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# Uncommon gastritis: eosinophilic, lymphocytic and granulomatous

- Lesion

Some gastritis is caused by allergy, by lymphocytes linked to coeliac disease, or by granulomas from Crohn disease, sarcoid or infection.

Updated Nov 12, 2026

## Key points

- Eosinophilic gastritis: dense eosinophils in mucosa and muscle, usually antrum or pylorus; allergy (cow milk and soy in children), parasites, systemic sclerosis, H. pylori; peripheral eosinophilia and high IgE.
- Lymphocytic gastritis: many intraepithelial T lymphocytes; mostly adult women; about two in five are linked to coeliac disease; varioliform endoscopic look.
- Granulomatous gastritis: any gastritis with granulomas; in Western series Crohn disease first, then sarcoidosis and infections (mycobacteria, fungi, CMV, H. pylori).
- Transmural granulomatous inflammation can narrow and stiffen the antrum.

## What it is

Beyond H. pylori, NSAIDs and autoimmunity, three patterns are recognized by the cells that dominate the biopsy. Each points to a different underlying disease, so the pathologist's label leads the clinician to the next test.

## Three uncommon gastritides

| Pattern | Key cell | Where | Look for |
| --- | --- | --- | --- |
| Eosinophilic | Eosinophils in mucosa and muscularis | Antrum and pylorus | Food allergy, parasites, connective tissue disease |
| [Lymphocytic](https://durgical.com/en/conditions/coeliac-disease/) | Intraepithelial T lymphocytes | Whole stomach; thick folds with tiny aphthous nodules (varioliform) | Coeliac disease |
| [Granulomatous](https://durgical.com/en/conditions/crohn-disease/) | Epithelioid granulomas | Often antrum | Crohn disease, sarcoidosis, tuberculosis and fungi |

## Clinical notes

- A granuloma in a gastric biopsy should prompt stains for acid-fast bacilli and fungi; in Colombia tuberculosis and histoplasmosis are on the list.
- Lymphocytic gastritis should prompt serology for coeliac disease.

## Memory aid

Eosinophils say allergy, lymphocytes say coeliac, granulomas say Crohn, sarcoid or a microbe.

## Test yourself

Think of the answer, then tap the question to see it.

## Which disease is linked to a large share of lymphocytic gastritis?

Coeliac disease, in about two of every five cases.

## What is the most common specific cause of granulomatous gastritis in Western populations?

Crohn disease, followed by sarcoidosis and infections.

## Which allergens most often cause eosinophilic gastritis in children?

Cow milk and soy proteins.

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## Elsewhere in DurgiPedia

- [Eosinophil](https://durgical.com/en/immunology/eosinophil/)

## Connections

## Related 5

- [Helicobacter pylori gastritis](https://durgical.com/en/general-pathology/helicobacter-pylori-gastritis/)
- [Eosinophilic oesophagitis, and how it differs from reflux](https://durgical.com/en/general-pathology/eosinophilic-oesophagitis-and-how-it-differs-from-reflux/)
- [Coeliac disease](https://durgical.com/en/general-pathology/coeliac-disease/)
- [Crohn disease](https://durgical.com/en/general-pathology/crohn-disease/)
- [Granulomatous inflammation: caseating vs non-caseating, the causes to know](https://durgical.com/en/general-pathology/granulomatous-inflammation-caseating-vs-non-caseating-the-causes-to-know/)

## Related conditions 5

- [Crohn disease](https://durgical.com/en/conditions/crohn-disease/)
- [Sarcoidosis](https://durgical.com/en/conditions/sarcoidosis/)
- [Coeliac disease](https://durgical.com/en/conditions/coeliac-disease/)
- [Helicobacter pylori gastritis](https://durgical.com/en/conditions/helicobacter-pylori-gastritis/)
- [Tuberculosis](https://durgical.com/en/conditions/tuberculosis/)

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Helicobacter Pylori](https://www.ncbi.nlm.nih.gov/books/NBK534233/) (StatPearls (NCBI Bookshelf), 2025); [Crohn Disease](https://www.ncbi.nlm.nih.gov/books/NBK436021/) (StatPearls (NCBI Bookshelf), 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/uncommon-gastritis-eosinophilic-lymphocytic-and-granulomatous/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/uncommon-gastritis-eosinophilic-lymphocytic-and-granulomatous/