First, many reviews of these diseases show that when eosinophils are high, they cause damage and irritation to the gastrointestinal tract. EoG affects all age groups. People with eosinophilic gastroenteritis often have a personal or family history of other allergic conditions such as allergic rhinitis, asthma, and eczema.

Definitive diagnosis

In adult patients

First, many reviews of these diseases show that when eosinophils are high, they cause damage and irritation to the gastrointestinal tract. EoG affects all age groups. People with eosinophilic gastroenteritis often have a personal or family history of other allergic conditions such as allergic rhinitis, asthma, and eczema.

The symptoms of EG/EoD are nonspecific and resemble those of a number of other diseases. This is one of the reasons why EG/EoD is not diagnosed easily and promptly and why some patients are initially misdiagnosed.

The gold standard for diagnosing EG/EoD is gastrointestinal endoscopy and tissue biopsy, which can be performed under anesthesia to obtain appropriate biopsy specimens. Together with the patient’s symptoms and medical history, it helps diagnose EG/EoD. Patients can access the diagnosis and apply appropriate clinical tests to make a final diagnosis.

Figure 1a. CT image shows ascites, paracentesis in the area of ​​colitis with increased BCAT

Talley et al proposed three diagnostic criteria for eosinophilic gastroenteritis that are still widely used today:

1.Presence of gastrointestinal symptoms;

2. Histopathology shows eosinophilic infiltration in one or more areas of the gastrointestinal tract or the presence of high levels of eosinophils in the ascitic fluid, which then usually shows a subserosal variety;

3. There is no evidence of parasitic infection or extraintestinal disease.

Eosinophilia is an important marker of immune response and may be absent in up to 20% of patients, but hypo albuminemia and other abnormalities are associated with malabsorption. CT scans may show nodular thickening of the distal stomach and proximal small bowel, but these findings may also be present in other conditions such as Crohn’s disease or lymphoma.

The endoscopic appearance of patients with eosinophilic gastroenteritis is also nonspecific; it includes images of partial ulceration, easy rupture, nodularity, and erythema. Sometimes there is diffuse inflammation, loss of intestinal villi, involving multiple layers of the digestive system mucosa, edema, and submucosal fibrosis.

Definitive diagnosis involves histopathological evidence of eosinophilic infiltration on biopsy specimens. Microscopic manifestations>20 BCATs/high power field. The infiltrate is often patchy, may be misleading, and endoscopic biopsy may be required to aid in diagnosis.

Radioisotope scanning with technetium (^99mTc) exametazime‐labeled leukocyte SPECT may be useful in assessing the extent of disease and response to treatment, but is of little diagnostic value, as the scan does not help differentiate eosinophilic gastritis from other causes of inflammation. When eosinophilic gastroenteritis is found to be associated with eosinophilic infiltration of other organs, the diagnosis is primary eosinophilic syndrome or idiopathic eosinophilic syndrome. (idiopathic hypereosinophilic syndrome) should consider.

Radiologically, eosinophilic gastritis usually involves the pylorus or antrum and body of the stomach simultaneously. However, the disease is rarely identified in the proximal part of the stomach. Barium scans may reveal nodular mucosa, thickened folds, or narrowing and induration of the gastric wall. Occasionally, severe antral stenosis may cause gastric obstruction. Approximately 50% of patients with eosinophilic gastritis also have small bowel involvement, manifesting as nodular formation and diffuse thickening of the gastric mucosa throughout the small bowel.

In pediatric patients

How to diagnose EoG in children? Experts in the field of pediatric nutrition diagnosis and treatment are designing methods with easy‐to‐understand, user‐friendly language and easy‐to‐use devices to help improve the condition. To diagnose children, we will:

• Perform a physical examination and review of complete medical records, including previous surgical procedures, blood tests, and allergy test results;
• Additional testing: Next steps may involve additional blood tests, allergy tests, and imaging.These diagnostic procedures will help clarify the clinical picture and the increased BCAT levels as well as any foods suspected of promoting this process.

Differential diagnosis

When a patient has eosinophilic gastroenteritis with increased pain and folds, the differential diagnosis should include bacterial antral gastritis. H. pylori, hypertrophic gastritis, Ménétrier’s disease, Zollinger‐Ellison syndrome, lymphoma, and other conditions involving more folds. Although rare, eosinophilic gastritis should be considered in patients with elevated peripheral blood eosinophil counts or a history of allergy.

When eosinophilic gastritis causes antral stenosis, the differential diagnosis to consider includes: gastric cancer with a jagged appearance. (scirrhous gastric carcinoma), due to digestion, radiation, Crohn’s disease and other granulomas involving the stomach such as sarcoidosis, tuberculosis and syphilis. In such cases, further tests and procedures may be recommended for a correct diagnosis.

When eosinophilic gastritis is suspected after upper gastrointestinal examination, a flexible endoscopy is needed to determine whether the small bowel is involved.

Treatment & Case Management

In adult patients