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Table of Contents
What are eosinophil- associated gastrointestinal disorders
(EGID)?
What is an Eosinophil?
What is Eosinophilic Esophagitis?
What are the Symptoms of EGID?
Diagnosis?
Treatment?
Dietary Therapy
Restricted diets
Elemental diets
Feeding tubes
Medication
Living with EE and EGID (Adults)
How will EGID Affect my Life? (Children)
Resources for Healthcare Professionals and Consumers
Recipes - Extreme Cooking for Extreme Diets, APFED recipe book
"Celebrating the Holidays" Courtesy of Kids With Food Allergies
Frequently Asked
Questions
April 2008 Patient Power replay with Dr. Furuta
About
Eosinophil-associated Gastrointestinal Disorders (EGID)
What is EGID?
A growing number of children and adults suffer from a chronic
and complex group of disorders described as
Eosinophilic (ee-oh-sin-oh-fill-ick)
Gastrointestinal Disorders
(EGID). These disorders are
characterized by having above normal amounts of eosinophils, a
type of white blood cell, in one or more specific places
anywhere in the digestive system. EGID is further subdivided
into organ-specific diagnosis. For example, Eosinophilic
Gastritis means eosinophils infiltrating the stomach. "itis"
means inflammation. While visual inflammation is not always
present, inflammation may be apparent under the microscope.
Eosinophilic Esophagitis (EE):
high numbers of eosinophils occurring in the esophagus.
Learn more:
Eosinophilic Esophagitis
Eosinophilic Gastritis (EG): high numbers of eosinophils in the stomach.
Eosinophilic Gastroenteritis (EGE):
affects the stomach and small intestine.
Eosinophilic Colitis (EC):
describes the occurrence of high numbers of eosinophils in the
large intestine.
Above normal amounts of eosinophils within the digestive system
may or may not be enough to diagnose a person with an EGID; what
the eosinophils are doing while present is equally important.
Currently, without a standardization of diagnostic criteria,
medical institutions use different variations of the same
criteria including: inflammation, numbers and activity of
eosinophils, and symptoms.
The increased numbers of eosinophils present does not always indicate EGID. Other inflammatory cells and other inflammatory changes that include eosinophils, but which are not exclusively eosinophilic, are common in other inflammatory diseases such as Crohn's disease and ulcerative colitis.
Return to
Table of Contents
What is an Eosinophil?
Eosinophils (ee-oh-sin-oh-fillz)
are a type of white blood cell (WBC). Eosinophils are the least
common of the white blood cells and comprise approximately 1-4%
of the blood’s cellular make-up. Named after “Eos” the Greek
goddess of dawn, eosinophils are characterized by their bright
red-pink color and double nucleus when stained and viewed under
the microscope. Eosinophils are most commonly associated with
allergic diseases and parasite infections. Learn more:
What are the Symptoms of EGID?
Symptoms vary widely, depending on the area affected.
Symptoms include:
• Nausea or Vomiting
• Diarrhea
• Failure to thrive (poor growth or weight loss)
• Abdominal or chest pain
• Reflux that does not respond to usual therapy (which includes
proton pump inhibitors,
a medicine which stops acid production)
• Dysphagia (Difficulty swallowing)
• Food impactions (food gets stuck in the throat)
• Gastroparesis (Delayed emptying of the stomach)
• Anorexia (poor appetite)
• Bloating
• Anemia
• Blood in the stool
• Malnutrition
• Difficulty sleeping
Since none of these symptoms are specific for EGID, and many
occur at times in healthy children or adults, the diagnosis is
generally sought only after the symptoms have failed to resolve.
Eosinophilic disorders can mimic the symptoms of other diseases
like inflammatory bowel disease, food allergies, irritable bowel
syndrome and reflux, among others.
Return to Table of Contents
How are Eosinophil-associated GI
disorders Diagnosed?
Endoscopy and biopsy is the ONLY way to
confirm the diagnosis of EGID.
During an endoscopy, the gastroenterologist looks at the GI
tract through an endoscope and takes multiple small samples
(biopsies) which the pathologist reviews. A high number of
eosinophils (counted per high power field) suggest the diagnosis
of EGID. The pathologist will also look for the location of the
eosinophils, changes in the tissue layers, and degranulation
(spilling of the contents of the eosinophils). Eosinophils may
be normally found in small numbers in all areas of the GI tract
except the esophagus. GERD (reflux) is associated with low
numbers of eosinophils in the esophagus. With eosinophilic
esophagitis, the number of eosinophils seen is much higher and
remains elevated on medication for reflux.
Once the diagnosis of EGID is confirmed, food allergy testing is
typically recommended to guide treatment. Tests for food
allergies include skin prick testing, patch testing and
Radioallergosorbent test (RAST).
