What Is Eosinophilic Gastritis?

Overview

Eosinophilic gastritis is a rare disease of the stomach that is caused by the buildup of eosinophils. The estimated prevalence of eosinophilic gastritis is 6.3 cases per 100,000.¹ However, cases may be underestimated as it can be difficult to diagnose with symptoms including nausea, abdominal pain, diarrhoea, and weight loss.

Eosinophils are white blood cells and part of the inflammatory response of the immune system, which can cause tissue damage when there are too many in one area. They are produced in the bone marrow and makeup approximately 1% of the leukocytes in healthy people, but this can be raised to 5% in people with allergic symptoms.

Allergens, infections, medications, or cancer can also lead to an increase in eosinophils (eosinophilia), which can lead to inflammation and damage in the tissues of your stomach (gastritis or other organs. A build-up of eosinophils in the oesophagus can also lead to eosinophilic oesophagitis.

The exact cause of eosinophilic gastritis isn’t always clear; however, it is usually due to a non-IgE-mediated allergic immune response to certain foods. Other atopic diseases such as allergic rhinitis, bronchial asthma, IgE-mediated food allergies, and eczema appear to be far more prevalent among people suffering from eosinophilic diseases than the general population.²

Gastritis can also develop due to other causes such as a bacterial infection with Helicobacter Pylori, the use of certain medications such as non-steroidal inflammatory drugs (NSAIDs) for pain relief, and negative lifestyle choices such as excessive alcohol intake. The most common cause of gastritis worldwide is an infection with the bacterium Helicobacter Pylori, which can cause both acute and chronic gastritis.

Causes of eosinophilic gastritis

The exact cause of eosinophilic gastritis is not always clear. However, it is thought to be triggered by an immune response from eating certain types of foods. People with a personal or family history of having allergic conditions may be at a higher risk of having eosinophilic gastritis. 

Signs and symptoms of eosinophilic gastritis

Symptoms can include the following:

• Abdominal pain
• Diarrhoea
• Loss of appetite
• Dysphagia
• Fatigue
• Heartburn
• Nausea and vomiting
• Weight loss or poor weight gain
• Anaemia

Management and treatment for eosinophilic gastritis

There is no cure for eosinophilic gastritis, but it can be managed with dietary changes and medications. This is also important to prevent severe complications, especially in babies and children. Infants may be given a different type of baby formula to ease symptoms.

If you are suffering from eosinophilic gastritis, you may be given the following medications to reduce symptoms:

• Steroids to reduce swelling
• Immunosuppressants to decrease the immune system reaction
• New investigational medicines that reduce the number of eosinophils in the stomach are also being trialled.

You may also be told to follow an elimination diet in which certain foods that may trigger an allergic reaction are removed from your diet.

You may also be given an elemental diet. This is where solid foods are replaced with a liquid, which contains nutrients broken down to their most “elemental” form. This makes them easy to absorb into the upper digestive tract, therefore allowing the digestive system to recover.

Iron supplements may also be given to prevent anaemia.

Regular biopsies and endoscopies may be needed to monitor your condition and to adjust the treatment, if necessary.

Diagnosis

Diagnosis of eosinophilic gastritis may take some time as symptoms are not very specific. Also, due to the lower gut containing some eosinophils, even in a healthy person, the exact figure of raised levels of eosinophils for a diagnosis has not been agreed on yet in the UK. Your healthcare provider will probably first perform a physical exam, a full symptom assessment, and blood tests, including a full blood count. A diagnosis is usually made based on a high eosinophil count in the lining of the gut and in the blood and changes in the stomach, which can be seen in an endoscopy.

To diagnose eosinophilic gastritis, a gastroenterologist may insert a small tube with a camera (an endoscope) down the oesophagus and into the stomach. They will then be able to look at the stomach lining and take small tissue samples called biopsies. These will then be reviewed for the presence of eosinophils and if there is tissue damage. However, a diagnosis can not occur on high eosinophil levels in the gut alone. Other conditions, such as parasitic infections and other types of inflammation in the gut, need to be carefully ruled out. 

Allergy testing may also be used to help identify the foods leading to an increase in eosinophils.

FAQs

How can I prevent eosinophilic gastritis?

Eosinophilic gastritis can’t be prevented as it is due to an allergic response to certain foods. Allergy testing, eliminating the foods that trigger the allergic response, and taking medications can help control the immune system's response and reduce symptoms. A healthy diet and lifestyle may also reduce the overall risk of developing the disease, especially if you suffer from allergies or have a family history of eosinophilic gastritis.

How common is eosinophilic gastritis?

Eosinophilic gastritis is a rare condition. However, as symptoms are quite unspecific and resemble those other conditions, it may be underdiagnosed. It has an estimated prevalence of 6.3 cases per 100,000.¹ 

Who is at risk of eosinophilic gastritis?

People with a family history of eosinophilic gastritis or who suffer from atopic diseases or have a family history of them seem to be at higher risk of developing eosinophilic gastritis.

When should I see a doctor?

If you are suffering from stomach pain or notice symptoms after eating certain types of food, or your symptoms aren’t improving or getting worse, talk to your healthcare provider.

Summary

Eosinophilic gastritis is a rare disease of the stomach which is due to the presence of too many eosinophils. People with eosinophilic gastritis often have other allergic conditions such as allergic rhinitis, bronchial asthma, eczema, a family history of eosinophilic gastritis or other allergic conditions. It can be difficult and take time to diagnose as symptoms are not specific, and diagnosis is dependent on symptom analysis, the presence of high levels of eosinophils, tissue damage, and inflammation, and excluding other conditions such as parasitic infections.

Symptoms of eosinophilic gastritis are managed through supportive care. Options include dietary changes and eliminating certain foods, steroids, and immunosuppressants. Nutritional supplements may also be needed. While there is no cure for eosinophilic gastritis, symptoms can be managed with the help of medication and dietary changes.