A 51-year-old man visited our outpatient department. He complained of nausea and epigastric pain which had sustained 3 to 4 days before admission, and aggravated from 24 hr before visit. He had no specific relevant history of hypertension, diabetes or allergic diseases. Physical examination revealed soft abdomen, mildly tender epigastrium but no rebound tenderness and abnormal mass-like lesions. We prescribed antacids and mucosal protecting agents for symptomatic care. Gastric endoscopy was performed 5 days after presentation. Endoscopy revealed a 2 cm sized submucosal tumor-like lesion with turtle back-like change, at the antrum of the stomach. Two similar lesions were found at the antrum and greater curvature (Figs. 1A, 1B). A biopsy revealed severe eosinophilic infiltrations and inflammation (Fig. 2A). History taking revealed eating of raw anchovy before the symptom onset. Considering the history of eating raw fish, the symptom pattern, endoscopic and histopathologic findings, we suspected the submucosal tumor-like lesion as being caused by anisakiasis and prescribed albendzole. Two months later, follow-up examination revealed that the submucosal tumors at the antrum reduced in size (Figs. 1C, 1D), and eosinophilic infiltrations in the biopsy specimen were remarkably reduced (Fig. 2B). Laboratory data showed white blood cell count of 7,700 × 10³/µL, eosinophils 4.3% and total IgE of 439 IU/ml. Two mo later, endoscopy revealed a further reduction in the size of the submucosal tumor-like lesions (Figs. 1E, 1F).

A 45-year-old man complained of abdominal pain and loose stools which had persisted 3 to 4 times a day but without bloody or mucoid diarrhea, fever, or myalgia. His medical history showed no evidence of any specific disease. Physical examination showed stable vital signs. Abdominal epigastric tenderness was presented without rebound tenderness. We prescribed antacids and mucosal protecting agents for conservative management and gastric endoscopy was performed. Endoscopy showed a submucosal tumor-like lesion with yellowish surface at the proximal part of the antrum in the stomach. Some lesions showed erosions and hard surface consistency (Fig. 3A). A biopsy finding revealed severe gastritis with eosinophilic infiltrations. History taking revealed eating of raw sea eels and ascidians before the symptom onset. Laboratory data showed white blood cell count of 13,920 × 10³/µL, and eosinophils 12.8%. Considering his history, laboratory test results, and endoscopic and pathologic findings, a submucosal tumor-like lesion caused by anisakid larval infection was suspected. We prescribed albendazole and 2 months later performed a follow-up endoscopy which showed a decrease in size and scarring corresponding to the location of the previous submucosal lesion at the anterior wall of the antrum (Figs. 3B, 3C). A biopsy showed reduced eosinophilic infiltrations and laboratory test showed that white blood cell counts reduced to 7,700 × 10³/µL, with eosinophils at 9.6%.

A 56-year-old woman visited our outpatient department, complaining of nausea and vomiting, which occurred 1 week previously. She had received medication at local clinic for several days. Endoscopy showed a submucosal tumor-like lesion at lesser curvature of the stomach and a biopsy showed chronic gastritis with severe eosinophilic infiltrations. She had eaten a raw flatfish 2 days ago. In laboratory tests, her white blood cell count was 6,530 × 10³/µL, with eosinophils 9.9%, and her total IgE was more than 2,000 IU/ml. We suspected gastric anisakiasis, and prescribed albendazole. Two mo later, gastric endoscopy was performed and showed reduced mucosal erosion at the lower body of the stomach and a decrease in size of the submucosal lesion. A biopsy showed a reduced eosinophilic infiltration, and laboratory test showed white blood cell count of 5,490 × 10³/µL and eosinophils 3%. Five mo after presentation, a second follow-up endoscopy revealed that the submucosal lesion disappeared. At this time, her white blood cell count was 3,900 × 10³/µL, with eosinophils 3%.

A 52-year-old woman complained of epigastric pain from 3 to 4 days before admission. Several days before she consumed raw sea eels and took a pain-killer. Endoscopy was performed 6 days after the symptom onset, and showed erosion, ulceration, and a submucosal elevated lesion at the antrum of the stomach. The CLO test was positive, and a biopsy showed chronic gastritis with eosinophilic infiltrations. Laboratory examination showed white blood cell count of 9,880 × 10³/µL with eosinophils 9.2%. Clinically we suspected gastric anisakiasis, and prescribed medications only for symptomatic managements. Two months later, she was followed-up by endoscopy which showed scarring at the previous erosion. Biopsy showed reduced eosinophilic infiltrations. Gastric anisakiasis was suspected and albendazole was prescribed.