Gastric motor dysfunction: is eosinophilic mural gastritis a causative factor?

Area of Science:

• Gastroenterology
• Gastrointestinal Motility Disorders
• Surgical Pathology

Background:

• Delayed gastric emptying, including gastroparesis, is a debilitating condition often unresponsive to medical treatment.
• Surgical interventions like fundoplication are sometimes employed for refractory gastro-oesophageal reflux disease, with variable outcomes.
• Profound gastric motor dysfunction can occur post-fundoplication, necessitating further surgical intervention.

Observation:

• Two patients developed severe gastric motor dysfunction after fundoplication for medically refractory gastro-oesophageal reflux.
• Histological examination of excised gastric tissue revealed eosinophilic mural gastritis in both cases.
• This represents the first reported association between mural eosinophilia and symptomatic gastric motor dysfunction.

Findings:

• Eosinophilic mural gastritis may be an underlying cause of severe gastric motor dysfunction in select patients.
• Surgical management of gastric motor dysfunction, including near-total gastro-oesophagectomy, provided symptomatic improvement in these cases.
• Early diagnosis of eosinophilic gastritis via mural biopsy could enable targeted medical therapy.

Implications:

• Consider laparoscopy and mural biopsy for patients with refractory gastric motor dysfunction before extensive surgery.
• Medical therapy targeting eosinophilic inflammation, such as leukotriene D4 receptor antagonists or corticosteroids, may be beneficial.
• This finding could lead to novel treatment strategies for debilitating gastric motility disorders.