Eosinophilic Gastritis in Children: A Clinicopathological Study
Huai-Bin M Ko, Mirna Chehade, Raffaella A Morotti. Mount Sinai School of Medicine, New York, NY; Yale University School of Medicine, New Haven, CT
Background: Eosinophilic gastritis(EG) in children is generally considered part of a more extensive allergic gastroenteritis. Evaluation of concurrent hypereosinophilia in different locations in the gastro-intestinal(GI) tract and response to therapy has not been systematically studied.
Design: Pathology files were searched for "eosinophilic gastritis" involving the gastric antrum and/or fundus for patients ≤18 years of age, from January 2005 to present. Medical charts were reviewed for medical history including atopy, symptoms at presentation, endoscopic findings and response to therapies. EG was defined histologically by marked, diffuse, eosinophilic infiltrates with ≥70 eosinophils per high power field (HPF). Pathology reports and slides were reviewed for concurrent eosinophilic esophagitis (EoE, >15 eosinophils HPF) and hypereosinophilia in the duodenum and lower GI tract. Post-treatment biopsies were reviewed.
Results: 31 patients (13 M, 18 F), ages 3 months to 16 years, were identified. Twelve (38%) were ≤ 3 years old. Of the 31 patients, 16 had food allergies, 18 had an atopic disorder, and 6 had a protein losing enteropathy (PLE). Main symptoms at presentation were abdominal pain, followed by vomiting and anemia. The most frequent endoscopic findings were focal ulcers, erythema, and nodular lesions. Histologically, 29 patients had marked antral eosinophilia but in 2 hypereosinophilia was limited to the fundus. Eleven had concomitant EoE. Four patients had duodenal eosinophilia with villous blunting of which 1 was diagnosed with celiac disease. Of 11 patients who also had lower GI tract biopsies, 4 had an increase in mucosal eosinophils. 20/31 patients had post treatment biopsies, of which 17/20 had complete clearance of gastric eosinophilia with dietary restriction therapy. However, 8 of the patients with resolved EG had persistent or denovo eosinophilia limited to the esophagus.
Conclusions: EG is a distinct clinical-pathological entity characterized by marked eosinophilia selectively in the gastric antrum or fundus. There is a strong association with food allergies and atopic disorders. Symptoms and endoscopic findings vary widely, highlighting the importance of obtaining biopsies for diagnosis. EG can be associated with EoE, and rarely with hypereosinophilia of the lower GI tract. EG largely responds to dietary restriction with resolution of symptoms and clearance of eosinophils in the stomach. Associated EoE may persist or present de-novo after treatment.
Tuesday, March 20, 2012 8:00 AM
Platform Session: Section D, Tuesday Morning