Intest Res.  2025 Jan;23(1):107-111. 10.5217/ir.2024.00013.

Combined eosinophilic gastroenteritis and ulcerative colitis successfully treated by vedolizumab: a case report

• Takedomi H
• Fukuda K
• Inoue S
• Tsuruoka N
• Sakata Y
• Aoki S
• Esaki M

• KMID: 2564401
• DOI: http://doi.org/10.5217/ir.2024.00013

Abstract

A 47-year-old man with over 10 years’ duration of ulcerative colitis treated by 5-aminosalicylic acid and intermittent topical steroids complained of acute epigastric pain. Esophagogastroduodenoscopy revealed diffuse mucosal edema with patchy redness, multiple erosions and nodularity of the stomach. Bioptic examination revealed marked eosinophilic infiltration, confirming the diagnosis of eosinophilic gastroenteritis. Systemic steroid therapy was initiated, whereas his ulcerative colitis and eosinophilia recurred when tapering the steroid. Addition of azathioprine was ineffective, and we subsequently started vedolizumab for eosinophilic gastroenteritis and ulcerative colitis. The medication effectively improved his abdominal symptoms and esophagogastroduodenoscopy and ileocolonoscopy 1 year later revealed endoscopic improvement of both diseases with histologically decreased level of eosinophilic infiltration. Considering that eosinophils also express α4β7 integrins, vedolizumab can be a possible therapeutic candidate for eosinophilic gastroenteritis as well as ulcerative colitis.

Keyword

Eosinophilic gastroenteritis; Ulcerative colitis; α4β7 integrin; Vedolizumab; Case reports

Figure

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  Fig. 1. Endoscopic and histopathological findings of the stomach at diagnosis of eosinophilic gastroenteritis (EGE). (A-C) Esophagogastroduodenoscopy at diagnosis of EGE demonstrates mucosal edema, redness, erosion, and multiple nodules (arrows) in the stomach (A: antrum, B: body, C: cardia). (D) Histological findings of biopsy specimens from the stomach show marked eosinophilic infiltration (hematoxylin and eosin staining, ×400).

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  Fig. 2. Endoscopic and histopathological findings of the colon before vedolizumab therapy. (A, B) Ileocolonoscopy before vedolizumab therapy demonstrates reddish friable mucosa with purulent mucus in the left side colon (A: descending colon, B: rectum). (C) Histological findings of biopsy specimens from the descending colon show increased eosinophilic infiltration (hematoxylin and eosin staining, ×400).

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  Fig. 3. Endoscopic and histopathological findings of the stomach after vedolizumab therapy. (A-C) Esophagogastroduodenoscopy 1 year after the initiation of vedolizumab demonstrates improvement of gastric mucosal abnormalities (A: antrum, B: body, C: cardia). (D) Histological findings of biopsy specimens from the stomach demonstrate decreased level of eosinophilic infiltration (hematoxylin and eosin staining, × 400).

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  Fig. 4. Endoscopic and histopathological findings of the colon after vedolizumab therapy. (A, B) Ileocolonoscopy after vedolizumab therapy demonstrates endoscopic remission of UC (A: descending colon, B: rectum). (C) Histological findings of biopsy specimens from the descending colon show reduced eosinophil infiltration (hematoxylin and eosin staining, ×400).

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