What Are Lower Gut Eosinophilic Gastrointestinal Diseases? 

• EOSINOPHILIC GASTRITIS - EoG
• EOSINOPHILIC ENTERITIS - EoN
• EOSINOPHILIC COLITIS - EoC

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

What are the symptoms of Lower Gut Eosinophilic Gastrointestinal Diseases (EGIDs)?

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. 

Types of Lower Gut EGIDs

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 (EoG) 

• Small intestine - Eosinophilic Enteritis (EoN)

• Large intestine Colon  - Eosinophilic Colitis (EoC) 

 

What is the cause of Lower EGIDs?

The cause of lower gut eosinophilic diseases is not yet completely understood, and 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) dairy, 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 Lower EGIDs 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. Research does not yet conclude on an internationally agreed figure for the raised levels of eosinophils in diagnosing the EGIDs.

Currently, the diagnosis of these conditions relies on an 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 eosinophil levels. 

What are the Lower EGIDs 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 immune system's response. 

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 Lower EGIDs Long-Term Issues?

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

Hope for the Future

Interest is growing in the more complex lower EGID's and research is emerging. Find more on the following pages.

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

Learn about the new global terminology

Amino acid diet trials for Eosinophilic Gastritis and Eosinophilic Gastroenteritis

There is still much to learn about EGID’s for improved diagnosis, treatments and one day a CURE!

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Last updated 2/5/23 ©EOS Network 2023 All rights reserved