What is eosinophilic gastroenteritis?
Eosinophilic gastroenteritis (EG) is a rare condition that affects the gastrointestinal tract, particularly the stomach and small intestine. Common symptoms of the condition include diarrhea, abdominal pain, and nausea.
Eosinophilic gastrointestinal disease is sometimes called “eosinophilic gastritis” when the stomach is primarily affected, or “eosinophilic esophagitis” when the symptoms mainly affect the esophagus.
“Eosinophilic” is a term used to describe the presence of “eosinophils”, a type of white blood cell that plays an important role in immune system defense. Most eosinophils are found in the gut, uterus, bone marrow, mammary glands and adipose tissue, and are normally released into the blood when a foreign body – e.g. bacteria – enters the body and triggers an immune response.
When a person suffers from eosinophilic gastroenteritis, eosinophils are released in increased numbers from their respective tissues. These eosinophils infiltrate the gastrointestinal tract, resulting in inflammation.
The condition affects most parts of the digestive tract and causes various gastrointestinal symptoms. Most commonly it affects the stomach and small intestine, but other parts of the lower digestive tract can be affected too.
Unlike other digestive tract diseases – such as gastroesophageal reflux disease (GERD), which affects around a third of the global population – eosinophilic gastroenteritis is rare. It’s estimated that there are about 22-28 cases per 100,000 people in the US.
It can affect both children and adults. When it starts in infancy, there is a high chance of the child having recurrent gastroenteritis in late childhood.
The condition can affect all three layers of the intestinal wall: the muscular layer, the mucosal layer and the serosal layer. The term eosinophilic gastritis is used to describe eosinophilic gastroenteritis that affects the gastric mucosa (inner surface of the stomach).
What causes eosinophilic gastroenteritis?
Scientists don’t yet fully understand what causes eosinophilic gastroenteritis. Its progression over time in affected individuals is not well documented. However, some research suggests that hypersensitivity reactions trigger the condition.
Hypersensitivity reactions occur when the immune system – which normally protects your body – overreacts in a way that can produce harmful effects. Examples of hypersensitivity reactions include allergies and autoimmunity.
An allergy is when the immune system responds badly to otherwise harmless environmental agents such as animal dander, pollen and food. Autoimmunity is when the body fails to recognize its own cells and tissues, causing the immune system to attack healthy cells, tissues and organs. An example of autoimmunity is type 1 diabetes, where the immune system destroys the pancreatic cells that produce insulin.
About 50% of people diagnosed with the condition also have hypersensitive or allergic conditions such as asthma, rhinitis and eczema. Scientists believe that the allergic and inflammatory responses that result from these conditions can cause damage to the intestinal barrier, triggering the infiltration of eosinophils into the intestines.
Other digestive diseases that may be associated with the condition include celiac disease and ulcerative colitis. Despite these potential links, eosinophilic gastroenteritis can also occur alone.
There are also cases where a patient suffers from idiopathic eosinophilic gastroenteritis, which is when the cause of the condition is unknown.
More research still needs to be carried out on the causes and risk factors of this condition.
Is eosinophilic gastroenteritis serious?
Eosinophilic gastroenteritis can cause serious complications such as intestinal perforation and obstruction. An individual with this condition might experience sporadic symptoms that can be debilitating. However, fatalities are rare.
Symptoms of Gastroenteritis
Eosinophilic gastroenteritis is a chronic disease. About 80% of people suffering from it experience symptoms for several years.
The symptoms vary depending on the site affected and the depth of the inflammatory reaction of the intestinal wall layers.
For instance, eosinophilic gastritis (where the gastric mucosa is affected) may cause symptoms like anemia, weight loss, vomiting, abdominal pain and diarrhea. Infiltration of the subserosal layer may cause eosinophilic ascites, while infiltration of the muscular layer of the stomach may cause rigidity and thickening of the stomach walls and pyloric obstruction.
Other eosinophilic gastroenteritis symptoms include:
- Bloody stools
- Oedema
- Trouble swallowing
- Chest pain
- Indigestion
- Bloating
- Nausea
Is eosinophilic gastroenteritis curable?
According to the Canadian Society of Intestinal Research, there is currently no cure for eosinophilic gastrointestinal disease. However, evidence has shown the condition can be managed and its symptoms eased.
Some studies have shown promises of possible cures and effective treatment options for eosinophilic gastroenteritis. Treatment aims to improve histology of the gastrointestinal tract (a reduction in the number of eosinophils) as well as reduce symptoms.
How to test for eosinophilic gastroenteritis
Sadly, many people with eosinophilic gastrointestinal diseases go for years without receiving an accurate diagnosis. This is partly because other diseases that affect the digestive tract cause similar symptoms. Gastroesophageal reflux disease, celiac disease, ulcerative colitis and Crohn’s disease can all have a similar symptom profile to eosinophilic gastroenteritis.
For this reason, it’s important that you don’t start treatment without consulting your family doctor or specialist, ideally a gastroenterologist (a doctor who specializes in diagnosing and treating gastrointestinal diseases).
