EGE - Apfed

Eosinophilic Gastroenteritis

Eosinophilic gastroenteritis (EGE) is a rare disease in which a type of white blood cell, the eosinophil, causes injury and inflammation to the stomach and small intestine.

Eosinophilic duodenitis (EoD) is when the first part of the small bowel, the duodenum, is primarily involved. A more standardized term for this condition is expected to soon be coming, which will form the basis for clinical guidelines on how to diagnose and treat EGE and EoD.

Eosinophilic gastritis (EG) is when the inflammation and injury occur in only the stomach.

EGE, EoD, and EG are similar in how they affect the patient, how they are diagnosed, and how they are treated.

Data on the prevalence of EGE in the United States has been estimated to be between 5.1 to 8.4 out of 100,000 people. New research suggests that the condition may be more prevalent than these estimates, however, it’s still a rare disease, which is defined as affecting less than 200,000 people.

What causes eosinophilic gastroenteritis?

The cause is unknown in many patients. Food and/or environmental allergies may play a role in the development of eosinophilic gastroenteritis/eosinophilic duodenitis. People who have a personal or family history of allergic disorders may be at higher risk of developing EGE.

What are the symptoms?

Common symptoms of eosinophilic gastroenteritis include:

Vomiting, nausea
Difficulty feeding and/or gaining weight
Poor growth
Abdominal pain
Anemia (low blood counts)
Fatigue

Who is affected?

Eosinophilic gastroenteritis can affect both adults and children. Both males and females are affected. EGE is often seen in conjunction with other forms of eosinophilic disease.
Most people who have EGE also have other allergies (eczema, hay fever, asthma) and/or have food intolerances or allergies, especially children. A smaller percentage of sufferers may also have a family member with a similar eosinophilic disorder.

How is eosinophilic gastroenteritis diagnosed?

Eosinophilic gastroenteritis is diagnosed by an upper endoscopy. A small tube is inserted into the mouth and is directed into the esophagus, stomach, and the small intestine. This tube allows the doctor to see any visual changes in the tissue, such as erosions or irritated areas of the stomach and small intestine. The doctor will take small tissue samples (biopsies) for a pathologist to examine under a microscope. While it is normal for stomach and small intestine tissue to have some eosinophils present, the pathologist will determine if there is an abnormally high number of these cells in the tissue sample.

High levels of eosinophils in the stomach may also be caused by other conditions such as helminthic infections (e.g., pin worms, hookworms), inflammatory bowel disease, autoimmune disease, celiac disease, drug reactions, and in association with hypereosinophilic syndrome. Because of this, evaluation or exclusion of these conditions may be required prior to confirmation of the diagnosis.

Some patients with EGE also have high levels of eosinophils in their blood. An EGE diagnosis is given based on an individual’s symptoms, the appearance of the digestive tract as seen during the endoscopy, and the pathology report.

How is eosinophilic gastroenteritis treated?

There are currently no expert consensus guidelines for the diagnosis and treatment of eosinophilic gastroenteritis. The goal of the treatment is to reduce the inflammation and damage caused by the eosinophils. Medical society meetings and research symposiums offer forums for discussion among researchers that are helping to pave the way for the development of clinical treatment guidelines and management for this condition. Additionally, EGE is a focus of the research being conducted by the Consortium of Eosinophilic Gastrointestinal Disease Researchers.

Your doctor may suggest allergy testing to help determine if a specific allergen is triggering EGE. Once allergens have been identified or ruled out, there are two main therapies used to manage EGE:

Dietary Therapy – Dietary therapy involves removing suspected causative foods; eliminating common food allergens such as milk, wheat, soy, fish, shellfish, peanuts, tree nuts, and eggs; or removing food entirely from the diet and relying on specialized formula for nutrition. For some patients, especially infants, only a few foods are identified as causing the problem (typically milk and/or soy), and once those foods are removed from the diet, EGE resolves.

Medications – Medications such as systemic steroids (prednisone) or other anti-inflammatory medicines may be prescribed. If the patient is iron deficient, iron supplements may also be recommended.

To evaluate how you are responding to treatment, periodic endoscopies with biopsies will be performed.

Research into potential therapies to treat EGE and Eosinophilic Duodenitis are currently underway. You may learn about these on our Clinical Trials page.

What is the prognosis?

Eosinophilic gastroenteritis is generally not considered life threatening, though the condition can have a significant impact on quality of life. Life threatening complications from EGE can develop without intervention, such as severe malnutrition or dehydration. These issues are more likely to have significant impacts on infants and young children unlike teens/adults who can describe difficulties more easily.

Eosinophilic gastroenteritis s is a chronic disease that requires ongoing monitoring and management. Patients may experience periods of symptom activity and periods of apparent remission.

If left untreated, individuals may experience issues such as malabsorption, ulcers, anemia, and/or poor growth.

Other Resources

References

Eosinophilic gastroenteritis: review of a rare and treatable disease of the gastrointestinal tract. Mori A, Enweluzo C. Grier D, Badireddy M. Case Rep Gastroenterol. 2013 Jul 16;7(2):293-8. doi: 10.1159/000354147.

Eosinophilic gastroenteritis and related eosinophilic disorders. Prussin C. Gastroenterol Clin North Am. 2014 Jun;43(2): 317-27. doi: 10.1016/j.gtc.2014.02.013.

Prevalence of Eosinophilic Gastroenteritis and Colitis in a Population-Based Study, From 2012 to 2017 Mansoor E, Saleh M, Cooper G. Clin Gastroenterol Hepatol 2017 Nov;15(11):1733-1741. doi: 10.1016/j.cgh.2017.05.050. Epub 2017 Jun 8.

Prevalence of eosinophilic gastritis, gastroenteritis, and colitis: Estimates from a national administrative database. Jensen E, Martin C, Kappelman M, Dellon E. J Pediatr Gastroenterol Nutr. 2016 Jan; 62(1): 36–42.

Epidemiology of Nonesophageal Eosinophilic Gastrointestinal Diseases in Symptomatic Patients: A Systematic Review and Meta-Analysis. Licari A, Votto M, Scudeller L, De Silvestri A, Rebuffi C, Cianferoni A, Marseglia G. J Allergy Clin Immunol Pract. Volume 8, Number 6.