Advances and Challenges in Pediatric Helicobacter pylori-Negative Eosinophilic Gastritis: From Th2-Driven Pathogenesis to Precision Medicine Management

Helicobacter pylori-negative eosinophilic gastritis (EoG) in children remains a diagnostic and therapeutic challenge due to heterogeneous presentation and lack of standardized management. Recent studies have elucidated a Th2-skewed immunopathogenesis driven by key cytokines (IL-5, IL-13) and epithelial-derived chemokines (eotaxin-3, TSLP), which orchestrate eosinophil recruitment and disrupt mucosal integrity. Multimodal diagnostic frameworks that combine quantitative histology (≥30 eos/HPF), high-resolution endoscopic assessment, and molecular biomarkers (e.g., EGDP18 transcript levels, serum TSLP) have enhanced both sensitivity and specificity. Current treatment strategies, including dietary elimination, corticosteroids, and emerging biologics, show variable efficacy and require individualized combination approaches based on severity, tolerability, and safety. However, the field still faces major limitations in standardized outcome metrics, long-term safety data, and guidance for personalized therapy. This review integrates current insights into pediatric EoG immunopathogenesis, diagnostic standardization, treatment paradigms, and translational obstacles, and outlines priorities for future research toward evidence-based, precision medicine strategies. Emerging biomarker panels and multi-omics approaches receive focus for refining patient stratification and monitoring therapeutic responses. Long-term safety assessments and multidisciplinary collaboration are emphasized as essential for advancing novel targeted therapies.