2023 Volume 65 Issue 9 Pages 1421-1427
In 2016, a 42-year-old man presented to a primary care doctor with epigastric pain that did not improve with proton pump inhibitors. An EGD revealed active ulcers in the antrum of the stomach and duodenal bulb. Despite taking vonoprazan at 20 mg/day, the ulcerative lesions did not improve, and the patient was referred to our department. The initial EGD at our hospital showed no abnormalities in the esophagus but partially scarred multiple ulcers in the antrum and ulcer beds. Biopsy results from a gastric ulcer revealed eosinophil infiltration of ≥100/HPF. Based on these findings, we diagnosed the patient with eosinophilic gastroenteritis and started him on oral steroids. His symptoms improved, and he was subsequently given vonoprazan. His symptoms were stable with vonoprazan at 10 mg/day. However, the improvement of ulcerative lesions in the antrum was poor, and he was started on oral prednisolone (20 mg). One month after oral administration of prednisolone, EGD confirmed a healing tendency of gastric ulcer lesions, and the prednisolone was discontinued. After that, maintenance therapy with vonoprazan at 10 mg/day was continued, and the patientʼs symptoms and endoscopic findings did not show any significant change. However, in 2021, EGD surveillance revealed a coarse mucosal area with a loss of vascular permeability in the lower esophagus, accompanied by circular and longitudinal furrows and white plaque. Biopsy results from the esophageal lesion revealed marked eosinophilic infiltration, and we diagnosed an esophageal lesion of eosinophilic gastroenteritis. Although eosinophilic gastroenteritis can occur throughout the gastrointestinal tract, the asynchronous onset of esophageal lesions is rare in Japan. We report a case of eosinophilic gastritis developing an asynchronous esophageal lesion during surveillance.