View
Images of Upper and Lower Endoscopy
Learn
more:
Can EGID be Cured?
There is no
"cure" for EGID, but treatment can help alleviate symptoms and
prevent further damage to the gastrointestinal (GI) tract.
Treatment of eosinophilic disorders will vary based on the
location of the eosinophils, severity of symptoms, and other
medical problems the child/adult may have. In most cases,
dietary measures and medications can significantly improve
problems related to the underlying eosinophilic disease. Your
doctor will help guide you through the various treatment options
to find a therapy that is best for you and your family.
Learn more:
Treatment options include:
• Restricted
or "elimination" diets
Learn more:
• Elemental
diets
Learn more:
• Medications
Return to
Table of Contents
Dietary
Therapy
Food allergy testing is used as a guide for an "Elimination"
diet. An elimination diet means strictly avoiding all foods to
which the patient has tested positive on allergy testing. Skin
and patch testing are used to guide elimination diets, but it
only takes one false negative food for the diet to "fail".
Single ingredient cooking for food trials.pdf
Recipes for restricted diets
(coming soon)
Sometimes a stricter diet – an elemental diet – is needed. Skin
and patch testing are used to guide elimination diets, but it
only takes one false negative food for the diet to "fail".
Elemental diet means No protein, either in its whole or
incomplete (pre-digested or hydrolyzed) form is allowed. Special
elemental formulas are made of amino acids (the building blocks
of proteins), fats, sugars, vitamins and minerals. Amino acids
do not cause allergic reactions but whole or partial proteins
can.
Children and adults who rely in part, or
completely, on an elemental amino acid based formula may have a
difficult time drinking enough of the formula. To maintain
proper nutrition, some require tube feedings directly into the
stomach (enteral feeds). In the most severe cases, nutrition is
administered directly into the blood stream (parenteral feeds).
Learn More: Sticking with an elemental diet
Learn more:
Medication
There are no medications to ‘cure’ eosinophilic disorders.
Medication may suppress eosinophils in the gastrointestinal
tract and relieve symptoms of the disease. Steroids are most
commonly used in conjunction with dietary management. Steroids
can be given topically (spray that is swallowed), by mouth,
through a feeding tube or through an intravenous line. Your
healthcare provider will determine the type of steroid, amount
and duration of treatment based on individual needs. Side
effects from steroids often limit long-term use. Aside from diet
and steroid treatment, there is no "magic bullet" available to
treat eosinophilic disorders. Not all types of eosinophilic
diseases respond to the same treatment and different people with
the same disease type may need very different medications.
Learn more:
Return to Table of Contents
How will EGID Affect my Life?
The diagnosis of an eosinophilic disorder is life-altering.
Beyond the debilitating physical symptoms, those afflicted often
suffer social and emotional scars by living in a society that
focuses on food. A positive attitude and a focus on non-food
activities go a long way in learning to live with these
disorders.
Adults with EGID
face unique issues associated with employment, inter-personal
relationships, insurance, medical care and family. Holidays,
parties and family gatherings are often food-focused,
particularly for adults. There is no need to miss out on holiday
and other celebrations. Attend anyway, and engage in cheerful
conversation!
Learn
more:
Learn more:
Learn more:
The challenges
Children with EGID
face depend
on the severity of illness, treatment, and dietary restrictions.
Some children with eosinophilic esophagitis do well with
elimination of a few foods from their diet. Staying
involved in your child’s school is important.
Tips
for restricted diets at school
§
Plan ahead when
possible to ‘match’ food served at birthday parties and snack
time with a ‘safe’ version.
§
Be sure your child
has a stash of ‘safe’ foods or stickers in the classroom for
unexpected parties.
§
While educating
teachers and school administrators about your child’s
restriction is important, even small children can remember to
only accept ‘safe’ foods from a known source (parent, guardian).
Other,
more severely affected children, face the additional challenge
of managing chronic illness while in school. Missed school days,
holidays parties, feeding pumps and the feeling of isolation
complicate what should otherwise be a care-free childhood.
Children often reflect parental attitude about their illness and
limitations. Readjusting attitude towards food is a very
important first step. Food is simply nutrition, whether formula
through a tube or a severely restricted diet.
Some suggestions to help your
child adjust:
• Focus on
what your child CAN do.
• Encourage your child to pursue non-food
related interests and hobbies.
• Stay involved in your child’s school.
Participate in planning holiday celebrations.
• Plan creative fun birthday parties.
Learn
more about school issues:
Health Information Sheet, Patient
Resources
for Healthcare Professionals and Consumers
Link to
page.
Revised
4-1-06
Mail@apfed.org
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