Eosinophilic enteritis requiring differentiation from chronic enteropathy associated with SLCO2A1 gene:A case report

BACKGROUND Eosinophilic gastrointestinal disease(EGID)is a disorder characterized by infiltration of eosinophils causing mucosal damage and dysfunction of the gastrointestinal tract.The endoscopic findings of eosinophilic enteritis(EoN),an EGID variant,are nonspecific and occasionally difficult to diagnose.In contrast,chronic enteropathy associated with SLCO2A1(CEAS)is a chronic persistent small intestinal disorder characterized by endoscopic findings such as multiple oblique and circular ulcers.CASE SUMMARY We report the case of a 10-year-old boy who had suffered abdominal pain and fatigue for the preceding 6 mo.He was referred to our institute for investigation of suspected gastrointestinal bleeding because of severe anemia with hypoproteinemia and positive fecal human hemoglobin.The upper and lower gastrointestinal endoscopic findings were normal;however,double-balloon small bowel endoscopy showed multiple oblique and circular ulcers with discrete margins and mild constriction of the intestinal lumen in the ileum.The findings were highly consistent with CEAS,but urine prostaglandin metabolites were within normal limits,and no previously reported mutations in the SLCO2A1 gene were identified.Histological evaluation demonstrated moderate to severe eosinophilic infiltration localized to the small intestine suggesting a diagnosis of EoN.Clinical remission was maintained with montelukast and a partial elemental diet,but emergent surgery for bowel obstruction due to small intestinal stenosis was performed two years after the initial treatment.CONCLUSION EoN should be considered in the differential diagnosis of CEAS-like small intestinal ulcerative lesions and normal urinary prostaglandin metabolite levels.

Food allergy in children-the current status and the way forward

Food allergy in children is a major health concern,and its prevalence is rising.It is often over-diagnosed by parents,resulting occasionally in unnecessary exclusion of some important food.It also causes stress,anxiety,and even depression in parents and affects the family’s quality of life.Current diagnostic tests are useful when interpreted in the context of the clinical history,although cross-sensitivity and inability to predict the severity of the allergic reactions remain major limitations.Although the oral food challenge is the current gold standard for making the diagnosis,it is only available to a small number of patients because of its requirement in time and medical personnel.New diagnostic methods have recently emerged,such as the Component Resolved Diagnostics and the Basophil Activation Test,but their use is still limited,and the latter lacks standardisation.Currently,there is no definite treatment available to induce life-long natural tolerance and cure for food allergy.Presently available treatments only aim to decrease the occurrence of anaphylaxis by enabling the child to tolerate small amounts of the offending food,usually taken by accident.New evidence supports the early introduction of the allergenic food to infants to decrease the incidence of food allergy.If standardised and widely implemented,this may result in decreasing the prevalence of food allergy.