Eosinophilic Gastritis: An Imposter of Gastric Malignancy

Abstract

Introduction: Eosinophilic gastroenteritis (EGE) is an uncommon condition characterized by eosinophilic infiltration into the lining of the GI tract with a predilection for the stomach and proximal small bowel. Symptoms are non-specific, and the disease is known to take a chronic, relapsing/remitting course. To date, approximately 300 cases are described in literature. Here, we present a case of EGE closely mimicking gastric malignancy. Case Description: A 57-year-old male with a past medical history of DM II, HTN, GERD, and ESRD was admitted to the hospital with 30 lbs weight loss, postprandial fullness, and intractable vomiting. Physical examination showed moderate tenderness to deep palpation in the upper abdomen. CT scan revealed gastric outlet obstruction from an incidental finding of gastric antrum mass. An EGD was performed and revealed a malignant appearing mass in the pre-pyloric region of the stomach. Biopsies showed peptic duodenitis without any evidence of malignancy or H. Pylori infection. After a multi-disciplinary discussion, the decision was made to perform diagnostic laparoscopy, followed by gastrojejunostomy, for the gastric outlet obstruction. Discussion The pathogenesis of EGE is not well understood. Available evidence suggests that it is a hypersensitivity reaction. Histopathological analysis can confirm the diagnosis. Eosinophilic infiltration can involve any layer of the stomach (mucosa, muscularis propria, or serosa), which impacts clinical presentation. The treatment is primarily based on dietary modifications and systemic steroids. In conclusion, eosinophilic gastroenteritis should remain on the differential diagnosis in appropriate clinical cases where the diagnosis of cancer is unclear.