Health Questions and Answers

Question: In what circumstances do granulomatous and eosinophilic gastritis occur?

Answer:

Granulomatous and eosinophilic gastritis probably do not exist as diseases isolated to the stomach. They are more often associated with other systemic diseases. Granulomatous gastritis, when it involves the stomach, is usually part of the spectrum of Crohn’s disease. Because the antrum is the portion of the stomach most often involved with this disease, the most common clinical presentation is gastric outlet obstruction. Endoscopically, the entire antrum feels firm, and the pylorus is small and rigid. Aphthous ulcers are often seen in the antrum, but the deep crevice-like ulcers seen elsewhere in the gastrointestinal tract are not normally noted in the stomach. Histologic confirmation is difficult to obtain; however, biopsies taken with jumbo forceps are sometimes diagnostic. Other diseases that can produce this picture are sarcoidosis, Wegener’s granulomatosis, and systemic granulomatosis. Eosinophilic gastritis is part of the overall syndrome of eosinophilic gastroenteritis. The most common areas of involvement, however, are the stomach and small bowel. The most common clinical presentation of this entity is antral ulceration, and the patient often presents with the typical symptoms of ulcer disease. Biopsies are diagnostic. No definite therapy is recommended, except treatment for the ulcers; however, there are empiric reports of success with corticosteroid therapy.

Reference: Cello JP: Eosinophilic gastroenteritis: A complex entity. Am J Med 67:1097-1104, 1979.

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