Eric, I once spoke to Dr.Pennick about these stripings and she wasn’t sure of their significance as well. I will give you my take on it for what it is worth. When the muscle layering hypertrophies I think that there is more of an opportunity to see the contrasting connective tissue between muscle fiber bundles.  This is kind of like muscle marbling . Although it is fat that we are seeing in the muscles, the contrast gradient is similar in that of the muscularis. To me if it is truly fibrosis overtime we should see evidence of contractures that distort the muscularis outline.

Eric, I once spoke to Dr.Pennick about these stripings and she wasn’t sure of their significance as well. I will give you my take on it for what it is worth. When the muscle layering hypertrophies I think that there is more of an opportunity to see the contrasting connective tissue between muscle fiber bundles.  This is kind of like muscle marbling . Although it is fat that we are seeing in the muscles, the contrast gradient is similar in that of the muscularis. To me if it is truly fibrosis overtime we should see evidence of contractures that distort the muscularis outline. If you look at the video closer to the end of it you will see how organised and evenly dispersed the striping is. If you go back a few Forum cases to that of the hyperechoic densities in the muscularis you will see that the pattern is very different. These were the result of constant trauma caused by a FB being impacted on that portion of the gastric wall. In some very high resolution of the muscularis layering of the jejunum you can see a hyperechoic line that separates the longitudinal and circular muscle layers within the muscularis. This I believe is similar to what we are seen in the thickened gastric portion of the stomach wall. Interestingly enough, if and when I see this change in appearance to the stomach wall it is usually associate with food hypersensitivity , food allergies or chronic sub clinical pancreatitis.

Your point of endoscopic biopsies is very well taken. I too believe that there is little chance of capturing the true lesion. With similar lesion I actually measure their depth with respect to the surface of the gastric mucosa. I then compare it to the size of the cup from the biopsy forceps and see if it will even reach. In this case it would help differentiate lymphocytic plasmacytic gastritis over the more simpler eosinophilic flavor of the day. Does any of this make sense?