Eosinophilic Gastritis

Eosinophilic gastritis is a rare, chronic disease where a type of white blood cell called eosinophils accumulates in excessive amounts in the stomach, causing inflammation and damage that can lead to symptoms like nausea, stomach pain, and difficulty eating.

What Is Eosinophilic Gastritis?
Who Gets This Condition and What Causes It?
Symptoms
How Is Eosinophilic Gastritis Diagnosed?
Treatment Options
Related Eosinophilic Gastrointestinal Disorders

What Is Eosinophilic Gastritis?

Eosinophilic gastritis is a rare disease that affects the stomach. In this condition, a type of white blood cell called an eosinophil gathers in large numbers in the stomach, causing injury and inflammation (swelling and irritation)^[1].

Normally, your bone marrow (soft tissue inside bones) produces a small number of eosinophils, which make up about 1% to 5% of white blood cells in healthy people. These cells support your immune system and help protect your digestive system^[1]. It is also normal for some eosinophils to be present in the stomach to protect against illness and parasites^[2].

However, when your body produces too many eosinophils, you can develop inflammation in the tissues of your stomach. When these cells accumulate in elevated amounts, they become harmful. They release toxic substances including major basic protein, eosinophil-derived neurotoxin, eosinophilic cationic protein, and eosinophilic peroxidase, which damage stomach tissue^[5].

Eosinophilic gastritis is a chronic (long-term) disease that can affect anyone at any age. Healthcare providers most often diagnose it in adults between ages 30 and 50. Slightly more males than females develop the disease^[1]. Both adults and children can be affected^[2].

Healthcare providers believe that eosinophilic gastritis is relatively rare. The prevalence in the United States is estimated at 5.1 per 100,000 people^[5]. However, it is likely underdiagnosed because symptoms are similar to symptoms of many other conditions^[1].

Who Gets This Condition and What Causes It?

In many cases, it is not known what causes eosinophilic gastritis. Healthcare providers don’t always know the exact cause. In most cases, people develop this condition due to an abnormal immune system response to certain foods^[1]^[2].

The disease is believed to involve the overproduction of certain immune system chemicals. Multiple studies have shown overproduction of T-helper-2 cytokines (such as interleukin-13), chemokines (such as eotaxin-3), eotaxin-1, interleukin-5, and interleukin-15, which increase eosinophils in the body^[5].

Research shows that food allergies, inflammatory conditions, infections, malignancy, and some medications like gold therapy, azathioprine, enalapril, carbamazepine, and antitumor necrosis factor can trigger the inflammatory process^[5].

You may be at higher risk of developing eosinophilic gastritis if you have a history of allergic disorders or a family member with a related disease^[1]^[2]. Those with a personal or family history of allergic conditions like food allergy, anaphylaxis, eczema, hay fever, or asthma, or those who have other eosinophil-associated diseases may be at higher risk^[4].

People who develop eosinophilic gastritis often have allergic conditions such as^[1]:

Asthma
Food intolerance or food allergies
Hay fever (allergic rhinitis)
Runny nose (rhinitis)
Skin rash (eczema)

Symptoms

Signs of eosinophilic gastritis are usually mild or moderate^[1]. The presentation can vary based on age, the region of the digestive tract involved, and how deeply the eosinophils infiltrate into different layers of the gastrointestinal tract^[5].

Common symptoms include^[1]^[2]^[4]:

Abdominal pain or fluid buildup in the abdomen (ascites)
Nausea and vomiting
Diarrhea
Difficulty eating, such as loss of appetite, problems swallowing (dysphagia), refusal to eat, eating slowly, or not eating enough
Heartburn
Fatigue (tired feeling)
Low levels of healthy red blood cells (anemia)
Weight loss or poor growth, particularly in children
Hard to gain weight

How Is Eosinophilic Gastritis Diagnosed?

It can take a while to diagnose eosinophilic gastritis due to its common symptoms. A detailed history along with a physical examination is essential, as the list of conditions that could cause similar symptoms is broad^[5].

To diagnose eosinophilic gastritis, a gastroenterologist (a doctor who specializes in digestive system diseases) will perform an endoscopy, also called an upper scope. This is the only definitive way to diagnose the condition^[6].

During the endoscopy, you or your child is placed under anesthesia. The procedure is done as an outpatient visit in same-day surgery. The doctor puts a thin, flexible tube through the mouth and guides it into the esophagus, stomach, and part of the small intestine. During this procedure, the doctor examines these organs for signs of inflammation or other abnormalities and collects small tissue samples from each section of the upper gastrointestinal tract. These samples are called biopsies^[2]^[4].

