Eosinophilic Gastritis – A case report

Background: Eosinophilic gastritis is a rare chronic inflammatory disorder characterized by an eosinophilic infiltration of various layers from mucosa to serosa in the stomach wall, with peripheral eosinophilia, in the absence of any known cause for eosinophilia. It presents with varying symptoms depending on the layer of the stomach wall involved. Mucosal involvement presents with chronic dyspeptic symptoms whereas muscular involvement can presents with obstructive suomptoms masquerading as gastric neoplasms. We describe a patient with isolated eosinophilic gastritis who presented with dyspeptic symptoms. Although it has been reported elsewhere, this is the first such case to be reported from a Sri Lanka. Case presentation: A 20 year old male presented with a history of epigastric burn and regurgitation for three weeks which was not related to meals without any other gastro intestinal symptoms. He poorly responded to different acid suppression medications. The examination was unremarkable except for mild epigastric tenderness. His full blood count revealed an eosinophilia (White blood cells-14 000/mm with 53% of Eosinophils) with normal haemoglobin and platelets. The upper gastro intestinal endoscopy revealed areas of erythema and oedema in the stomach and was otherwise unremarkable up to the second part of duodenum. Gastric biopsy showed scattered areas of inflammatory infiltrate in the lamina propria with an eosinophil predominance; having 24 eosinophils per high power field. He was treated with prednisolon along with montelukast and he had a marked symptomatic improvement within a month. Conclusion: The aim of reporting this case is to make the physicians aware of this disease entity which should be included in the differential diagnosis when patients present with dyspeptic symptoms specially if there is no response to acid suppression. This is also to emphasize the necessity of research work to explain the aetiology and pathophysiology of eosinophilic gastritis as infective aetiological reason is possible in the tropics in particular.