A recent study, published in Diseases of the Esophagus, sheds new light on the complexity of Eosinophilic Gastrointestinal Diseases (EGIDs), revealing that overlapping involvement across multiple regions of the gastrointestinal (GI) tract is more common than previously recognised.

Drawing on patient-reported data from the international EGID Partners network, the research identifies clear links between segmental overlap, increased symptom burden, and greater treatment needs, with important implications for diagnosis, management, and patient support.

Introduction

EGIDs are immune-mediated type 2 inflammatory conditions characterised by the abnormal infiltration of eosinophils in various areas of the GI tract, resulting in chronic symptoms that depend on the affected site. Eosinophilic Oesophagitis (EoE) is the most studied form and is increasingly diagnosed.

However, non-oesophageal (non-EoE) EGIDs, such as Eosinophilic Gastritis (EG), Enteritis (EoN), and Colitis (EoC), are also on the rise, often underdiagnosed and significantly affecting quality of life. Although recent efforts have refined disease nomenclature and introduced pediatric guidelines, research into the overlapping gastrointestinal involvement in EGIDs and its influence on symptoms and treatment remains limited.

Study Objectives

A multidisciplinary team of researchers and patient advocacy groups, including the EOS Network, represented by our CEO, Amanda Cordell, conducted the study using data from EGID Partners, an online patient-centred research network that includes both adult and paediatric patients with EGIDs involving various segments of the GI tract. The objective was to assess the frequency of overlapping GI tract involvement in EGIDs and explore potential differences in clinical presentation and treatment among patients with EoE alone, non-EoE EGID without oesophageal involvement (EGID-NE), and non-EoE EGID with oesophageal involvement (EGID-WE).

Methods

To do this, researchers assessed the EGID Partners cohort. Adults aged 18 and older, as well as caregivers of children under 18 with a diagnosis of EoE or non-EoE EGIDs, were invited to participate.

Participants completed surveys at enrollment, reporting on EGID type, demographics, symptoms, comorbid conditions, and treatments. Patients were categorised as having EoE alone, EGID without oesophageal involvement (‘EGID-NE’), and EGID with oesophageal involvement (‘EGID-WE’).

Results

Patient Groups and Overlap:

Of 527 cases enrolled:

• 402 had EoE alone
• 125 had non-EoE EGID (57 (46%) with EGID-NE and 68 (53%) with EGID-WE)

Importantly, 70% of the non-EoE cases showed overlap, demonstrating the disease affected multiple regions of the GI tract, not just one.

Gender and Family History

• EGID-NE had a much higher proportion of female patients (79%; P < 0.001).
• A family history of EoE or EGIDs was most common in EGID-WE (19% vs. 11% in EoE and 7% in EGID-NE; P = 0.007).

Mental Health Impact

Patient-Reported Outcomes Measurement Information System (PROMIS) measures for anxiety were above general population averages and highest for EGID-WE. 

Treatment Differences

Treatments such as elemental formula (47% vs. 32% vs. 20%; P = 0.001), systemic steroids (33% vs. 56% vs. 14%; P < 0.001), and biologics were also more common in EGID-WE and EGID-NE. 

Conclusion

In conclusion, overlap in regions with eosinophilic infiltration is common among non-EoE EGIDs, with more than half of these conditions involving the oesophagus and a high proportion showing multi-segmental involvement. EGID-WE patients tended to have a greater disease burden.

Further Discussion

This study among a population of both adults and children revealed that the overlap of eosinophilic infiltration across different GI regions is common in EGID patients within the EGID Partners cohort, with more than half showing oesophageal involvement and only one-third limited to a single GI segment.

Patients with EGID-WE tended to report more symptoms, more comorbidities, and higher anxiety and required more intensive treatments. These findings suggest that EGIDs may exist on a spectrum, with increasing severity as more segments are involved. Insights from this patient-reported data can help guide counselling and care strategies.

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Reference:

Corey J Ketchem, Elizabeth T Jensen, Xiangfeng Dai, Chelsea Anderson, Ellyn Kodroff, Mary Jo Strobel, Amy Zicarelli, Sarah Gray, Amanda Cordell, Girish Hiremath, Evan S Dellon, Segmental overlap is common in eosinophilic gastrointestinal diseases and impacts clinical presentation and treatment, Diseases of the Esophagus, Volume 38, Issue 1, February 2025, doaf011, https://doi.org/10.1093/dote/doaf011

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