title: Eosinophilic gastroenteritis with refractory ulcer disease and gastrointestinal bleeding as a rare manifestation of seronegative gastrointestinal food allergy.
abstract: Gastrointestinal bleeding and iron deficiency anaemia may cause severe symptoms and may require extensive diagnostics and substantial amounts of health resources.This case report focuses on the clinical presentation of a 22 year old patient with recurrent gastrointestinal bleeding from multilocular non-healing ulcers of the stomach, duodenum and jejunum over a period of four years. Extensive gastroenterological and allergological standard diagnostic procedures showed benign ulcerative lesions with tissue eosinophilia, but no conclusive diagnosis. Multiple diagnostic procedures were performed, until finally, endoscopically guided segmental gut lavage identified locally produced, intestinal IgE antibodies by fluoro-enzyme-immunoassay.IgE antibody concentrations at the intestinal level were found to be more-fold increased for total IgE and food-specific IgE against nuts, rye flour, wheat flour, pork, beef and egg yolk compared with healthy controls.Thus, a diet eliminating these allergens was introduced along with antihistamines and administration of a hypoallergenic formula, which resulted in complete healing of the multilocular ulcers with resolution of gastrointestinal bleeding. All gastrointestinal lesions disappeared and total serum IgE levels dropped to normal within 9 months. The patient has been in remission now for more than two years.Eosinophilic gastroenteritis (EG) is well known to induce refractory ulcer disease. In this case, the mechanisms for intestinal damage and gastrointestinal bleeding were identified as local gastrointestinal type I allergy. Therefore, future diagnostics in EG should also be focused on the intestinal level as identification of causative food-specific IgE antibodies proved to be effective to induce remission in this patient.
authors.affiliation: Department of Medicine I, University Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. martin.raithel@uk-erlangen.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Raithel
authors.forename: Markus
authors.initials: M
authors.lastname: Hahn
authors.forename: Konrad
authors.initials: K
authors.lastname: Donhuijsen
authors.forename: Alexander F
authors.initials: AF
authors.lastname: Hagel
authors.forename: Andreas
authors.initials: A
authors.lastname: Nägel
authors.forename: Ralf J
authors.initials: RJ
authors.lastname: Rieker
authors.forename: Markus F
authors.initials: MF
authors.lastname: Neurath
authors.forename: Max
authors.initials: M
authors.lastname: Reinshagen
mesh_terms: D000328:Adult; D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000097:blood; D000818:Animals; D002417:Cattle; D004530:Egg Yolk; D004751:Enteritis / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D004802:Eosinophilia / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005433:Flour; D005512:Food Hypersensitivity / Q000150:complications / Q000175:diagnosis*; D005756:Gastritis / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D041981:Gastrointestinal Tract / Q000473:pathology; D064368:Healthy Volunteers; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008460:Meat; D008875:Middle Aged; D009754:Nuts; D012434:Secale; D013552:Swine; D014456:Ulcer / Q000150:complications / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D007073:Immunoglobulin E