Eosinophilic gastritis - a rare diagnosis

Abstract

Introduction: Eosinophilic Gastritis (EG), one of the less common amongst Eosinophilic Gastrointestinal Disorders (EGID), with a prevalence of 6.3 cases/100.000, is an uncommon cause of unspecific abdominal symptoms, including epigastric pain.

Case: A 23-year-old female, was admitted with recurrent episodes of nausea, vomiting, abdominal pain and weight loss. She was discharged one week previously after being treated for similar symptoms. The patient had failed an outpatient treatment with a Proton Pump Inhibitor (PPI). During her re-admission, Esophagogastroduodenoscopy (EGD) was performed, and results were significant for gastritis without ulcers or esophagitis. While awaiting biopsy results, the patient experienced a minimal improvement in her symptoms with intravenous fluids and PPI. Extensive workup remained negative except of eosinophilia in peripheral blood. Gastric mucosal biopsy revealed eosinophilic infiltrates in Lamina Propria, confirming the diagnosis of Eosinophilic Gastritis. Helicobacter pylori on immunohistochemistry was negative. The patient was counseled regarding the Six Food Elimination Diet for the management of this condition. Her symptoms began to improve under dietary restrictions. Repeated EGD with biopsy at 12 weeks showed resolved eosinophilic infiltrates.

Discussion: EG remains a rare diagnosis, and it should be included as a differential diagnosis in every patient with refractory symptoms of nausea, vomiting, abdominal pain, and failure to thrive. Diagnosis of EGID is established after the exclusion of other causes of eosinophilia in the gastrointestinal tract.

Keywords

Eosinophilic gastritis / Six food elimination Ddiet / Eosinophilic infiltrates in gastric mucosa

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