BACKGROUND:
Eosinophilic gastritis is related to
eosinophilic gastroenteritis, varying only in regards to the extent of disease and small bowel involvement. Common symptoms reported are similar to our patient's including:
abdominal pain, epigastric
pain,
anorexia, bloating,
weight loss,
diarrhea, ankle
edema,
dysphagia, melaena and postprandial
nausea and
vomiting. Microscopic features of eosinophilic infiltration usually occur in the lamina propria or submucosa with perivascular aggregates. The disease is likely mediated by eosinophils activated by various
cytokines and
chemokines.
Therapy centers around the use of
immunosuppressive agents and dietary
therapy if
food allergy is
a factor. CASE PRESENTATION: The patient is a 31 year old Caucasian female with a past medical history significant for
ulcerative colitis. She presented with recurrent bouts of
vomiting,
abdominal pain and chest discomfort of 11 months duration. The bouts of
vomiting had been reoccurring every 7-10 days, with each episode lasting for 1-3 days. This was associated with extreme weakness and
cachexia. Gastric biopsies revealed intense eosinophilic infiltration. The patient responded to
glucocorticoids and
azathioprine. The differential diagnosis and molecular pathogenesis of
eosinophilic gastritis as well as the molecular effects of
glucocorticoids in eosinophilic disorders are discussed. CONCLUSIONS: The patient responded to a combination of glucocorticosteroids and
azathioprine with decreased
eosinophilia and symptoms. It is likely that eosinophil-active
cytokines such as
interleukin-3 (IL-3),
granulocyte macrophage colony stimulating factor (
GM-CSF) and
IL-5 play pivotal roles in this disease.
Chemokines such as eotaxin may be involved in eosinophil recruitment. These mediators are downregulated or inhibited by the use of immunosuppressive medications.