Eosinophilic Gastritis: Symptoms, Types, Causes and Treatment

Eosinophilic gastritis (EG) is an increasingly recognized gastrointestinal disorder that can significantly affect quality of life. Although once considered rare, awareness and diagnosis rates are rising, thanks in part to advances in research and a broader understanding of its clinical presentation. This article provides a comprehensive overview of the symptoms, types, causes, and treatment options for eosinophilic gastritis, synthesizing evidence from recent scientific studies.

Symptoms of Eosinophilic Gastritis

Eosinophilic gastritis can present with a range of gastrointestinal symptoms that often overlap with other digestive diseases, making diagnosis challenging. Understanding the core symptoms is crucial for timely recognition and management.

Symptom	Description	Prevalence/Notes	Source(s)
Abdominal Pain	Persistent or recurrent pain	Most common symptom in EG and EGIDs	1 3 4 5
Nausea	Feeling of sickness	Frequently reported, often with vomiting	1 3 4 5
Vomiting	Expelling stomach contents	Particularly common in children	1 3 4 5
Bloating	Sensation of fullness	Common, sometimes with visible distension	4
Early Satiety	Fullness after small meals	Reduces appetite and food intake	4
Diarrhea	Loose or frequent stools	Less common, but seen especially in EGE overlap	4 5
Loss of Appetite	Reduced desire to eat	Can contribute to weight loss	4 5

Table 1: Key Symptoms

Abdominal Pain and Discomfort

Abdominal pain is the hallmark symptom of eosinophilic gastritis, reported by the majority of patients. The pain can be intermittent or persistent, varying in intensity from mild to severe. It often leads to significant distress and may be mistaken for more common gastrointestinal problems like gastritis of other causes, irritable bowel syndrome, or peptic ulcers. Pain may be localized to the upper abdomen and can worsen after eating 1 3 4 5.

Gastrointestinal Symptoms: Nausea, Vomiting, and Bloating

Nausea and vomiting are frequently observed, especially in children and adolescents. These symptoms can be severe enough to interfere with daily activities and nutrition. Bloating and a feeling of fullness (early satiety) are other common complaints, sometimes leading to visible abdominal distension. These symptoms are not specific to EG but often prompt further evaluation when persistent 1 4 5.

Appetite Changes and Weight Effects

Loss of appetite is reported by many patients, sometimes resulting in unintended weight loss. Early satiety—feeling full quickly after starting a meal—also contributes to reduced food intake 4 5. In severe cases, ongoing symptoms can lead to malnutrition.

Diarrhea and Overlapping Symptoms

While diarrhea is less common in isolated eosinophilic gastritis, it becomes more prevalent in patients with overlapping eosinophilic gastroenteritis (EGE). The presence of diarrhea may indicate more extensive involvement of the gastrointestinal tract 4 5.

Persistent and Chronic Nature

A notable feature of EG is the persistence of symptoms even after diagnosis and during treatment. Many patients continue to experience symptoms such as abdominal pain, diarrhea, and vomiting, highlighting the chronic and relapsing nature of the disease 5.

Types of Eosinophilic Gastritis

Eosinophilic gastritis is part of a broader group of eosinophilic gastrointestinal disorders (EGIDs). Within EG and related diseases, various subtypes and patterns exist, depending on the location and depth of eosinophilic infiltration.

Type	Defining Feature	Typical Presentation	Source(s)
Isolated EG	Eosinophilic infiltration in stomach only	Abdominal pain, nausea, vomiting	1 3 11
EG with Overlap	Involvement of other GI segments	Symptoms reflect multisite involvement	1 3 7
Mucosal Pattern	Infiltration limited to mucosa	GI symptoms, often less severe	10 16
Muscular Pattern	Involvement of muscle layers	Risk of obstruction, severe pain	10
Serosal Pattern	Involvement of outer GI layers	Ascites, more systemic symptoms	10

Table 2: Types and Patterns

Isolated vs. Overlapping Disease

• Isolated EG: Involvement is restricted to the stomach. Patients primarily experience upper gastrointestinal symptoms like pain, nausea, and vomiting 1 3.
• EG with Overlap: Frequently, eosinophilic inflammation extends to other parts of the GI tract, such as the esophagus or intestines. This is more common in children and leads to a broader range of symptoms, including diarrhea and malabsorption 1 3 7.

Histological Patterns

• Mucosal Pattern: The most common type, characterized by eosinophilic infiltration limited to the gastric mucosa. Symptoms are usually gastrointestinal, such as pain and nausea, but complications are less frequent 10 16.
• Muscular Pattern: Eosinophilic infiltration extends into the muscular layer of the stomach wall. This can cause thickening, reduced motility, and even mechanical obstruction, leading to severe pain, vomiting, or gastric outlet obstruction 10.
• Serosal Pattern: The rarest form, where the serosal (outermost) layer is involved. Patients may develop ascites (fluid in the abdomen) and more systemic signs, sometimes requiring hospitalization 10.

Disease Course Patterns

Depending on the individual, EG can follow a single flare, a recurring course, or a chronic persistent course. This variation underscores the heterogeneity of the disease and complicates management 12.

Causes of Eosinophilic Gastritis

The exact cause of eosinophilic gastritis remains incompletely understood. However, recent research has highlighted the interplay of immune, genetic, and environmental factors.

