Eosinophilic gastritis is a rare inflammatory condition where a specific type of white blood cell builds up in the stomach lining, causing discomfort and damage that can affect daily life, appetite, and overall wellbeing.

Understanding Eosinophilic Gastritis

Eosinophilic gastritis is a rare disease affecting the stomach, where too many eosinophils—a type of white blood cell that normally helps protect the body from infections and allergens—accumulate in the stomach tissue. In healthy individuals, eosinophils represent only about 1% to 5% of all white blood cells and are produced by the bone marrow. While some eosinophils naturally exist in the stomach to protect against illness and parasites, eosinophilic gastritis develops when these cells gather in abnormally high numbers, triggering inflammation and injury to the stomach lining.^[1][2]

This condition belongs to a broader family of disorders called eosinophilic gastrointestinal diseases (EGIDs), which can affect different parts of the digestive tract. When eosinophils accumulate specifically in the stomach, the condition is called eosinophilic gastritis. When they affect the small intestine, it’s known as eosinophilic enteritis, and when both the stomach and small intestine are involved, doctors call it eosinophilic gastroenteritis. The most common EGID is eosinophilic esophagitis, which affects the esophagus. Many people with eosinophilic gastritis may also have eosinophilic inflammation in other parts of their digestive system at the same time.^[1][4]

Eosinophilic gastritis is considered chronic, meaning it persists over time and requires ongoing management. However, with proper treatment and regular monitoring, people with this condition can manage their symptoms and maintain a reasonable quality of life. The disease affects individuals differently, and symptoms can range from mild to moderate in most cases.^[1]

How Common Is This Condition?

Eosinophilic gastritis is quite rare, though experts believe the condition is likely underdiagnosed. This means many people may have the disease without knowing it, because its symptoms often resemble those of many other common digestive conditions. In the United States, the estimated prevalence is approximately 5.1 per 100,000 people, though some earlier studies suggested numbers closer to 28 per 100,000. Despite these variations in reported numbers, research indicates that the overall prevalence of eosinophilic gastrointestinal diseases appears to be increasing over the past two decades.^[5]

The rarity of eosinophilic gastritis creates significant challenges for both patients and healthcare providers. Only about 1 in 5,500 patients have an EGID that is not eosinophilic esophagitis, and even fewer have eosinophilic gastritis by itself. With so few individuals affected, there are fewer opportunities for researchers to study the condition thoroughly, which makes it harder to develop standardized diagnostic criteria and evidence-based treatment guidelines.^[20]

The condition affects both children and adults, though healthcare providers most often diagnose it in adults between ages 30 and 50. Slightly more males than females develop eosinophilic gastritis. However, one study focusing on eosinophilic gastrointestinal disorders in general found that these conditions predominantly affect females and are more prevalent in the population aged 18 years or younger.^[1][5]

What Causes Eosinophilic Gastritis?

The exact cause of eosinophilic gastritis remains largely unknown, which reflects the ongoing challenge researchers face in understanding this rare condition. In most cases, doctors believe the disease develops due to an abnormal immune system response to certain foods. The body mistakenly treats certain food proteins as threats, triggering the immune system to send eosinophils to the stomach lining. These white blood cells then release toxic substances including enzymes and proteins designed to destroy what the body perceives as harmful invaders, but instead they cause inflammation and damage to healthy stomach tissue.^[1][4]

Research suggests that the disease involves an overproduction of certain immune system chemicals called cytokines, particularly type 2 helper T cell cytokines. These include substances like interleukin-13, interleukin-5, and interleukin-15, as well as proteins called chemokines such as eotaxin-1 and eotaxin-3. When these chemicals become overactive, they recruit more eosinophils to the stomach lining. Once there, the eosinophils become toxic by producing factors like major basic protein, eosinophil-derived neurotoxin, eosinophilic cationic protein, and eosinophilic peroxidase—all of which contribute to tissue damage and inflammation.^[5]

While food allergies appear to play a possible role in eosinophilic gastritis, the connection is not straightforward. Standard allergy testing is not always effective in identifying which specific foods might trigger the condition. The immune response involved in eosinophilic gastritis may be different from the typical IgE-mediated allergic reactions that cause immediate symptoms like hives or difficulty breathing. Instead, this appears to be a delayed or non-IgE-mediated response that develops more slowly and affects the digestive tract specifically.^[4]

Risk Factors for Developing the Condition

Certain factors appear to increase a person’s risk of developing eosinophilic gastritis, though having these risk factors does not guarantee that someone will develop the disease. The most significant risk factor is having a personal or family history of allergic conditions. People with eosinophilic gastritis frequently have other allergic disorders running alongside their digestive condition, suggesting a connection between general allergic tendencies and the development of eosinophilic inflammation in the stomach.^[1][4]

Common allergic conditions associated with eosinophilic gastritis include:

• Asthma, a chronic respiratory condition causing breathing difficulties
• Food intolerance or food allergies that trigger digestive or other symptoms
• Hay fever, also called allergic rhinitis, which causes sneezing, congestion, and itchy eyes in response to environmental allergens like pollen
• Rhinitis, or persistent runny nose and nasal congestion
• Eczema, a skin condition causing red, itchy rashes
• Other eosinophil-associated diseases affecting different body systems

Having a family member with eosinophilic gastritis or a related eosinophilic gastrointestinal disease may also increase risk, suggesting that genetic factors could play a role in susceptibility to the condition. Some research has identified genes involved in immune system function and the integrity of the esophageal and stomach lining that may contribute to the development of eosinophilic diseases.^[1][6]

