Eosinophilic Gastroenteritis and Eosinophilic Esophagitis
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Eosinophilic Gastroenteritis and Eosinophilic Esophagitis are disorders characterized by the presence of large numbers
of eosinophils in the tissues of the gastrointestinal tract (specifically the stomach for eosinophilic gastroenteritis and the
esophagus for eosinophilic esophagitis). First described in the late 1930’s, these disorders affect people of any age -
from infants to older adults. It appears that these disorders are becoming more frequent than they used to be. Over
half of affected patients will have a personal or family history of an allergic disorder such as food allergies, asthma,
atopic dermatitis, or environmental allergies.
Clinical Features
Common symptoms of eosinophilic gastroenteritis and eosinophilc esophagitis include:
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 and that, in many, avoiding allergic triggers identified with allergy
tests result in significant improvement of the disease.
Diagnosis
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.
Treatment
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 (RAST) lacks sensitivity/specificity. If
the prick skin tests are negative, then patch testing to foods can be performed to assess for delayed food sensitivities.
An avoidance diet should then be done based on the test results. 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 children, formulas such as Elecare or Neocate 1+ have been found to be effective in improving symptoms
and decreasing the number of eosinophils in the gastrointestinal tract.
When dietary restrictions do not work, medications called steroids can be used. These are often effective, but
symptoms often return when steroids are stopped and they can result in a number of side effects (such as acne, mood
changes, osteoporosis, and increased risk of infections). Other medications that can be tried include cromolyn sodium
and Singulair. Much research is currently being done to find more effective treatments with fewer side effects than
steroids.
Check out the American Partnership For Eosinophilic Disorders for more information on Eosinophilic Esophagitis and
Eosinophilic Gastroenteritis.
updated 25 January 2010
Sources include:
Lake AM Allergic Bowel Disease. Adolesc Med Clin 2004;15:105-117
Liacouras C, Markowitz J Eosinophilic Esophagitis, Gastroenteritis, and Proctolitis in: Pediatric Allergy: Principles
and Practice Donald Y.M. Leung et al. Mosby 2003.
Furuta GT et al. First International Gastrointestinal Eosinophil Research Symposium Subcommittees. Eosinophilic
esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment.
Gastroenterology 2007:133:1342-1363.
Liacouras C Eosinophilic Esophagitis. Gastroenterol Clin N Am 2008;37:989-998.
Kahn S and Orenstein S Eosinophilic Gastroenteritis Gastroenterol Clin N Am 2008:37:333-348.
Hong et al. Food allergy and eosinophilic esophagitis: learning what to avoid. Cleveland Clinic Journal of Medicine
2010;77:51-59.
of eosinophils in the tissues of the gastrointestinal tract (specifically the stomach for eosinophilic gastroenteritis and the
esophagus for eosinophilic esophagitis). First described in the late 1930’s, these disorders affect people of any age -
from infants to older adults. It appears that these disorders are becoming more frequent than they used to be. Over
half of affected patients will have a personal or family history of an allergic disorder such as food allergies, asthma,
atopic dermatitis, or environmental allergies.
Clinical Features
Common symptoms of eosinophilic gastroenteritis and eosinophilc esophagitis include:
- Abdominal pain
- Nausea and/or vomiting
- Difficulties swallowing
- Sensation of food getting stuck
- 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 and that, in many, avoiding allergic triggers identified with allergy
tests result in significant improvement of the disease.
Diagnosis
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.
Treatment
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 (RAST) lacks sensitivity/specificity. If
the prick skin tests are negative, then patch testing to foods can be performed to assess for delayed food sensitivities.
An avoidance diet should then be done based on the test results. 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 children, formulas such as Elecare or Neocate 1+ have been found to be effective in improving symptoms
and decreasing the number of eosinophils in the gastrointestinal tract.
When dietary restrictions do not work, medications called steroids can be used. These are often effective, but
symptoms often return when steroids are stopped and they can result in a number of side effects (such as acne, mood
changes, osteoporosis, and increased risk of infections). Other medications that can be tried include cromolyn sodium
and Singulair. Much research is currently being done to find more effective treatments with fewer side effects than
steroids.
Check out the American Partnership For Eosinophilic Disorders for more information on Eosinophilic Esophagitis and
Eosinophilic Gastroenteritis.
updated 25 January 2010
Sources include:
Lake AM Allergic Bowel Disease. Adolesc Med Clin 2004;15:105-117
Liacouras C, Markowitz J Eosinophilic Esophagitis, Gastroenteritis, and Proctolitis in: Pediatric Allergy: Principles
and Practice Donald Y.M. Leung et al. Mosby 2003.
Furuta GT et al. First International Gastrointestinal Eosinophil Research Symposium Subcommittees. Eosinophilic
esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment.
Gastroenterology 2007:133:1342-1363.
Liacouras C Eosinophilic Esophagitis. Gastroenterol Clin N Am 2008;37:989-998.
Kahn S and Orenstein S Eosinophilic Gastroenteritis Gastroenterol Clin N Am 2008:37:333-348.
Hong et al. Food allergy and eosinophilic esophagitis: learning what to avoid. Cleveland Clinic Journal of Medicine
2010;77:51-59.
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