Eosinophilic gastritis (EoG) is a rare disease in which eosinophils accumulate in elevated amounts in the stomach, causing injury and inflammation. When eosinophils accumulate and cause damage in the intestine, it is referred to as eosinophilic enteritis (EoN), or by the specific part of the intestine. When the stomach and the small intestine are affected, the disease is categorized as eosinophilic gastroenteritis. Both EoG and EoN are similar in how the disease affects the patient, how they are diagnosed, and how they are treated. Those who have a diagnosis of eosinophilic duodenitis, jejunitis, or ileitis may refer to the information that discusses eosinophilic enteritis (EoN), as the information applies to these subsets.
What causes EoG and EoN and who is affected?
The cause of EoG and EoN is not well understood. It is believed that allergies may have a role. Those with a personal or family history of allergic conditions like food allergy, anaphylaxis, eczema, hay fever, asthma, or those who have other eosinophil-associated disease may be at a higher risk of developing EoG or EoN. These diseases affect both adults and children.
What are the symptoms of EoG or EoN?
Common symptoms include:
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Abdominal pain
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Diarrhea
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Difficulty feeding, tolerating foods, and/or gaining weight
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Fatigue
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Nausea
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Poor growth
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Bloating
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Vomiting
Anemia (low blood counts) can also develop.
How are EoG and EoN diagnosed?
To diagnose EoG and EoN, a gastroenterologist will perform an upper endoscopy. A thin, flexible tube is inserted through the mouth and guided into the esophagus, stomach, and small intestine. During this procedure, the doctor examines these organs for signs of inflammation or other abnormalities and collects small tissue samples (biopsies) for a pathologist to examine under a microscope.
While it is normal for some eosinophils to be present in the stomach and small intestine, the pathologist evaluates whether there is an abnormally high number of these cells. Additionally, many individuals with EoG or EoN have elevated eosinophil levels in their blood.
A diagnosis is typically made by combining:
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The patient’s symptoms
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The findings from the endoscopy
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The results of the pathology report
How are EoG and EoN treated?
Treatment goals include reducing the number of eosinophils and the associated symptoms, inflammation, and damage. Currently, in the United States, there is no medication approved by the Food and Drug Administration that is indicated to treat EoG or EoN. Two main therapies are used to manage the conditions:
- Dietary therapy. Food allergies may have a possible role in EGIDs. While allergy testing is not always effective in identifying specific food triggers for EGIDs, your doctor may suggest it to help guide an elimination diet. Elimination diets (avoiding specific foods or food groups) and/or specialized amino acid-based formulas (elemental diets) help reduce eosinophils and improve symptoms in some people.
- Medications. Medications such as systemic steroids (prednisone), steroids that are topically active in the intestine (“enteral release” budesonide), or other anti-inflammatory or immunomodulatory medicines may be prescribed.
If there is an iron deficiency, iron supplements may also be recommended.
What is the prognosis of EoG and EoN?
EoG and EoN are chronic conditions with periods of activity and apparent remission. To monitor treatment effectiveness, a gastroenterologist will perform regular endoscopies with biopsies. The prognosis depends on a person’s response to treatment. If left untreated or undertreated, individuals may experience issues such as:
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Malabsorption
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Ulcers
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Anemia
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Poor growth
Resources
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