Eosinophilic Gastroenteritis and Eosinophilic Esophagitis
Eosinophilic gastroenteritis and eosinophil esophagitis are disorders of the upper gastrointestinal tract which involve
cells called eosinophils.   There is an abnormal accumulation of these cells  in the tissues of the stomach for eosinophilic
gastroenteritis and the esophagus for eosinophilic esophagitis.    These disorders used to be quite rare, but in the past
20 years have become increasingly common and can affect people of any age - from infants to older adults.  

Clinical Features
Common symptoms of eosinophilic gastroenteritis and eosinophilc esophagitis include:

  • Abdominal pain
  • Nausea and/or vomiting
  • Difficulties swallowing
  • Sensation of food getting stuck, or chocking, while eating
  • Heartburn
  • Poor appetite
  • Weight loss
  • Diarrhea

In some people, symptoms will be frequent and severe.   In others, symptoms may be infrequent and mild.   Individuals
with severe disease may also develop blood in their stool, poor growth, and swelling of the extremities.   Some patients
may complain of persistent, severe, symptoms of gastroesophageal reflux (heartburn)  which does not improve with
strong antacids.  About 75% of patients will have high levels of eosinophils in their blood.

What is the Cause of Eosinophilic Gastroenteritis and Eosinophilic Esophagitis?
Unfortunately, the exact cause is unknown.    What is known is that individuals affected with these disorders have a
high incidence of food allergies and seasonal allergies.  In many affected individuals, avoiding certain foods can
dramatically help improve the condition.

In order to make the diagnosis of eosinophilic esophagitis and eosinophilic gastroenteritis, one needs a history
consistent with the disease along with the presence of abnormally high numbers of eosinophils in the wall lining of the
gastrointestinal tract.   This is done by a gastroenterologist performing an endoscopy - a test where a small scope is
inserted through the mouth to take a look at the esophagus and stomach.

As foods are thought to be one of the causes of these disorders,  an evaluation for food sensitivities should be
undertaken.  The International Gasterointestinal Eosinophil Research Symposyium recommends
skin testing for the
evaluation of food allergies in eosinophilic esophagitis/gastritis as the blood test lacks sensitivity/specificity.  An
avoidance diet should then be done based on the test results. The 2 most common foods identified are cow milk and
wheat but just about any food can result in eosinophilic esophagitis - even salad!  Skin testing for environmental
allergies can also be done to check for seasonal allergies if the symptoms are seasonal.

Unfortunately, selected food avoidance does not work for everybody.    In severe cases, a very basic diet may be
required. In adults and older children, the complete elimination of peanut, soybean, cow milk, egg, wheat, and seafood
has been shown to be helpful.  In infants, an "elemental" diet can be tried.  This involves using formulas such as Elecare
or Neocate 1+.

When dietary restrictions do not work, medications called steroids can be used.  This is most commonly done by using
inhaled steroids used for asthma - but instead of breathing the medication into the lungs, it's swallowed.  These are
often effective, but symptoms can return when the medications are stopped, so it's important to try to figure out what is
causing the problem.  Other medications that can be tried include cromolyn sodium and Singulair.  

Check out the
American Partnership For Eosinophilic Disorders for more information on Eosinophilic Esophagitis and
Eosinophilic Gastroenteritis.  

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