What Are Lower Gut Eosinophilic Gastrointestinal Diseases? 

• EOSINOPHILIC GASTRITIS - EG
• EOSINOPHILIC GASTROENTERITIS - EGE
• EOSINOPHILIC COLITIS - EC

Lower gut EGID cases are rare, current USA figures show EC affects 3.3 people in 100,000 and EG affects 6.3 people in 100,000.

What are the symptoms?

It typically presents with a combination of chronic nonspecific GI symptoms which include:

• Abdominal pain
• Diarrhoea and/or blood or mucus in the stool
• Nausea and or vomiting
• Trouble eating (loss of appetite, problems swallowing, food refusal, eating slowly or not enough)
• Weight loss/failure to thrive/poor growth
• Fatigue  

These conditions can affect both children or adults, many have symptoms for several years, and diagnosis is often complicated and delayed. 

The type of lower gut EGID depends on where the eosinophil’s gather in increased numbers and break up (degranulate) releasing their toxins causing inflammation, injury to the affected areas:

• Stomach -Eosinophilic Gastritis EG 

• Small intestine and Stomach - Eosinophilic Gastroenteritis EGE

• Large intestine - Eosinophilic Colitis EC 

 

What is the cause?

The cause of the lower gut eosinophilic diseases is not yet completely understood, more research is needed.   

Eosinophilic Disease is often found in those with a family history of allergic diseases such as rhinitis, asthma and/or eczema.

It has been found that it can be triggered by eating certain foods most commonly (but not exclusively) milk, wheat, nuts, soya, fish and eggs or possibly breathing in certain substances. 

Studies so far have shown that the cause is related to a combination of environmental and genetic factors.

 

How is it diagnosed?

Obtaining a diagnosis can be difficult. Unfortunately, unlike the Oesophagus, the lower part of the gut naturally has some eosinophils even in a healthy person and research does not yet conclude on an internationally agreed figure for the raised levels of eosinophils in a diagnosis of the EGIDs.

Currently, the diagnosis of these conditions relies on expert Gastroenterologist performing a colonoscopy and endoscopy to look at your gut lining and take multiple biopsies.

It is also essential to have a full assessment of your symptoms and medical history. The symptoms are not diagnostic, but a clue can be the observation of the symptoms that are aggravated by specific foods, as food intolerance seems to play a role in the cause of the conditions. The biopsies are examined under the microscope by an expert pathologist. The pathologist determines the level of eosinophils and the presence of pathological features. In the case of eosinophilic gastritis, there is a  preliminary agreement that the diagnosis requires eosinophils to be greater than 30 cells per high powered microscopic field in at least 5 fields.

Diagnosis also requires careful exclusion of parasite infections and other types of inflammatory conditions in the gut that can increase the eosinophil levels. 

 

What are the treatment options? 

​Identifying the causative foods in EGID's can be extremely difficult, due to delayed responses (non-ige reactions)and often there are multiple ​causes/sensitivities. Therefore, therapy is often a combination of numerous food type avoidance (specialised formulas for infants or complex cases) along with antihistamines and/or anti-inflammatory medication including glucocorticoids (steroids).

Some patients have difficulty achieving remission of their symptoms ​with these approaches, i.e. systemic drug therapies (ones that rely on absorbed drugs) and/or diet and may then require medicine that decreases the response of the immune system. 

Currently, there is no consensus on the best approach and no licenced therapies.  

Achieving a healthy ​diet in children with EGIDs can be challenging, and expert help is needed from a dietician.

 

What are the long term issues?

Eosinophilic gut disorders are long term conditions (chronic is the medical term), and therefore patients need a lifelong method to control the symptoms and reduce the potential complications. The lack of generally accepted therapies makes the management of the condition challenging for both doctors and their patients. 

Hope for the future

Interest is growing into the more complex lower EGID's and research is emerging. 

Eosinophilic gastrointestinal disease below the belt - Robert D. Pesek, MD,a and Marc E. Rothenberg, MD, PhDb

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Last updated 13/10/20 ©EOS Network 2020 All rights reserved