Modern Pathology, December 17, 2010
Thida Lwin, MD, Shelby D. Melton, MD, and Robert M. Genta, MD
Eosinophilic gastritis remains a poorly characterized condition that pathologists
may consider when “greater than normal” numbers of eosinophils
are found in the gastric mucosa. In contrast to eosinophilic esophagitis,
no clinicopathologic diagnostic criteria have been identified for eosinophilic
gastritis. Furthermore, the normal eosinophilic content in the lamina
propria of the gastric mucosa has rarely been investigated. While acknowledging
this uncertainty, the updated Sydney System specifically stated that intraepithelial
eosinophils must always be viewed as abnormal. Increased numbers of eosinophils
in the lamina propria have been reported following eradication therapy
for H. pylori, in reactive gastropathy caused by certain drugs, and in
focal responses to tissue-invading parasites, particularly Anisakis spp. larvae.
Increased gastric eosinophils can also be identified in patients with the
rare eosinophil-associated gastrointestinal disorders.
The purpose of this study was to identify a set of histologic features
that could serve as a foundation for the development of diagnostic criteria
for eosinophilic gastritis and to investigate its clinical and pathological
associations. To achieve these goals, we reviewed the histopathology,
clinical, and endoscopic information of all patients whose gastric biopsies
had been diagnosed as having increased eosinophilic infiltrates at a large
gastrointestinal pathology referral laboratory.
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