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[Chronic upper abdominal pain without improvement after using proton pump inhibitors]
J Tiesmeier1, H Hinner, J Kraus
1Medizinische Klinik II, Krankenhaus Bad Oeynhausen.
Deutsche Medizinische Wochenschrift (1946)
|July 10, 2004
Summary
Eosinophilic gastroenteropathy is a rare cause of persistent abdominal pain and gastric ulcers unresponsive to standard treatments. Prompt diagnosis and specific therapies like corticosteroids and azathioprine can lead to symptom relief and remission.
Area of Science:
- Gastroenterology
- Immunology
Background:
- Investigating persistent, therapy-resistant abdominal pain and gastric ulcers.
- Evaluating cases unresponsive to proton pump inhibitors and standard ulcer treatments.
Observation:
- A 57-year-old woman presented with a 6-year history of relapsing upper abdominal pain and gastric ulcers.
- Multiple gastroscopies revealed gastritis and non-healing ulcers, negative for Helicobacter pylori.
- Histological examination showed eosinophilic infiltration, indicative of eosinophilic gastroenteropathy.
Findings:
- Initial treatment with prednisone (60 mg/day) resulted in complete symptom resolution.
- Relapse occurred upon dose reduction, necessitating long-term immunosuppressive therapy with azathioprine (100 mg/day).
- After 1.5 years of azathioprine therapy, complete remission of ulcers and symptoms was achieved.
Implications:
- Highlights the importance of considering rare conditions like eosinophilic gastroenteropathy in refractory abdominal pain and ulcer cases.
- Emphasizes the role of accurate histological diagnosis for effective treatment.
- Demonstrates the efficacy of corticosteroids and azathioprine in managing eosinophilic gastroenteropathy, leading to significant clinical improvement.