Eosinophilic gastroenteritis (EGE) is characterized by gastrointestinal symptoms, eosinophil infiltration in both the stomach and small intestine, and elevated levels in the blood. Eosinophils are one of several types of white blood cells. It is not clear exactly how they work, but they are known to be involved as part of the body’s allergic response.
This is one of several eosinophilic enteropathy disorders, with each one affecting a different part of the digestive system. Others are:
- Eosinophilic Esophagitis (esophagus)
- EosinophilicGastritis (stomach)
- EosinophilicEnteritis (small intestine)
- EosinophilicColitis (large intestine)
The cause (etiology) of the disorder is not known. About half of patients have a history of asthma or allergies, commonly food allergies but sometimes airborne as well. It is slightly more likely to occur in men but is not age specific. It is most often reported in Caucasians, although some reports are of Asian patients.
Typical symptoms include abdominal pain, nausea and/or vomiting, diarrhea, bloating, poor appetite, weight loss. These are symptoms for many common illnesses as well, so a patient often does not pursue an aggressive diagnosic approach until he has suffered from the unresolved symptoms for an extended period of time.
Because EGE is a rare disease, few physicians have experience diagnosing it and diagnostic criteria have not yet been standardized. Typically however, diagnosis will be made based on the presence of GI symptoms, histological evidence of eosinophilic infltration in the GI tract, and the absence of parasites or other eosinophilic disorders.
An absolute diagnosis cannot be made without an endoscopy and tissue biopsy.
With a confirmed diagnosis, the physician will usually recommend food allergy testing. This will be very useful to guide the patient in managing his illness.
There is no cure for eosinophilic gastroenteritis, but symptoms can often be managed well with medication and dietary adjustments. The main medical treatment is corticosteroids which are very effective in reducing inflammation and appear to suppress eosinophis production as well. However, long term use of these medications can bring harmful side effects. Several other drugs have been tried with mixed results. When food allergies are determined to be present, any of several dietary therapies may be effective in managing the disease.
- elimination diet - all foods that the patient tested positive to in allergy testing are strictly avoided.
- elemental diet - a very strict diet in which no protein is permitted. It requires special formulas made of amino acids. These are the building blocks of proteins and allow the patient’s own body to build the proteins lacking from his diet.
- food trials - patients that had a positive result from an elimination or elemental diet, may then undergo a food trial. Previously excluded foods are added back into the diet one at a time. Anything causing a response will be permanently eliminated from the diet, but some foods may be added back making the dietary restrictions a bit less burdensome.
An Overview of Eosinophilic Enteropathy