What is Eosinophilic Gastritis?
It is a very rare gastrointestinal disease that affects both children and adults. This disease should be properly diagnosed and treated by a doctor as it can lead to an Irritable Bowel Syndrome. This is a heterogeneous condition characterized by patchy or diffuse eosinophilic infiltration of gastrointestinal (GI) tissue.
It was first described by Kaijser in the year 1937. The presentation of the disease depends on the depth and extent of bowel wall involvement. It usually runs a chronic relapsing course.
Eosinophilic Gastritis Symptoms
This disease usually represents itself with varied nonspecific GI symptoms which are chronic in nature. They include:
Picture 1 – Eosinophilic Gastritis
- Abdominal pain
- Weight loss
- Abdominal distension
Strict diagnosis is required as the disease is quite rare and may also present itself at times in the form of an extreme pain in the abdomen or bowel obstruction. In some patients, the symptoms may be severe and occur more often. More than 50% of the patients are likely to be diagnosed with eosinophils in the blood.
The general symptoms of the condition are:
- Bouts of vomiting and nausea
- Pain in the abdomen
- Weight loss
- Stools with blood
- Difficulty in swallowing and the feeling of food getting stuck in the throat
- Loss of weight
Eosinophilic gastritis Types
Following are the types of EG that people affected with the disease characteristically experience:
It shows itself with obstruction of gastric outlet or small intestine. Sometimes it presents itself with obstruction caecal mass or intussusception.
This is the most common variety of EG. It has features like mal-absorption, protein losing enteropathy, failure to cope with anaemia. Presence of lower gastrointestinal bleeding may imply colonic involvement.
It presents itself with ascites that is exudative and which is abundant peripheral eosinophilia.
Other noticeable features are eosinophilic splenitis, Cholangitis, acute appendicitis, pancreatitis, and giant refractory duodenal ulcer.
Eosinophilic gastritis Diagnosis
The three widely used diagnostic criteria for this condition are:
- The presentation of gastrointestinal symptoms
- Absence of parasitic or extraintestinal disease
- Presence of high eosinophil count in ascetic fluid or the infiltration of eosinophils in more than one areas of the gastrointestinal tract.
Know about some other criteria for detecting this disorder:
- A CT scan will show nodular and uneven thickening of folds in the distal stomach and proximal small bowel but these conditions may also be present with Crohn’s disease and lymphoma.
- Definitive diagnosis involves evidence of eosinophilic infiltration in biopsy slides. Microscopy shows less than 20 eosinophils per high power field. The nature of infiltration is often patchy and can be missed. Therefore, laparoscopic full thickness biopsy may be required.
- Hypereosinophilia is the proof of allergic response which may be absent in about 20% of the patients. Mal-absorption is suggested by hypoalbuminaemis and other abnormalities.
- Radio-isotope scan uses Technetium exametazime labeled leukocyte SPECT – which may be fruitful in evaluating the extent of the disease and response to treatment.
- Endoscopy shows friable, nodular, occasional and ulcerative alterations. At times, inflammation gets diffused and leads to loss of villi, submucosal oedema and fibrosis.
Eosinophilic gastritis Treatment
Medical treatment could be one option for treating EG. Here are the following options:
Picture 2 – Eosinophilic Gastritis Image
- Those who have obstructive symptoms can go for supportive treatment with pharmacotherapy, mainly glucocorticosteroids.
- Drugs like montelukast, mycophenolate mofetil, suplatast tosilate, and ketotifen.
- Patients whose mucosal layer is involved, anti-inflammatory medications or diet elimination therapy if they report allergy of food intolerance.
Foods which cause triggers should be removed from the diet. In some cases, the diet changes do not work in a severe case like that the patient might need a basic diet. Patients can begin with a very simple diet and then wait for some days for the symptoms to disappear. Once this is started, a food can be added one at a time. If the food is clear another food can be added after every five days. In extreme cases, an elementary diet is recommended. A patient is restricted from having foods that contain protein. He or she has to consume only amino acid which is the building blocks of protein. Patients can have salts, oils and simple sugars. Elementary diet is known to be very valuable in curing this disease. However, because of the limitations that the diet has, it is not good for young adults and children who are in the process of growth.
Corticosteroids have anti-inflammatory properties and create deep and varied metabolic effects. It modifies the immune response of the body to different stimuli.
Some of the corticosteroids that patients can take are:
- Fluticasone Inhaled – It limits the entry of inflammatory cells and eosinophils and reduces the release of eotaxins and other inflammatory mediators. The dosage required is higher than what is administered in case of asthma.
- Budesonide (oral viscous suspension) – It reduces inflammation and lowers capillary permeability.
- Prednisolone – It decreases inflammation by blocking the migration of polymorphonuclear leukocytes and reducing capillary permeability. Equal dosages of prednisone or methylprednisone may be used.