Eosinophilic Gastritis: A Histopathologic Diagnosis in Search of Clinical Correlates

Published in Modern Pathology, December 17, 2010

Thida Lwin, MD, Shelby D. Melton, MD, and Robert M. Genta, MD

Eosinophilic gastritis remains a poorly characterized condition that pathologists may consider when “greater than normal” numbers of eosinophils are found in the gastric mucosa. In contrast to eosinophilic esophagitis, no clinicopathologic diagnostic criteria have been identified for eosinophilic gastritis. Furthermore, the normal eosinophilic content in the lamina propria of the gastric mucosa has rarely been investigated. While acknowledging this uncertainty, the updated Sydney System specifically stated that intraepithelial eosinophils must always be viewed as abnormal. Increased numbers of eosinophils in the lamina propria have been reported following eradication therapy for H. pylori, in reactive gastropathy caused by certain drugs, and in focal responses to tissue-invading parasites, particularly Anisakis spp. larvae.

Increased gastric eosinophils can also be identified in patients with the rare eosinophil-associated gastrointestinal disorders.

The purpose of this study was to identify a set of histologic features that could serve as a foundation for the development of diagnostic criteria for eosinophilic gastritis and to investigate its clinical and pathological associations. To achieve these goals, we reviewed the histopathology, clinical, and endoscopic information of all patients whose gastric biopsies had been diagnosed as having increased eosinophilic infiltrates at a large gastrointestinal pathology referral laboratory.

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