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A 24-year-old man was diagnosed with eosinophilic gastritis. Eosinophilic gastritis is inflammation of the stomach involving the infiltration of eosinophils, a type of white blood cell. The patient was admitted to the hospital with nausea and stomach pain after undergoing treatment for a hernia. He had been treated for asthma with corticosteroid drugs since childhood and ha experienced occasional difficulty in swallowing and nausea, vomiting and abdominal pain after meals for a number of years. Examination of the patient's gastrointestinal tract did not reveal any abnormalities. A tissue biopsy from his gastrointestinal tract, however, showed that he had allergic eosinophilic gastritis that may have been caused by food allergies. He was treated with prednisone for two weeks, and maintained on oral cromolyn sodium. His symptoms subsided and he gained weight.

Context.--Most types of gastritis can be diagnosed on hematoxylin-eosin stains. The most common type of chronic gastritis is Helicobacter pylori gastritis. Reactive or chemical gastropathy, which is often associated with nonsteroidal anti-inflammatory drug use or bile reflux, is common in most practices. The diagnosis of atrophic gastritis can be challenging if few biopsy samples are available and if the location of the biopsies in the stomach is not known, such as when random biopsies are sampled in one jar. If the biopsy site is not known, immunohistochemical stains, such as a combination of synaptophysin and gastrin, are useful in establishing the biopsy location. Objective.--To demonstrate a practical approach to achieving a pathologic diagnosis of gastritis by evaluating a limited number of features in mucosal biopsies. Data Source.--In this article, we present several representative gastric biopsy cases from a gastrointestinal pathology practice to demonstrate the practical application of basic histopathologic methods for the diagnosis of gastritis. Conclusions.--Limited ancillary tests are usually required for a diagnosis of gastritis. In some cases, special stains, such as acid-fast stains, and immunohistochemical stains, such as for H pylori and viruses, can be useful. Helicobacter pylori immunohistochemical stains can particularly contribute (1) when moderate to severe, chronic gastritis or active gastritis is present but no Helicobacter organisms are identified upon hematoxylin-eosin stain; (2) when extensive intestinal metaplasia is present; and (3) in follow-up biopsies, after antibiotic treatment for H pylori., Gastritis refers to a group of diseases characterized by inflammation of the gastric mucosa. Histologic examination of gastric mucosal biopsies is necessary to establish a diagnosis of gastritis. In clinical [...]

To the Editor.-- Helicobacter pylori infection is usually contracted in early childhood, before the age of 5 years. (1) The infection causes chronic gastritis that is responsible in adulthood for [...]