Eosinophilic infiltration of the stomach and bowel.

Infiltration of various organs, notably the lung, has been recognized as an allergic manifestation since Loeffler (1932) first described his syndrome, the main features of which were: i. Recurring mild afebrile illness with minimal physical signs. 2. Slight and transient infiltration of the lung fields noted on chest X-ray. 3. Variable and inconstant eosinophilia in the blood picture. Kaijser (I937) reported a case in which the most significant findings were an infiltration causing thickening of the pyloric end of the stomach, eosinophilia in the blood picture and marked allergic sensitivity to onions. Herrera and de la Guardia (1948) reported a similar case in which operation was undertaken for pyloric obstruction. Although no blood eosinophilia was noted before the operation it became a marked feature later. In the same year Barrie and Anderson described a case of a woman aged 27 who developed pyloric obstruction due to concentric hypertrophy of the muscular coats of the stomach, pylorus and duodenum with massive eosinophilic infiltration of the pylorus. The patient was allergic to certain foods and had a constant blood eosinophilia. Moloney (949) reported a case of hypertrophy of the muscle coats of the pylorus with eosinophilic infiltration, but in this case there was no evidence of allergy. Vanek (I949) reported a series of six patients with thickening of the gastric submucosa due to eosinophilic infiltration, none of whom gave a history of allergy or of blood eosinophilia. In some reported cases, obstruction developed only after years of gastro-intestinal upset, as in the case recorded by Spencer, Comfort and Dahlin (I950), when a man aged 40 complained of epigastric and lower abdominal cramps with diarrhoea and vomiting recurring over a period of years. Pyloric obstruction was finally diagnosed and at operation a thickening of stomach, duodenum and proximal jejunum was found. A resection was carried out and microscopical examination -of the specimen revealed sheets of mature eosinophils lying between the muscle layers ofthe stomach and bowel. Eosinophilic infiltration of serous and submucosal layers was less marked. The only case recorded in the literature, so far, of jejunal infiltration without involvement of the stomach was reported by Polayes and Krieger, I950. One of the most complete and recently recorded cases is that of a male patient aged 55, described by Ruzic, Dorsey, Huber and Armstrong (I952). This patient suffered from a pyrexial illness associated with asthma. He complained of lower abdominal tenderness and his blood picture revealed eosinophilia. A barium meal examination revealed a filling defect of the lesser curvature of the stomach. Chest X-rays showed apical thickening suggestive of tubercle but Koch's bacilli were never found. At operation the stomach wall was found thickened from cardia to pylorus. No other organs were involved. Inspection of the interior of the stomach revealed no lesion of the mucosa. Histologically the biopsy specimen showed a chronic inflammatory process around the vascular channels in the submucosa, muscularis and serosa. The inflammatory reaction was most marked in the serosal zone and consisted of perivascular infiltration of lymphocytes, macrophages, giant cells and a fairly large number of eosinophils. We have had the opportunity of investigating two such cases by laparotomy, biopsy, blood examination and skin sensitivity tests. One of these is of special interest in that four abdominal explorations were carried out over a period of as many years. On each occasion the area of involvement differed and on the final exploration the condition was found to be completely quiescent.