Factor	Role in Pathogenesis	Key Details / Associations	Source(s)
Atopy/Allergy	High co-occurrence	Up to 40% of patients have allergic diseases	1 2 7 9
Immune Response	Type 2 (Th2) inflammation	Involvement of IL-4, IL-5, IL-13, and eotaxins	9 13 16
Genetics	Likely polygenic susceptibility	Family and population studies suggest predisposition	9 12
Environmental	Diet and microbiome factors	Food antigens and dysbiosis implicated	3 12
Secondary Causes	Excluded for diagnosis	Infections, drugs, and malignancy must be ruled out	6 9 11 16

Table 3: Key Causes and Risk Factors

Allergic and Atopic Associations

A significant proportion of patients with eosinophilic gastritis have a personal or family history of atopy, including asthma, eczema, or food allergies. This suggests an allergic or hypersensitivity component as a driving force behind the disease 1 2 7 9.

Immune Pathways and Inflammatory Mediators

• Type 2 Immune Response: EG is characterized by a predominance of type 2 (Th2) immune responses. Elevated levels of cytokines such as IL-4, IL-5, and IL-13, as well as chemokines like eotaxin, are commonly found in gastric tissue, driving eosinophil recruitment and activation 9 13 16.
• Cellular Players: Eosinophils, mast cells, and certain T-cell subsets play central roles in the inflammatory cascade, contributing to tissue injury and symptom generation 13 15.

Genetic and Environmental Contributors

• Genetics: Evidence points to a polygenic inheritance, with susceptibility determined by multiple genetic factors. Family clustering and higher rates in certain populations support this 9 12.
• Dietary and Microbiome Factors: Food antigens are believed to trigger immune responses in susceptible individuals. Changes in the gut microbiome may also modulate disease activity 3 12.

Exclusion of Secondary Causes

Diagnosis of EG requires ruling out other known causes of gastrointestinal eosinophilia, such as:

• Parasitic infections
• Drug reactions
• Malignancies
• Hypereosinophilic syndromes

Only primary (idiopathic) cases are classified as EG 6 9 11 16.

Treatment of Eosinophilic Gastritis

Managing eosinophilic gastritis can be complex, with no universally agreed-upon guidelines. Current approaches combine dietary, pharmacologic, and, in rare cases, procedural interventions.

Treatment	Mechanism/Approach	Benefits / Limitations	Source(s)
Dietary Therapy	Elimination of trigger foods	May reduce symptoms, limited efficacy	2 3 10 12 16
Corticosteroids	Systemic or topical anti-inflammatory	Mainstay, effective but side effects	2 5 8 10 16
Biologics/Novel	Targeted immune modulation	Promising results, under investigation	14 15 17
Supportive Care	Symptom management, nutrition	Essential for quality of life	5 10 12
Surgery	For severe complications only	Avoided if possible	10

Table 4: Treatment Approaches

Dietary Therapy

• Food Elimination: Since food allergens are implicated in many cases, elimination diets (removing common triggers such as milk, soy, wheat, eggs, nuts, and seafood) are often tried first, particularly in children. However, complete symptom resolution is uncommon, and strict diets are difficult to maintain long-term 2 3 10 12 16.
• Elemental Diets: Rarely, elemental (amino acid-based) diets may be used when multiple food allergies are suspected, but compliance is challenging.

Pharmacologic Therapy

• Corticosteroids: Systemic corticosteroids (e.g., prednisone) are the mainstay of treatment, rapidly reducing inflammation and symptoms. Topical (enteric-coated) steroids like budesonide are alternatives with potentially fewer systemic side effects. However, long-term steroid use is associated with significant adverse effects, and many patients relapse when steroids are withdrawn 2 5 8 10 16.
• Other Immunomodulators: Limited case reports suggest possible benefit from leukotriene inhibitors, mast cell stabilizers, and anti-IgE agents, but robust data are lacking 16.
• Biologic Therapies: Newer therapies targeting specific immune pathways are in clinical trials. For example, anti-Siglec-8 antibody (lirentelimab/AK002) has shown marked reductions in eosinophil counts and symptoms in early studies, offering hope for more targeted and safer long-term management 14 15. Vedolizumab, an anti-integrin antibody, may also reduce steroid dependency and improve outcomes in steroid-refractory cases 17.

Supportive and Symptom-Based Care

Management often includes nutritional support, hydration, and pain control. For patients with severe disease or nutritional compromise, dietitian involvement is important 5 10 12.

Procedural and Surgical Interventions

Surgery is rarely needed and is reserved for complications such as gastric outlet obstruction or severe bleeding. Most patients are managed medically 10.

Challenges and Future Directions

Despite available treatments, many patients continue to experience persistent symptoms, underscoring the need for better diagnostic criteria, disease awareness, and novel therapies 5 14. Ongoing research into the immunologic and genetic underpinnings of EG promises to expand future treatment options.

Conclusion

Eosinophilic gastritis is a complex disorder involving allergic, immune, and environmental processes, with variable presentation and often chronic, persistent symptoms. Although advances in understanding and treatment are being made, significant challenges remain in diagnosis and management.

Key points:

• EG presents with non-specific but often severe gastrointestinal symptoms, primarily abdominal pain, nausea, and vomiting.
• Multiple types exist, including isolated stomach involvement and multisite disease, each with distinct clinical implications.
• The disorder is closely linked to atopy, food allergies, and type 2 immune responses, but its exact causes remain under investigation.
• Diagnosis requires biopsy-proven eosinophilia and exclusion of other causes.
• Treatment typically starts with dietary modifications and corticosteroids, with emerging biologic therapies showing promise.
• Many patients endure a lengthy diagnostic process and ongoing symptoms, highlighting the need for improved disease awareness, standardized diagnostic criteria, and new therapeutic strategies.

With ongoing research and increased recognition, there is hope for better outcomes for individuals living with eosinophilic gastritis.