Although limited data exists, some research suggests that certain medications might trigger inflammatory processes similar to eosinophilic gastritis. These potentially triggering medications include gold therapy used for rheumatoid arthritis, azathioprine (an immunosuppressant), enalapril (a blood pressure medication), carbamazepine (used for seizures and nerve pain), and anti-tumor necrosis factor drugs used to treat autoimmune conditions. However, more research is needed to confirm these associations.^[5]

Recognizing the Symptoms

The symptoms of eosinophilic gastritis are generally mild to moderate in severity, though they can significantly impact a person’s daily life, nutrition, and overall wellbeing. Because the symptoms are similar to many other digestive conditions, it often takes considerable time before doctors arrive at the correct diagnosis. Understanding the common signs can help people recognize when they should seek medical evaluation.^[1]

Common symptoms include:

• Abdominal pain or discomfort, which may be persistent or come and go
• Nausea, or a feeling of queasiness and the urge to vomit
• Vomiting, which may occur frequently and interfere with nutrition
• Difficulty eating, including loss of appetite, problems swallowing, refusal to eat, eating very slowly, or not eating enough
• Diarrhea, with loose or watery bowel movements
• Heartburn, a burning sensation in the chest caused by stomach contents moving upward
• Fatigue, or persistent tiredness that doesn’t improve with rest
• Weight loss or poor growth, particularly noticeable in children
• Difficulty gaining weight despite adequate food intake

Some people with eosinophilic gastritis develop anemia, which means they have low levels of healthy red blood cells. Anemia can cause additional symptoms including weakness, pale skin, shortness of breath, and worsening fatigue. Another possible symptom is ascites, which is fluid buildup in the abdomen that causes swelling and discomfort. Some individuals may experience dysphagia, or difficulty swallowing, as if there is an obstruction in the esophagus preventing food from passing normally.^[1][2][17]

The unpredictability of symptoms creates significant stress for people living with eosinophilic gastritis. Flare-ups can occur without warning, making it difficult to plan activities, work, or social events. The constant fear of not knowing what triggers symptoms or when a flare-up might strike can take a substantial toll on mental health and quality of life. Living in this uncertainty stops people from having a normal life because they cannot plan properly.^[17]

Prevention and Risk Reduction

Because the exact cause of eosinophilic gastritis remains unclear, there are no proven methods to prevent the condition from developing. However, for people who already have allergic conditions, managing those conditions well may help reduce overall immune system inflammation, though this has not been specifically proven to prevent eosinophilic gastritis. Since food appears to play a role in triggering the condition in many people, identifying and avoiding problematic foods may help prevent symptom flare-ups in those already diagnosed.^[4]

For individuals with a family history of eosinophilic gastrointestinal diseases or multiple allergic conditions, being aware of digestive symptoms and seeking medical evaluation promptly if concerning symptoms develop may help achieve earlier diagnosis and treatment. Early intervention may potentially prevent some of the complications and long-term damage that can occur when inflammation persists untreated for extended periods.^[1]

How the Disease Affects the Body

Understanding what happens in the body during eosinophilic gastritis helps explain why symptoms occur and why treatment is important. The disease fundamentally involves an abnormal immune response that causes physical and biochemical changes in the stomach tissue. In a healthy stomach, a protective layer of mucus lines the stomach wall, shielding it from the harsh effects of digestive juices including stomach acid and bile. This protective barrier allows the stomach to break down food without damaging itself in the process.^[1]

In eosinophilic gastritis, the immune system becomes dysregulated, meaning its normal protective functions go awry. When certain food proteins or possibly environmental allergens enter the digestive system, the body launches an exaggerated immune response. The immune system produces excessive amounts of type 2 cytokines and chemokines—chemical messengers that normally help coordinate the body’s defense against parasites and allergens. These chemicals act like recruitment signals, calling eosinophils to migrate from the bloodstream into the stomach lining.^[5]

Once eosinophils arrive in the stomach tissue in large numbers, they release their stored toxic proteins and enzymes. These substances, which include major basic protein, eosinophilic cationic protein, eosinophil peroxidase, and eosinophil-derived neurotoxin, are designed to destroy parasites and other invaders. However, in eosinophilic gastritis, they instead attack the stomach’s own healthy tissue. This process breaks down the protective mucus barrier and causes direct damage to the cells lining the stomach, leading to inflammation and swelling.^[5]

The inflammation disrupts the stomach’s normal functions. It can interfere with the production of stomach acid and digestive enzymes, making it harder to break down food properly. The damaged stomach lining may not absorb nutrients efficiently. Inflammation can also affect the stomach’s ability to contract and move food along the digestive tract normally, potentially causing delayed emptying, nausea, and pain. When inflammation persists over time, it may lead to changes in the stomach tissue structure and potentially contribute to scarring or other complications.^[5]

The severity of tissue damage and the extent of eosinophil infiltration can vary considerably between individuals. Some classification systems divide eosinophilic gastrointestinal disease based on which layers of the stomach wall are affected—the innermost mucosal layer, the middle muscle layer, or the outer serosal layer. The layer affected influences which symptoms predominate and how severe the disease presentation may be. Most commonly, the mucosal layer is involved, but some people have eosinophils penetrating into deeper layers of the stomach wall.^[5]