A doctor called a pathologist will review the biopsies under a microscope to see if there are eosinophils and what the tissue looks like. While it is normal for some eosinophils to be present in the stomach, the pathologist evaluates whether there is an abnormally high number of these cells^[2]^[4].

A diagnosis is typically made by combining^[2]^[4]:

The patient’s symptoms
Medical history
What the doctor saw during the endoscopy
The pathology report (eosinophil levels and what the tissue samples look like)

High eosinophil levels in the stomach can occur in many conditions. Eosinophilic gastritis cannot be diagnosed on eosinophil levels alone. Currently, there is no consensus on how many eosinophils in the stomach are considered to be “too high.” This lack of defined guidelines can make diagnosis difficult^[2]^[6].

Additionally, many individuals with eosinophilic gastritis have elevated eosinophil levels in their blood^[4].

Treatment Options

There are no defined guidelines for the treatment of eosinophilic gastritis^[2]. Currently, in the United States, there is no medication approved by the Food and Drug Administration specifically indicated to treat this condition^[4].

Treatment goals include reducing the number of eosinophils and the associated symptoms, inflammation, and damage. Your healthcare provider can help you manage symptoms with regular testing, medication, and diet changes^[1]^[4].

Two main therapies are used to manage eosinophilic gastritis:

Dietary Therapy

Food allergies may play a possible role in eosinophilic gastrointestinal diseases. In infants, changing formulas may help. For older people, the condition has likely been there for a long time^[2].

While allergy testing is not always effective in identifying specific food triggers, dietary changes can help manage the condition^[4]. Dietary management is often treated by dietary elimination or an elemental diet^[6].

Three dietary approaches are available^[11]:

Elemental diet: Patients consume only an amino-acid based formula that does not include any intact proteins. All food protein is removed, and nutrition is provided through specialized formula^[6]. These diets achieve strong results, but their highly restrictive nature makes following them difficult and can greatly affect quality of life.
Empiric elimination diet: This removes foods more commonly associated with food allergy regardless of whether allergy testing was positive. A common approach is to begin by removing six common foods (milk, wheat, egg, soy, nuts, and fish/seafood), which are then gradually reintroduced to identify the culprits. However, patients must be motivated to follow this process, and success is greatly enhanced with assistance from a dietitian.
Allergy testing-directed food elimination: This involves avoidance of all foods for which specific antibodies were detected or that tested positive on skin tests.

In order to evaluate how well the treatment is working, periodic endoscopies with biopsies will be necessary^[6].

Medication

Eosinophilic gastritis may respond to^[2]:

Medicines that decrease inflammation (swelling), such as corticosteroids
Medicines that decrease the immune system
Iron supplements, which may also be prescribed if anemia develops^[6]

Corticosteroids, particularly prednisone, remain the main medication treatment. However, the disease is recognized as chronic and most frequently follows a course with periods when symptoms return, requiring ongoing treatment. Since prolonged steroid treatment carries a risk of serious adverse effects, other options with better safety profiles have been proposed. These include budesonide, steroid-sparing agents such as leukotriene inhibitors, azathioprine, anti-histamines, and mast-cell stabilizers^[9].

Research and clinical trials are being conducted to study investigational medicines and how they can help people with eosinophilic gastritis^[2].

Eosinophilic gastritis is one type of eosinophilic gastrointestinal disease (EGID). These conditions can affect different parts of your digestive system. You may have more than one disorder at once, which happens when you have high numbers of eosinophils in multiple locations^[1].

Many patients with eosinophilic gastritis also have eosinophilic gastrointestinal disease in other digestive segments^[2].

The six main types of EGID include^[1]:

Eosinophilic esophagitis (EoE), the most common EGID, involves your esophagus (the tube that connects your mouth to your stomach)
Eosinophilic gastritis (EG) involves your stomach
Eosinophilic gastroenteritis (EGE) primarily affects your stomach and small intestine
Eosinophilic duodenitis affects the first part of your small intestine
Eosinophilic enteritis (EoN) affects your small bowel
Eosinophilic colitis (EC) involves your large intestine (colon)

Other types of eosinophilic disease that can affect your digestive system include^[1]:

Hypereosinophilic syndrome, which involves the blood and any organ
Eosinophilic granulomatosis with polyangiitis (EGPA), which can affect many organs, including your heart

Stomach

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