What Is EGID and What Causes It?
Eosinophilic gastrointestinal disorder (EGID) occurs when a relatively rare type of white blood cell called an eosinophil builds up in the gastrointestinal tract and causes inflammation, polyps, ulcers and possibly tissue damage if left untreated. The eosinophils, which only account for 1 to 4 percent of the blood’s cellular structure, are responsible for fighting toxins within the body through inflammation, specifically those caused by parasitic infection or certain food antigens. Both adults and children can be affected by EGID.
EGID is actually a group of disorders, depending on where the higher levels of eosinophils are located:
- Eosinophilic esophagitis (EE) – high levels of eosinophils in the esophagus
- Eosinophilic gastritis (EG) – high levels of eosinophils in the stomach
- Eosinophilic gastroenteritis (EGE) – high levels of eosinophils in the stomach and small intestine
- Eosinophilic colitis (EC) – high levels of eosinophils in the large intestine
- Eosinophilic proctocolitis (EP) – occurs only in infants; also known as allergic proctocolitis or milk-protein proctocolitis
Elevated levels of eosinophils on their own are not always indicative of an eosinophilic disorder. Other diseases that have elevated eosinophil levels are Crohn’s disease, ulcerative colitis and other irritable bowel diseases, food allergies and reflux disease.
Symptoms of eosinophilic gastrointestinal disorder typically develop between the ages 20 through 50, but can occur at any age. Men seem to be more susceptible to eosinophilic disorders than women, especially of the esophagus.
Depending on where the elevated levels of eosinophils are located, some of the symptoms of EGID are:
- Nausea or Vomiting
- Reflux that does not respond to usual treatment therapies
- Dysphagia or difficulty swallowing
- Gastroparesis or delayed gastric emptying
- Failure to thrive
- Blood in the stool
- Abdominal or chest pain
The main symptom of eosinophilic proctocolitis in infants is the gradual appearance of rectal bleeding, specifically in infants less than six months old. Other signs of EP in infants are diarrhea, increased mucus production, straining during elimination and increased irritability.
How Is EGID Diagnosed?
Certain types of EGID are more commonly diagnosed then others, but the disorder as a whole is generally rare. Eosinophilic esophagitis (EE) and eosinophilic proctocolitis (EP) are the most common and easily diagnosed while eosinophilic gastritis (EG) is not as common and is tougher to diagnose.
Diagnosis of an EGID can only be confirmed by a gastroenterologist through an endoscopic biopsy. During an endoscopy, the gastroenterologist uses an endoscope to view the gastrointestinal tract and removes several small biopsies for analysis by a pathologist. The pathologist reviews the biopsy to determine if there is a higher than normal number of eosinophils; where the eosinophils are located in the GI tract; if the tissue layers have changed due to the overabundance of eosinophils; and if the eosinophils have released their contents, which is also known as degranulation.
After the EGID diagnosis has been established, food allergy tests such as RAST or radioallergosorbent tests, skin prick testing, or patch testing should be administered to determine the best course of treatment. The most common food that can cause EGID are milk, soy, wheat, eggs, nuts, shellfish, corn and rice. Proteins such as beef, pork, chicken, and turkey along with fruits and vegetables can cause EGID, but to a lesser extent.
Treatment for other conditions associated with higher levels of eosinophils can also be used to confirm or rule out an eosinophilic gastrointestinal disorder. For example, if a traditional GERD or reflux medication does not decrease the amount of eosinophils in the esophagus, than the diagnosis of EGID may be more appropriate.
What Treatment Options Are Available?
Unfortunately, eosinophilic gastrointestinal disorder cannot be cured, but there are treatment options, such as dietary therapy and medication, that can successfully manage the disease, control symptoms and avoid additional damage to the gastrointestinal tract. The recommended and most successful treatment option is dietary therapy, which comes in two forms – elimination diets and elemental diets.
Elimination diets use allergy testing to determine what foods cause an allergic reaction in the individual. Once the allergens have been determined, the individual must rigorously keep away from any foods containing that allergen, even in trace amounts. Allergy testing for elimination diets is not foolproof and may give a false negative on a particular food. If symptoms still occur after following a strict elimination diet, an elemental diet should be implemented to further determine the cause of the EGID.
Elemental diets are extremely strict diets that do not allow protein of any type – whole or partial – and rely on special formulas made of amino acids, sugars, fats, vitamins, and minerals because amino acids are hypoallergenic, unlike whole or partial proteins. Snacks are allowed, but they must not contain sugar, salt and artificial flavors. Elemental diets are very difficult to follow for children and adults; sometimes a feeding tube must be used on children if the diet continues for a long period of time. EGID can be very tough on children and special care should be taken to minimize the psychological effects on them. Also, elemental diets are very useful in determining if the individual’s EGID is food allergy-related or caused by something else.
If an individual responds favorably to either the elimination or elemental diets, certain foods can be slowly introduced back into their diet through carefully controlled food trials under a physician’s supervision. A new “pure" food, starting with one that initially tested negative, can be introduced every 1 to 3 weeks with a re-evaluation occurring after several foods have been successfully reintroduced.
Medications such as glucosteroids and topical steroids can be used to reduce eosinophils in the gastrointestinal tract and lessen symptoms, but most have serious side effects if used long term and the symptoms generally reoccur after steroid treatment stops. Leukotrine inhibitors such as montelukast or Singulair can minimize symptoms, but have no effect on eosinophil levels.
American Partnership for Eosinophilic Disorders website, https://www.apfed.org/egid.htm
Cincinnati Children's Hospital Medical Center website, https://www.cincinnatichildrens.org/svc/alpha/e/eosinophilic/about/default.htm
Liacouras, Chris A. "Eosinophilic Gastrointestinal Disorders". Practical Gastroenterology, March 2007, https://www.medicine.virginia.edu/clinical/departments/medicine/divisions/digestive-health/nutrition-support-team/copy_of_nutritionarticles/LiacourasArticle.pdf
National Institutes of Health's Office of Rare Diseases Research website, https://rarediseases.info.nih.gov/GARD/Condition/9142/Eosinophilic_enteropathy.aspx