactive bowel sound. Endoscopy demonstrated the presence of mild edematous mucosa in the esophagus and stomach. There was eosinophilic infiltration in the esophagus, stomach and duodenum on as determined by a histological examination and muscular layer hypertrophy as determined on an endoscopic ultrasound examination. A CT scan showed wall thickening of the lower esophagus and gastric antrum to the mid-jejunum with mesenteric fat haziness, and a small amount of ascites was seen in the pelvic cavity. Eosinophilia was seen in the serum and from a fluid examination of aspirated fluid determined by culdocentesis. There was no evidence of parasitic infection based on a serum immunoassay and stool examination. The symptoms disappeared with oral prednisolone management and the patient was discharged from the hospital. This case showed continuous involvement from the lower esophagus to the mid-jejunum with transmural eosinophilic infiltration. (Korean J Gastrointest Endosc 2007;35:404-409)

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A Case of Autoimmune Pancreatitis with Eosinophilic Infiltration that Demonstrated Multiple Masses on Endoscopic Ultrasonography: Won Jae Yoon, M.D., Hye-Ryoun Kim, M.D., Jun Kyu Lee, M.D., Kwang Hyuck Lee, M.D., Ji Kon Ryu, M.D., Yong-Tae Kim, M.D. and Yong Bum Yoon, M.D.; Korean J Gastrointest Endosc 2006;32(1):75-78. Published online January 30, 2006

Abstract PDF: Autoimmune pancreatitis can be defined as an inflammation of the pancreas that is due to autoimmune mechanisms. Since the first report in 1961, there have been many reports on the autoantibodies, the radiological findings and the pathology of autoimmune pancreatitis. Lymphoplasmacytic infiltration with fibrosis is the characteristic histological feature of autoimmune pancreatitis. Eosinophilic infiltration has been reported in a subset of autoimmune pancreatitis patients. We report here on a case of autoimmune pancreatitis with eosinophilic infiltration, and the endoscopic ultrasonography showed multiple hypoechoic masses throughout the whole pancreas. (Korean J Gastrointest Endosc 2006;32:75⁣79)

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49세 남자, 간헐적인 혈변: Korean J Gastrointest Endosc 2000;20(5):365-366. Published online November 30, 1999

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조기 위암에 동반된 간내 다발성 과호산구성 농양 1예 ( A Case of Early Gastric Carcinoma Combined with Hypereosinophilic Multiple Liver Abscesses ): Korean J Gastrointest Endosc 1999;19(5):808-813. Published online November 30, 1998

Abstract PDF: Eosinophilia is defined as the presence of more than 500 eosinophil/mL of blood and is common in the clinical condition such as parasite infestation, drug, allergy, hypereosinophilic syndrome, and malignant diseases. Determining the cause of eosinophilia may be one of the most frustrating endeavors in clinical medicine. Hepatic infiltration of eosinophils and microabscess formation are observed in many disorders. Gastric cancer and intestinal malignancies show frequent liver metastasis and blood eosinophilia. Several cases of an early gastric carcinoma (EGC) with metastasis of the liver have been reported. When multiple intrahepatic lesions of suspicious malignancy appear in radiologic study, clinicians must differentiate malignancy from benign diseases. A case is herein reported of a 56- year-old male patient with synchronously developed, multiple low density hepatic lesions with early gastric carcinoma. He was managed with systemic chemotherapy at another hospital, because he was diagnosed with distant metastasis of early gastric carcinoma. Upon operating these lesions were proved to be EGC combined with hypereosinophilic multiple liver abscesses. This case is herein reported with a review of relevant literatures. (Korean J Gastrointest Endosc 19: 808∼813, 1999)

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증례 : 식도위장관 ; 호산구성 소장염 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Eosinophilic Enteritis ): Korean J Gastrointest Endosc 1997;17(6):827-833. Published online November 30, 1996

Abstract PDF: Eosinophilic gastroenteritis is a rare disorder of the stomach, small intestine and colon, characterized by variable eosinophilic infiltration of the bowel wall and peripheral blood eosinophilia, abnormal gastrointestinal symptoms and signs. The pathogenesis of this dis- ease still remains unknown, but several studies support allergic or immunologic etiology. Considerable variability in clinical presentation depends on the site of the gastrointestinal tract and the depth of bowel wall involvement. Herein we experienced a case of eosinophilic gastroenteritis confined to small intestine presenting progressive weight loss, abdominal pain and diarrhea. Enteroscopic findings showed diffuse multiple nodularity of mucosal folds in small bowel, especially duodenum and proximal jejunum. Jejunal and duodenal biopsy specimen demonstrated marked eosinophilic infiltration. These symptoms and signs were improved within 3 weeks after short course of prednisone therapy. (Korean J Gastrointest Endosc 17: 827- 831, 1997)

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