2759 Eosinophilic Gastritis Responding to Proton Pump Inhibitor

Abstract

INTRODUCTION: Eosinophilic gastritis is a rare condition that is part of a spectrum of gastrointestinal eosinophilic infiltration disorders which also includes eosinophilic esophagitis, enteritis, and colitis. They are characterized by excess eosinophils in the mucosal biopsy of one or more sites of the gastrointestinal tract in the absence of any specific causes of eosinophilia. Patients may present with symptoms including nausea, vomiting, abdominal pain, and weight loss. First-line of treatment is steroids. We describe a case of eosinophilic gastritis that was successfully treated with Proton pump inhibitor therapy. CASE DESCRIPTION/METHODS: A 23-year-old male presented to the outpatient clinic with a six-month history of episodic epigastric discomfort and retrosternal burning pain. Each episode lasted several hours and was precipitated by food intake. He had previously taken omeprazole 10 mg on and off for 4 weeks without any response. He had no history of any allergic disease. H.pylori stool antigen was negative. He was subsequently treated with four-week therapy of tricyclic anti-depressants with no response. Following this, he underwent upper gastrointestinal (UGI) endoscopy which showed mild erythema in the antrum. Gastric biopsy showed extensive eosinophilic infiltration with >50 cells/HPF in >5 HPF with normal esophageal and duodenal biopsy. Differential WBC count showed mild eosinophilia (7%). In line with a diagnosis of eosinophilic gastritis the patient was advised six food elimination which he refused. He was then started on Pantoprazole 40 mg once daily which was increased to twice daily after a week due to continued reflux symptoms. His symptoms gradually resolved over the next 12 weeks. On follow-up visit 3 months later he underwent repeat UGI endoscopy with biopsy which showed complete resolution of eosinophilic gastritis. The patient continues to remain asymptomatic. DISCUSSION: Eosinophilic gastrointestinal disorders can involve any part of the gastrointestinal tract from the esophagus to the colon. The antrum of the stomach is most commonly involved. There are no recognized guidelines for the treatment of eosinophilic gastritis, although steroid therapy is the mainstay of treatment. The role of PPI in the treatment of eosinophilic esophagitis is well known, but the utility of the same in eosinophilic gastritis has not been well defined. Our patient had symptomatic gastritis with biopsy revealing extensive eosinophilic infiltration. He responded excellently to 12-week pantoprazole therapy.