Eosinophilic proctitis and gastro-entero-colitis induced by oral allergens, mimicking ulcerative proctitis

Background: Eosinophilic gastritis, entero-colitis are uncommon heterogeneous disorders.

Case report: In 1996 a 19 year old girl was referred with a history of blood in stool as well as diarrhoea. Chronic aspecific inflammatory reaction of the rectum mucosa with eosinophilic infiltration and 20% peripheral eosinophilia was found. Allergic origin and worm infection were ruled out. In December 2000 blood in stools and upper abdominal complaints developed without peripheral eosinophilia. Olsalazine, budesonide enema and famotidin treatment were started, but then later changed to mesalazine and pantoprazol. The next five months passed without any symptoms. The patient had to break off her seashore journey in July 2000 because of stomach complaints, vomiting and exiccosis. Peripheral eosinophilia (27.3%) was evident. Biopsies from the jejunum, duodenum antrum, and the rectum showed mild eosinophilic infiltration. Allergy test proved the presence of IgE against salicylate, egg protein, seafood protein. Oral food challenges proved to be negative, the amino-salicylate treatment was stopped. After a temporary symptom free period, bloody stools reappeared in May 2003. Esomeprazol, and methyl-prednisolone containing enema (40mg/day/2 weeks) followed by budesonide enema twice a week resulted in a symptom free period and peripheral eosinophilia became almost normalised (6.2%). Conclusion: Under the influence of oral allergens eosinophilic proctitis gastritis and enterocolitis developed in our patient, with the signs and symptoms of ulcerative proctitis.