Eosinophilic Gastroenteritis

Overview

Eosinophilic gastrointestinal disorders (EGIDs) are rare conditions that affect the gastrointestinal (GI) tract. EGIDs can occur in infants, children, and adults. They are often identified by irregular food-related reactions. This occurs with a high number of eosinophils in the GI tract. Eosinophils are white blood cells linked with allergic-type reactions. Their exact role is not known, but they are part of the body’s immune response. These cells release toxins that are harmful to the body. Inflammation occurs when these are active, which causes redness and swelling.

Some common symptoms of EGIDs include nausea, vomiting, poor growth/malnutrition and abdominal pain.

EGIDs can occur in any area of the GI tract and are named to match the organs affected. People with EGID’s may have more than one of these disorders

  • Eosinophilic Esophagitis (EoE): high numbers of eosinophils occur in the esophagus. The esophagus is the muscular tube that passes food from the mouth to the stomach. This is the most common EGID.
  • Eosinophilic Gastritis (EG): high numbers of eosinophils occur in the stomach.
  • Eosinophilic Gastroenteritis (EGE): high numbers of eosinophils occur in both the stomach and small intestine.
  • Eosinophilic Colitis (EC): high numbers of eosinophils occur in the large intestine (colon)

Testing for EGID’s

Testing is always completed to confirm a diagnosis. Either an upper endoscopy or colonoscopy will be done to do so. The test chosen depends on the area of the GI tract being looked into.

  • An endoscopy is a simple test that does not involve cutting into the body. A physician using a long flexible tube called an endoscope. It is placed into the mouth, down the esophagus, and into the stomach and beginning of the small intestine. This tube has a camera and light on the end. This tool allows your physician to see inside your GI tract during the test.
  • A colonoscopy is a similar test that examines the lower portion of the GI tract. This flexible tube is inserted through the anus, into the rectum and large intestine

These tests are important throughout treatment of EGID’s after the original diagnosis. They may be repeated to check the disease progress. This makes it easier to track if the disease is worsening or getting better. Regular testing will show if treatment is working or may need changed.

Eosinophilic Esophagitis (EoE)

This EGID occurs within the esophagus. Eosinophils gather in the esophagus, causing redness, swelling, and damage

Symptoms of EoE

  • Reflux – a burning feeling in the esophagus (that does not respond well to acid controlling medication)
  • A hard time swallowing
  • Food getting stuck in the esophagus
  • Nausea – a feeling of sickness with an urge to vomit
  • Vomiting – bringing food back up from the stomach
  • Poor growth or malnutrition (a lack of proper nutrient intake)
  • Abdominal or chest pain – pain varying from dull to sharp that occurs inside the stomach, intestines, or chest
  • Poor appetite or refusing to eat
  • Problems sleeping in children (often because of the symptoms listed above)

Diagnosing EoE

A healthcare provider may also do tests to see if other conditions might be causing symptoms.

Gastroesophageal Reflux Disease (GERD) has many symptoms similar to those of EoE. GERD is a common condition where patients feel burning in their chest and throat.

An upper endoscopy is done to look for visible signs of EoE. Biopsies are taken to confirm an EoE diagnosis. The endoscopy will show any damage, inflammation, or thickening of the esophagus wall. The biopsy is reviewed to find the number of eosinophils in the tissue sample. Biopsies are especially important in EoE testing because about 20% of people with EoE can have an endoscopy that appears normal.

Treatment for EoE

Treatment of all EGIDs vary from person to person. The symptom severity and other conditions play a role in building a treatment plan.

  • Dietary restrictions are one of the most common treatment options for EoE. Food allergy testing may be used to find foods that are causing the increase in eosinophils. The results of this test are then used to develop restriction diets. This type of diet is used to find and eliminate foods that cause symptoms.
    • IFFGD’s Dietitian Listing is a resource that allows you to search for a dietitian that is in your area or treats a specific condition.
  • Drugs are also a common treatment option for EoE. Some drugs that helps treat EoE are
    • Topical or systemic corticosteroids to ease symptoms. These drugs can cause long or short-term symptom improvement. Topical and systemic corticosteroids are man-made drugs. They mimic the hormones naturally found in the body. This can help to control tasks in the body when there are not enough hormones present. One important task of these hormones is to minimize swelling.
    • Proton pump inhibitors (PPIs) are used for people who have reflux symptoms. Reflux occurs when there is burning feeling in the throat or chest. PPI’s affect the glands in the stomach to reduce the amount of acid they produce.
  • Some people with EoE will sometimes feel food getting stuck in their throat. A healthcare provider might suggest dilating the throat to resolve this symptom. This procedure involves inserting a tube or balloon into the narrowed portion of the throat. The tube or balloon then expands to stretch out the muscle.