Currently, the most important diagnostic test for eosinophilic gastrointestinal diseases is an endoscopic biopsy. For this test, a clinician will take samples from your gastrointestinal tract. Experts will examine your sample for the characteristic features of eosinophilic gastrointestinal diseases by counting the number of eosinophils. An absence of parasitic infection, a high eosinophil count, and the presence of relevant symptoms will point towards eosinophilic gastroenteritis.
Your family doctor or specialist might also order laboratory tests, such as stool samples, blood tests and skin prick tests, to rule out other conditions.
Treatment
The good news is that eosinophilic gastroenteritis can be treated and managed. Treatment varies depending on the part of the digestive tract that is affected but generally involves a mixture of medication and dietary changes.
Medication
The symptoms of flare-ups can be managed effectively using oral corticosteroids, which offers a 90% response rate. Common corticosteroids prescribed include prednisolone, budesonide and fluticasone. One of the side effects of taking oral corticosteroids is oral thrush. Your family doctor might suggest that you rinse your mouth and spit after ingesting your drug.
Your family doctor or specialist might also prescribe other drugs like mast cell stabilizers (which reduce the effects of specific cells of the immune system) and antihistamines (which block the inflammatory actions of histamine).
Dietary therapy
Dietary therapy has also been used for treating eosinophilic gastroenteritis. However, there is currently no concrete evidence that dietary therapy is effective in lessening the disease’s manifestations.
Dietary therapy involves eliminating the most common foods that cause allergies. These can include wheat, soy, eggs, dairy, fish/shellfish and peanuts/nuts. A diet tailored for the management of eosinophilic gastroenteritis may exclude some or all these food groups.
Surgery
In rare cases, surgery may be required. This is usually when other treatment options haven’t helped with the management of the condition.
Summary
Eosinophilic gastroenteritis is a rare chronic disease of the digestive system which can pose challenges for both patients and their doctors. This is because there are few studies on its causes, diagnosis and treatment.
Despite this, eosinophilic gastroenteritis is rarely fatal, and long-term treatments have proven to be effective in easing symptoms and improving overall quality of life.
If you do not treat eosinophilic gastritis properly, it might lead to anemia, malnutrition and poor growth. Speak with your doctor if you experience common symptoms of chronic gastroenteritis. You can also contact GAAPP or one of its member organizations for further advice.
References
- Canadian Society of Intestinal Research. Eosinophilic Gastrointestinal Disease. https://badgut.org/information-centre/a-z-digestive-topics/eosinophilic-gastrointestinal-disease/
- Carr, S., Chan, E.S. and Watson, W. Correction to: Eosinophilic esophagitis. Allergy Asthma Clin Immunol 15, 22 (2019). https://doi.org/10.1186/s13223-019-0336-3
- Christopher, V., Thompson, M. H., Hughes, S. (2002). Eosinophilic gastroenteritis mimicking pancreatic cancer. Postgraduate Medical Journal, 78(922), 498-9. https://pmj.bmj.com/content/78/922/498
- Ingle, S.B., and Hinge (Ingle), C.R. (2013). Eosinophilic gastroenteritis: An unusual type of gastroenteritis. World Journal of Gastroenterology, 19(31), 5061-5066. https://www.wjgnet.com/1007-9327/full/v19/i31/5061.htm
- Kinoshita, Y., Oouchi, S. and Fujisawa, T. (2019). Eosinophilic gastrointestinal diseases – Pathogenesis, diagnosis and treatment. Allergology International, 68(4), 420-429. https://www.sciencedirect.com/science/article/pii/S1323893019300358?via%3Dihub
- Kita, H. (2013). Eosinophils: Multifunctional and distinctive properties. International Archives of all Allergy and Immunity, 161(0 2), 3-9. https://www.karger.com/Article/Abstract/350662
- Lucendo, Alfredo J., Serrano-Montalbán, Beatriz, Arias, Ángel, Redondo, Olga, Tenias, José M. (2015). Efficacy of Dietary Treatment for Inducing Disease Remission in Eosinophilic Gastroenteritis. Journal of Pediatric Gastroenterology and Nutrition, 61(1), 56-64. https://journals.lww.com/jpgn/Fulltext/2015/07000/Efficacy_of_Dietary_Treatment_for_Inducing_Disease.13.aspx
- Richard, G. (n.d.). The prevalence and impact of gastroesophageal reflux disease. About GERD. https://aboutgerd.org/what-is/prevalence/
- Sachin B. Ingle, Yogesh G. Patle, Hemant G. Murdeshwar, Ganesh P. Pujari. (2011). A case of early eosinophilic gastroenteritis with dramatic response to steroids. Journal of Crohn’s and Colitis, 5(1), 71–72. https://doi.org/10.1016/j.crohns.2010.10.002
- Spergel, J. M., Book, W. M., Mays, E., Song, L., Shah, S. S., Talley, N. J., & Bonis, P. A. (2011). Variation in prevalence, diagnostic criteria, and initial management options for eosinophilic gastrointestinal diseases in the United States. Journal of pediatric gastroenterology and nutrition, 52(3), 300–306. https://doi.org/10.1097/MPG.0b013e3181eb5a9f