Eosinophilic Gastritis in a Child. How to Suspect? Diagnostic Criteria

Objective of the Review: To analyze current data on eosinophilic lesions of the stomach in children with the analysis of a clinical case.

Key points. Diseases of the gastrointestinal tract associated with primary tissue eosinophilia are a heterogeneous group of changes characterized by inflammation, with predominantly eosinophilic tissue infiltration in the absence of other known causes. Clinical manifestations of allergic inflammatory diseases of the gastrointestinal tract are most often nonspecific. Depending on the level of the lesion, eosinophils are distinguished: gastritis (EoG), enteritis, and colitis. In recent years, more and more attention of experts has been directed to research in this area, but so far there are no general epidemiological data on the prevalence of this pathology in the population, both adults and children.

Conclusion. Currently, there are no clear morphological criteria for diagnosing eosinophilic lesions of the stomach, small and large intestine in children, and clinical manifestations, especially in young children, are nonspecific. When making a diagnosis of EoG, it is necessary to take into account a family allergic history, a set of laboratory diagnostic data (eosinophilia in a clinical blood test and a high level of total IgE) and a morphological study of a biopsy of the gastric mucosa.

1. Pampura A.N. Diagnosis of food allergy in children: problems and ways of their solution. Russian Bulletin of Perinatology and Pediatrics. 2009; 4: 69–77. (in Russian)

2. Hill D.A., Spergel J.M. Atopic march: delayed and tested sensitivity. Ann. Allergic Asthma Immunol. 2018; 120(2): 131–7. DOI: 10.1016/j.anai.2017.10.037

3. Kornienko E.A., Moiseenkova Yu.A., Volkova N.L., Loboda T.B. Eosinophilic disorders of the gastrointestinal tract: clinical manifestations, diagnosis and treatment. Almanac of Clinical Medicine. 2018; 46(5): 482–96. (in Russian). DOI: 10.18786/2072-0505-2018-46-5-482-496

4. Hill D.A., Grundmeyer R.V., Ramos M., Spergel J.M. Eosinophilic esophagitis is a late minute allergic march. J. Allergy Clinic. Immunol. Pract. 2018; 6(5): 1528–33. DOI: 10.1016/j.jaip.2018.05.010

5. Ko H., Morotti R., Ershov O., Chehade M. Eosinophilic gastritis in children: clinical and pathological correlation, course of the disease and response to therapy. Am. J. Gastroenterol. 2014; 109(8): 1277 85. DOI: 10.1038/ajg.2014.166

6. Matsushita T., Maruyama R., Ishikawa N., Harada Y. et al. The number and distribution of eosinophils in the adult human gastrointestinal tract: a study and comparison of racial and environmental factors. Am. J. Surg. Pathol. 2015; 39(4): 521–7. DOI: 10.1097/PAS.0000000000000370

7. Caldwell J.M., Collins M.H., Stucke E.M., Putnam P.E. et al. Author information. Histologic eosinophilic gastritis is a systemic disorder associated with blood and extragastric eosinophilia, TH2 immunity, and a unique gastric transcriptome. J. Allergy Clin. Immunol. 2014; 134(5): 1114–24. DOI: 10.1016/j.jaci.2014.07.026

8. Collins M.H., Capocelli K., Yang G.-Yu. Eosinophilic gastrointestinal disorders pathology. Front. Med. 2018; 4: 261. DOI: 10.3389/fmed.2017.00261

9. Brenner E.J., Greenberg S.B., Chang N.S., Corder S.R. et al. Peripheral eosinophilia and hypoalbuminemia are associated with a higher biopsy diagnostic yield for eosinophilic gastroenteritis. Clin. Res. Hepatol. Gastroenterol. 2021; 45(5): 101746. DOI: 10.1016/j.clinre.2021.101746

10. Daidone А., Barbi Е., Villanacci V, Di Leo G. Severe anaemia after gastric biopsy in an infant with eosinophilic gastritis. It. J. Pediatr. 2019; 45: 69 DOI: 10.1186/s13052-019-0661-7

11. Pennelli G., Grillo F., Galuppini F., Ingravallo G. et al. Gastritis: update on etiological features and histological practical approach. Pathologica. 2020; 112: 153–65. DOI: 10.32074/1591-951X-163

12. Koutria E., Paterelib A., Nonia M., Gutiérrez-Junquerac C. et al. Distribution of eosinophils in the gastrointestinal tract of children with no organic disease. Ann. Gastroenterol. 2020; 33: 508–15. DOI: 10.20524/aog.2020.0518

13. Gupta N., Aggarwal A., Gupta R., Sule S. et al. The management of eosinophilic gastroenteritis. Scand. J. Gastroenterol. 2015; 50(11): 1309–14. DOI: 10.3109/00365521.2015.1049655

