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Questions in the Gastroenterology and Liver Diseases Forum have been answered by Dr. Kevin Pho who is board certified in Internal Medicine and by doctors from Henry Ford Health System.
Question Title: Eosinophils at 30!!Forum: The Gastroenterology and Liver Diseases Forum
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My wife has been suffering from chronic diarrhea and vomiting for three weeks. She has been hopitalized due to severe dehydration twice and has been given nutrition intravenously. She has had multiple CBCs, Colonoscopy, EGD ( scope inserted down the throat) and Barium Pass Through tests. She has supplied at least ten stool samples that have been tested for bacterial and parasitic traces. She has lost about ten pounds of wieght. She continues to have abdominal cramps, nausea and diarrhea after every attempt to eat. Bland diet or regular diet does not make a difference. The only abnormal results from these diagnostic measures has been a high eosinophil count (30), a visualized area of mild redness in the stomach and a slight melanomized area around the duodenum. The radioligists were surprised during the Barium Pass Through test that the compound moved through her small intestine extremely rapidly. The only slight relief that she has been able to achieve from the diarrhea is while using a product called LoCholest. This product seems to reduce the amount of water lost through the colon as well as making the stool somewhat more binding. Our doctor wants her to next have an ultrasound image of her gall bladder and a fat absorbtion test. He admits that he does not know what is causing the problem. Can you help? We know that high eosinophils can be a result of parasite infection and/or alergic reactions. When the stool is tested for parasites, is it only tested for certain ones or all types? Where do we go next? ________ Dear Chuck, I am sorry to read of your wife’s illness. I assume that she was well prior to the onset of this problem. The first thought that comes to mind is that the gastrointestinal problems and the elevated eosinophil count are the result of a parasitic infection. If you have traveled recently, this possibility would be even more likely. When the stool are examined for parasites, all possible infections are sought. The multiple stool tests are necessary because any single study can miss the infection. One of my first steps is to always repeat the stool studies. In your wife’s situation, I would wait at least 7-10 days after the barium has passed because infections can be missed after a barium investigation. You do not provide any information regarding your wife’s age or concurrent conditions. AIDS must always be considered as a diagnosis for patients with diarrhea and weight loss, if there are risk factors. We also know that other infections e.g. Cryptosporidium can cause a prolonged diarrhea. Stool tests for AFB may provide a diagnosis in these cases. There is a condition called eosinophilic gastroenteritis that can cause diarrhea and a high eosinophil count. Ask your physician if biopsies were taken during the endoscopy. A mucosal infiltration with eosinophils can be seen in the biopsies. Your letter would rule out food allergies as the cause of the problems. Is your wife taking any medications? Sometimes, other drugs can be the culprit. Before, undergoing any additional tests, it would be a good idea to have your wife fast for 24-48 hours while receiving intravenous liquids. Measuring the stool volumes, sodium and potassium before and during the fast will provide information that would help her physicians to decide on the best series of tests to identify the cause of her proble, Best of luck. This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician. If you want, we would be happy to see you in the Division of Gastroenterology at Henry Ford Hospital and perform the appropriate investigations after we have had the chance to meet you and to review your history in greater detail. You can arrange an appointment with Dr. Fogel, one of our experts in the diagnosis and treatment of diarrheal disease by calling the Henry Ford Physician Referral Line at (800)653-6568. HFHSM.D.-rf
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