Eosinophilic Gastritis (EG) and Eosinophilic Gastroenteritis (EGE)

EG occurs within the stomach. EGE occurs within both the stomach and small intestine. Eosinophils accumulate in these organs, causing redness, swelling, and injury to the tissue there. EG and EGE are most diagnosed in adults from 30 to 50 years of age. Like all EGIDs, EG and EGE can occur at any age.

Symptoms of EG and EGE

  • Nausea – a feeling of sickness with an urge to vomit
  • Vomiting – bringing food back up from the stomach
  • Difficulty eating and/or weight loss
  • Poor growth (more common in infants and children)
  • Abdominal pain – dull to sharp pain that occurs inside the belly, commonly in the stomach or intestines
  • Anemia – low blood counts
  • Fatigue – feeling low energy, overly tired

Diagnosing EG and EGE

The diagnosis of either EG or EGE is confirmed by an upper endoscopy. Biopsies are taken from the esophagus, stomach, and small intestine. A high number of eosinophils suggests a diagnosis of EG or EGE

Treatments for EG and EGE

Treatment of EG and EGE depends on how severe each person’s symptoms are. The treatment goal is to reduce the damage, redness, and swelling caused by the disease. A healthcare provider will consider any other drugs the patient is taking.

  • Dietary restrictions is one of the most common ways to treat EG and EGE. Food allergy testing may still be used to see if foods are causing the increase in eosinophils. The results of this test are then used to develop restriction diets. This type of diet is used to find and eliminate foods that cause symptoms.
  • Drugs may be used to treat EC. Systemic corticosteroids or other anti-inflammatory drugs to reduce pain, swelling, and redness (such as ibuprofen or naproxen sodium) may be prescribed. 

Eosinophilic Colitis (EC)

EC occurs when eosinophils gather in the large intestine (colon).  This causes redness, swelling, and damage in the intestines.

Symptoms of EC

Infants with EC may have bloody diarrhea. In some cases, this can lead to weight loss, difficulty feeding, and not taking in enough nutrients. Symptoms may be worsened by proteins in cow’s milk.

Both children and adults may experience the following symptoms:

  • Bloody diarrhea – passing of loose stools that contain blood, blood may be bright red to dark black in color
  • Anemia – low blood counts
  • Nausea – a feeling of sickness with an urge to vomit
  • Vomiting – bringing food back up from the stomach
  • Difficulty feeding and/or gaining weight
  • Poor growth and weight loss
  • Malnutrition – not taking in enough nutrients
  • Abdominal pain – dull to sharp pain that occurs inside the belly, commonly in the stomach or intestines
  • Fatigue – feeling low energy, overly tired

Diagnosis of EC

EC is most common in infants under 6 months of age. However, children and adults may develop this condition. The diagnosis is confirmed by a colonoscopy. During this test, a biopsy is taken from the large intestine. A high number of eosinophils suggests EC. High levels of eosinophil can also be seen in other conditions such as celiac disease and inflammatory bowel disease (IBD).  It is important to discuss the results and well as your symptoms thoroughly with your healthcare provider.

Treatment for EC

Treatment of EC is based on each person’s symptom severity. The goal is to reduce damage, redness, and swelling in the large intestine. Symptom severity and other medical conditions will be considered to find the best treatment option.

  • Like other EGIDs, dietary restrictions may be used to treat EC. Food allergy testing may still be used to see if foods are causing the increase in eosinophils. The results of this test are then used to develop restriction diets. This type of diet is used to find and eliminate foods that cause symptoms.
  • Drugs may be used to treat EC. Systemic corticosteroids or other anti-inflammatory drugs to reduce pain, swelling, and redness (such as ibuprofen or naproxen sodium) may be prescribed.

Conclusion

For all people diagnosed with EGIDs, a treatment plan designed for each person is ideal.  Biopsies will be done throughout treatment to manage the disease and check if treatment is effective.  It is important to discuss all symptoms with a healthcare provider.  A full medical history helps provide an accurate diagnosis.  Successful treatment can only happen after a proper diagnosis.  Early Diagnosis is important to ensure the best symptom relief and overall health.  Building a healthcare team will ensure the best care and disease management.  This team may include a gastroenterologist, allergist, pathologist, dietitian, and any other relevant healthcare provider. 

More Information

More information can be found at the following websites:

Adapted from IFFGD Publication #580 “Eosinophilic Gastrointestinal Disorders By: Marissa Lombardi, Program Coordinator, IFFGD; Edited by: Nirmala Gonsalves MD, Professor of Medicine, Northwestern University – The Feinberg School of Medicine, Chicago, IL

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