14. Chen M.J., Chu C.H., Lin S.C., Shih S.-C. et al. Eosinophilic gastro enteritis: clinical experience with 15 patients. World J, Gastroenterol. 2003; 9(12): 2813–16. DOI: 10.3748/wjg.v9.i12.2813

15. Prussin C. Eosinophilic gastroenteritis and related eosinophilic disorders. Gastroenterol. Clin. North Am. 2014; 43(2): 317–27. DOI: 10.1016/j.gtc.2014.02.013

16. Pineton de Chambrun G., Gonzalez F., Canva J.Y., Gonzalez S. et al. Natural history of eosinophilic gastroenteritis. Clin. Gastroenterol. Hepatol. 2011; 9(11): 950–6.e1. DOI: 10.1016/j.cgh.2011.07.017

17. Licari A., Votto M., D’Auria E., Castagnoli R. et al. Eosinophilic gastrointestinal diseases in children: a practical review. Curr. Pediatr. Rev. 2020; 16(2): 106–14. DOI: 10.2174/1573396315666191022154432

18. Zhang M., Li Y. Eosinophilic gastroenteritis: a state-of-the-art review. J. Gastroenterol. Hepatol. 2017; 32(1): 64–72. DOI: 10.1111/jgh.13463

19. Lucendo A.J., Serrano-Montalbán B., Arias Á., Redondo O. et al. Efficacy of dietary treatment for inducing disease remission in eosinophilic gastroenteritis. J. Pediatr. Gastroenterol. Nutr. 2015; 61(1): 56–64. DOI: 10.1097/MPG.0000000000000766

20. Foroughi S., Prussin C. Clinical management of eosinophilic gastrointestinal disorders. Curr. Allergy Asthma Rep. 2005; 5(4): 259–61. DOI: 10.1007/s11882-005-0062-4

21. D’Auria E., Mameli C., Piras C., Cococcioni L. et al. Precision medicine in cow’s milk allergy: proteomics perspectives from allergens to patients. J. Proteomics. 2018; 188: 173–80. DOI: 10.1016/j.jprot.2018.01.018

22. Lee J., Dierkhising R., Wu T.T., Alexander J. et al. Eosinophilic gastrointestinal disorders (EGID) with peripheral eosinophilia: a retrospective review at Mayo Clinic. Dig. Dis. Sci. 2011; 56(11): 3254–61. DOI: 10.1007/s10620-011-1754-3

23. Abou Rached A., El Hajj W. Eosinophilic gastroenteritis: approach to diagnosis and management. World J. Gastrointest. Pharmacol. Ther. 2016; 7(4): 513–23. DOI: 10.4292/wjgpt.v7.i4.513

24. Uppal V., Kreiger P., Kutsch E. Eosinophilic gastroenteritis and colitis: a comprehensive review. Clin. Rev. Allergy Immunol. 2016; 50(2): 175–88. DOI: 10.1007/s12016-015-8489-4

25. Iborra M., Alvarez-Sotomayor D., Nos P. Long-term safety and efficacy of budesonide in the treatment of ulcerative colitis. Clin. Exp. Gastroenterol. 2014; 7: 39–46. DOI: 10.2147/CEG.S34715

26. Ishido K., Tanabe S., Higuchi K., Sasaki T. et al. Eosinophilic gastroenteritis associated with giant folds. Dig. Endosc. 2010; 22(4): 312–5. DOI: 10.1111/j.1443-1661.2010.01012.x

27. Khan S., Orenstein S.R. Eosinophilic gastroenteritis: epidemiology, diagnosis and management. Paediatr. Drugs. 2002; 4(9): 563–70. DOI: 10.2165/00128072-200204090-00002

28. Schwartz D.A., Pardi D.S., Murray J.A. Use of montelukast as steroidsparing agent for recurrent eosinophilic gastroenteritis. Dig. Dis. Sci. 2001; 46(8): 1787–90. DOI: 10.1023/A:1010682310928

29. Friesen C.A., Kearns G.L., Andre L., Neustrom M. et al. Clinical efficacy and pharmacokinetics of montelukast in dyspeptic children with duodenal eosinophilia. J. Pediatr. Gastroenterol. Nutr. 2004; 38(3): 343–51. DOI: 10.1097/00005176-20040300000021

30. Daikh B.E., Ryan C.K., Schwartz R.H. Montelukast reduces peripheral blood eosinophilia but not tissue eosinophilia or symptoms in a patient with eosinophilic gastroenteritis and esophageal stricture. Ann. Allergy Asthma Immunol. 2003; 90(1): 23–7. DOI: 10.1016/S1081-1206(10)63609-5