Endoscopic findings of gastric lesions in patients with eosinophilic gastrointestinal disorders

Abstract

Background and study aims Eosinophilic gastrointestinal disorders are classified into eosinophilic esophagitis, eosinophilic gastritis, eosinophilic gastroenteritis, and eosinophilic colitis according to the site of eosinophilic infiltration. Although well established in eosinophilic esophagitis, endoscopic findings in eosinophilic gastritis and eosinophilic gastroenteritis with regard to gastric lesions have not been clearly described. The aim of this study was to identify endoscopic findings of gastric lesions associated with eosinophilic gastrointestinal disorders. Patients and methods Out of 278 patients with eosinophilic gastrointestinal disorders, 18 had eosinophilic gastritis or eosinophilic gastroenteritis confirmed by biopsy; their endoscopic images were analyzed retrospectively. The association between endoscopic findings and number of eosinophils in the gastric mucosa was investigated. Results Erythema was most frequently observed (72 %), followed by ulcers (39 %), discoloration (33 %), erosions (28 %), nodularity (28 %), and polyps (28 %). There were several unique endoscopic findings such as submucosal tumor-like deep large ulcers in three patients, antral Penthorum-like appearances (small nodules radially lined toward the pyloric ring) in three patients, “muskmelon-like appearances” (discolored mucosa-composed mesh pattern) in three patients, multiple white granular elevations in two patients, cracks (appearance of furrows similar to those in eosinophilic esophagitis) in five patients, and antral rings in one patient. No significant association was observed between endoscopic findings and number of gastric eosinophils. Conclusions Several unique endoscopic findings of gastric lesions were observed in patients with eosinophilic gastritis or eosinophilic gastroenteritis. Submucosal tumor-like ulcers, antral Penthorum-like appearances, muskmelon-like appearances, and cracks might be associated with eosinophilic gastrointestinal disorders.

Asymptomatic Eosinophilic Infiltration with Endoscopic and Histological Findings Consistent with Eosinophilic Gastritis

“…The white granular patches observed in our case are rare in EG but have been reported [10, 11]. Patchy discoloration, which appeared similar to atrophic gastritis in our case, has also been reported [11].…”

“…Endoscopic findings in EG are normal in a majority of cases, with various possible changes including erythema, erosions, fold thickening, nodules, and friability [10]. The white granular patches observed in our case are rare in EG but have been reported [10, 11]. Patchy discoloration, which appeared similar to atrophic gastritis in our case, has also been reported [11].…”

Prospective Endoscopic Activity Assessment for Eosinophilic Gastritis in a Multisite Cohort

“…We postulate that the increased detection is related to the prospective data acquisition, experience of the CEGIR investigators, and systematic inclusion of multiple features. It should be noted that one Japanese study that carefully reassessed endoscopic images of the stomach reported higher prevalence of endoscopic abnormalities compared with studies relying on endoscopic reports (6). Of note, this study also identified mucosal cracks (fissures), rings, and white exudate similar to features described in EoE that were not included in EG-REFS (6).…”

“…It should be noted that one Japanese study that carefully reassessed endoscopic images of the stomach reported higher prevalence of endoscopic abnormalities compared with studies relying on endoscopic reports (6). Of note, this study also identified mucosal cracks (fissures), rings, and white exudate similar to features described in EoE that were not included in EG-REFS (6). The heterogeneity in the prevalence of endoscopic findings may be related to varied demographics, diagnostic criteria, and use of active medical/diet therapies at the time of the endoscopies across studies.…”

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“…These data are confirmed by studies of some authors and indicate the need for histological examination [20]. However, despite this fact, there is a constant search for macroscopic changes in the mucous membrane of the gastrointestinal tract and their justification in terms of clinical, laboratory, and microscopic data, and it is proposed to take into account a number of features that are statistically significant [21,22]. Therefore, currently, mucosal biopsy is a reliable diagnostic method for the detection of characteristic changes and eosinophilic infiltration [23].…”