Eosinophilic gastritis is a component of eosinophilic gastroenteropathy, a rare disease characterized by prominent eosinophilic infiltration of the gastrointestinal tract. The cause is unknown and the mechanisms responsible for gastrointestinal infiltration by eosinophils remain poorly understood. Recently, it has been shown that the production of eotaxin, a protein with 73 amino acid residues and a member of the chekines family, at the site of inflammation promotes recruitment and aggregation of eosinophils in the tissue by up-regulating integrins and enhancing eosinophilic adhesion to endothelial cells. Finally, it may contribute to tissue damage by stimulating the release of highly cytotoxic granular proteins.53 It has been suggested that food allergy might be a triggering factor in childhood. Associations between eosinophilic gastritis and parasitic infection of the stomach have been described.
Any part of the gastrointestinal tract, from the esophagus to the rectum, can be affected, even though the stomach seems to be the most frequent site.54 Eosinophilic infiltration may involve the mucosa, the muscularis propria and the serosa. On the basis of the predominant affected layer, the enteropathy has been classified into three different forms: mucosal, which produces clinical features of inflammatory diseases; submucosal, usually producing obstruction; and serosal, producing eosinophilic ascites. The clinical picture depends on the site and depth of the inflammatory involvement. Gastric involvement is commonly associated with abdominal pain, bloating, growth failure, weight loss, nausea and non-bilious vomiting secondary to gastric outlet obstruction. Gastric perforation has also been reported. Patients with associated small bowel involvement may develop protein-losing enteropathy, malabsorption and iron-deficiency anemia. In some patients, an elevated circulating eosinophilic count and raised serum IgE level can be found, although their clinical significance remains unclear.
Endoscopy and biopsy are the main ways to establish the diagnosis. Endoscopic findings, when present, are non-specific and include erythema, antral nodular lesions, ulcers and, rarely, a narrowed lumen. In mucosal involvement, histology is diagnostic in more than 80% of patients, revealing a striking eosinophilic infiltrate of the lamina propria and penetration of eosinophils into the epithelium. Although eosinophils may be a prominent inflammatory component in other types of gastritis, such as H. pylori gastritis and chemical gastropathy, the diagnosis can be made in almost all cases through multiple biopsies. Rarely, laparoscopy and full-thickness biopsies are needed to confirm the suspicions.
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