Eosinophilic ascites and eosinophilic gastrointestinal diseases

Background. Eosinophilic ascites (EA) is characterised by a high eosinophil count in the ascitic fluid and, although very rare, is mainly caused by eosinophilic gastrointestinal diseases (EGIDs), parasitic infections, and hypereosinophilic syndrome (HES). Symptoms caused by EGIDs are varied and depend on the gastrointestinal tract affected as well as the layer(s) involved; typically, EA implies a serosal involvement. Herein, we report our single Centre experience of three cases of EA in patients suffering from EGIDs together with a systematic review of all the other cases described in the literature. Methods. Patients selection was performed by querying the database containing patients suffering from EGIDs referred to our hospital and extracting all cases with eosinophilic ascites. In order to describe the reported cases of eosinophilic ascites, a literature review was carried out on Pubmed. Results. We identified three patients with EA suffering from EGIDs at our Centre. In the systematic literature review, a total of 105 patients suffering from EA due to EGIDs were identified from 81 literature articles. For both groups, we described: demographic characteristics, other immunological diseases, gastrointestinal symptoms, how ascites was diagnosed, ascitic fluid characteristics, peripheral eosinophils, gastrointestinal tract affected, therapy, and relapses. Conclusions. EA is a rare presentation of EGIDs and proper evaluations should be performed to make a proper diagnosis; it is crucial to exclude clonal and secondary causes of hypereosinophilia, but differential diagnosis with single organ-HES is often unclear. Steroid therapy is effective and monoclonal antibodies directed against IL-5 could be as well, but further studies are needed.