PMC5968151_01
Transanal double-ballon enteroscopy showing prominent villous atrophy in the ileum.
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F1
Transanal double-balloon enteroscopy showed prominent villous atrophy in the ileum, with no obvious abnormality found in other GI tracts (Figure 1).
Hematoxylin & eosin (H&E) stain showing edema and fibrosis of the ileum mucosa with a maximum eosinophil infiltration of 23/high-power field in the ileum, even on continuous administration of prednisolone. (A) 10x. (B) 40x.
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F2
Histopathological results showed edema and fibrosis of the ileum mucosa, with a maximum eosinophil infiltration of 23/HPF in the ileum, even on continuous administration of prednisolone (Figure 2).
Clinical course after initial visit to our department. During dietary treatment, we identified dairy products and eggs as causative foods of the symptoms, and prednisolone was ceased.
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F3
Therefore, we designed and started a multiple food-elimination diet, including the 6 major food groups (wheat, milk, eggs, nuts, soy, seafood) and rice (Figure 3).
Endoscopy after 4 months of dietary treatment showing improvement of villous atrophy in lesion of ileum.
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F4
Endoscopy showed improvement of villous atrophy in the ileum (Figure 4).
H&E stain during dietary treatment showing improvement of villous atrophy in the ileum and eosinophil infiltration decreased to 2-3/high power field. (A) 10x. (B) 40x.
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F5
Histopathology showed eosinophilic infiltration decreased to 2-3/HPF (Figure 5).