Eosinophilic gastritis: histopathological characterization and quantification of the normal gastric eosinophil content

Abstract

There is limited information about normal eosinophil counts in the gastric mucosa. The purpose of this study was to evaluate the histopathology of 60 patients whose biopsies showed increased eosinophils in the gastric mucosa. We also investigated the eosinophil content in gastric biopsies from normal controls (matched for age, sex, and zip code), from patients with Helicobacter pylori gastritis, and patients with Crohn's disease. Eosinophils were counted in five random high-power fields (HPFs) and reported in eosinophils/mm 2 . Involvement of the muscularis mucosae or submucosa, sheets of eosinophils, and infiltration of the gastric epithelium were also evaluated. The median eosinophil count in the study patients was 539 eosinophils/mm 2 ; mean±SD ¼ 653±418 eosinophils/mm 2 ; range 127-2108. Sheets of eosinophils were seen in 38 patients, 27 showed involvement of the muscularis mucosae or submucosa. There were 7 patients without epithelial infiltration by eosinophils, whereas 34 were tallied as rare and 19 were scored as abundant. No study patient had no evidence of H. pylori. The mean eosinophil count for the 135 normal controls was 15.5 ± 16.8 SD eosinophils/mm 2 (range 0-110); in the 93 controls with H. pylori gastritis the mean eosinophil count was 25 ± 32.6 SD eosinophils/mm 2 (range 0-219); and for the 53 controls with Crohn's disease it was 31.4 ± 44.4 SD eosinophils/mm 2 (range 0-203). There were no significant differences between the counts in biopsies from the antrum and corpus, and no significant variations by age, geographic location, or season. This study confirms that, in the United States population, the normal gastric eosinophilic counts are usually o38 eosinophils/mm 2 . We recommend 'histological eosinophilic gastritis' for the diagnosis of gastric biopsies that show an average density Z127 eosinophils/mm 2 (or Z30 eosinophils per HPF) in at least five HPFs in the absence of known associated causes of eosinophilia.

Collagenous gastritis: a morphologic and immunohistochemical study of 40 patients

“…23 Collagenous gastritis is a part of the differential diagnosis for a histologic finding of eosinophilic gastritis and the eosinophilia should prompt a careful search for subepithelial collagen. There seems to be a trend toward increased eosinophils in younger patients, but it is important to underscore that all patients with collagenous gastritis we have observed have at least a minor degree of eosinophilic inflammation.…”

“…A threshold of 430 eosinophils per  400 high power field was considered as significant, as this number has been previously used to define 'histological eosinophilic gastritis'. 23 The biopsies were also assessed for the presence of Helicobacter pylori and, when available, histochemical and immunohistochemical stains were also reviewed. All available follow-up biopsies were assessed for histologic evidence of disease resolution or persistence.…”

Клінічні Прояви Гастроінтестинальної Форми Харчової Алергії У Дітей І Підходи До Її Діагностики

“…Залежно від глибини ушкодження гастроінтестинального тракту спостерігаються такі прояви: епігастральний біль, нудота, блювання, діа-рея (при ураженні тільки слизового шару шлунка та кишки); симптоми непрохідності -метеоризм, ну-дота, блювання (при ураженні м'язового шару цих відділів ШКТ); асцит (при концентруванні еозино-філів в субсерозному шарі) [18,27].…”

“…Також не існує єдиної думки щодо кон-кретного рівня тканинної еозинофілії для встанов-лення діагнозу. Гістологічна ознака, що базується на дослідженнях групи здорових дітей, характеризує еозинофілію шлунка від 30 еозинофілів у полі зору мікроскопа високої потужності при еозинофільно-му гастриті та від 50 еозинофілів у полі зору мікро-скопа високої потужності у дванадцятипалій киш-ці при еозинофільному дуоденіті [27]. Додаткові ознаки, такі як внутрішньозалозиста еозинофілія, внутрішньом'язова еозинофілія, також є вагомими у встановленні діагнозу еозинофільного гастроен-териту.…”

Histopathology of Eosinophilic Esophagitis

“…Biopsies from the stomach and duodenum should also be obtained to identify eosinophil-related or other pathologies at those sites. As with esophageal biopsies, biopsies at those sites should be obtained even if the mucosa appears normal because, for example, children and adults who have eosinophil gastritis may have normal-appearing gastric mucosa at endoscopy [12]. …”