Disorder Definitions
 

What is eosinophilic esophagitis?
Eosinophilic esophagitis (EoE) is an allergic inflammatory disease characterized by elevated eosinophils in the esophagus (the tube connecting the mouth to the stomach). These eosinophils persist despite treatment with acid blocking medicines. Common symptoms include:

  • Reflux that does not respond to medication (acid suppressors)
  • Difficulty swallowing (dysphagia)
  • Food impactions (food gets stuck in the esophagus)
  • Nausea and vomiting
  • Failure to thrive (poor growth, malnutrition, or weight loss)
  • Abdominal or chest pain
  • Feeding refusal/intolerance or poor appetite
  • Anorexia and early satiety (feeling full)

EoE is growing in prevalence, but currently is still considered a rare disease.

 

Who gets eosinophilic esophagitis?
EoE affects people of all ages and ethnic backgrounds. People of both sexes get EoE, but it is more common in males. In certain families, there may be an inherited tendency. People with EoE commonly have other allergic diseases such as rhinitis, asthma, and/or eczema.

 

What causes eosinophilic esophagitis?
The exact cause of EoE is not known. EoE is typically caused by an immune response to food.

Ongoing genetic studies have identified a number of genes that are differentially expressed and variable in sequence in patients with EoE compared to those without it, including most recently calpain 14. These sorts of advances in the genetics of the disease will hopefully lead to new diagnostic tools and treatment.

 

How is eosinophilic esophagitis diagnosed?
EoE can mimic other more common conditions such as gastroesophageal reflux disease, therefore, as part of the diagnostic process, patients presenting with EoE symptoms/suspected of EoE are usually prescribed acid blockers for about 8 weeks and subsequently re-evaluated. If symptoms do not improve, an upper endoscopy with biopsies is required to make the diagnosis. This involves insertion of a small tube down the esophagus and into the stomach and part of the small intestine. Small tissue samples from each section of the upper GI tract will be taken. A pathologist will review the biopsies to determine if eosinophils are present. A count of 15 eosinophils per high-powered microscopic field or higher warrants a diagnosis of EoE.

 

What is the treatment for eosinophilic esophagitis?
Treatments recommended for EoE include dietary management and topical swallowed corticosteroids, such as fluticasone and budesonide. Dietary management may include elimination diets, in which suspected foods or common food allergens are removed, and elemental diets in which all food protein is removed and nutrition is provided through specialized formula.

In order to evaluate the efficacy of the treatment, periodic endoscopies with biopsies will be necessary.

What is eosinophilic gastritis?
Eosinophilic gastritis is a rare disease in which a type of white blood cell, the eosinophil, accumulates in the stomach and causes injury and inflammation to the stomach. Common symptoms include:

  • Vomiting, nausea
  • Difficulty feeding and/or gaining weight
  • Poor growth
  • Abdominal pain
  • Anemia (low red blood cell counts)
  • Fatigue
 

Who gets eosinophilic gastritis?
Eosinophilic gastritis can affect both adults and children.

People with eosinophilic gastritis commonly have other allergic disorders, and there may be some genetic tendency to develop the disease.

 

What causes eosinophilic gastritis?
In many cases, it is not known what causes eosinophilic gastritis. Food and/or environmental allergies may play a role in the development of this disease.

 

How is eosinophilic gastritis diagnosed?
An endoscopy with biopsies is the only definitive way to diagnose eosinophilic gastritis. A doctor will perform an upper endoscopy where a small tube is directed through the esophagus, stomach, and part of the small intestine. Small tissue samples will be taken from each section of the upper GI tract.

A pathologist will review these biopsies to help determine if there are higher-than-normal levels of eosinophils present. Currently, there is no consensus on how many eosinophils in the stomach are considered to be “too high”. This can sometimes make diagnosis difficult. A doctor will use symptoms, visual evidence noted during the endoscopy and the pathology report to arrive at a diagnosis.

 

What is the treatment for eosinophilic gastritis?
Eosinophilic gastritis is often treated by dietary management or steroids. Dietary management may include elimination diets, in which suspected foods or common food allergens are removed, and elemental diets in which all food protein is removed and nutrition is provided through specialized formula. Iron supplements may also be prescribed.

In order to evaluate the efficacy of the treatment, periodic endoscopies with biopsies will be necessary.

What is eosinophilic colitis?
Eosinophilic colitis is a rare disease in which a type of white blood cell, the eosinophil, accumulates in the colon and causes injury and inflammation to the large intestine(colon). Common symptoms include:

  • Diarrhea, sometimes with blood
  • Difficulty gaining weight
  • Poor growth and weight loss
  • Abdominal pain
  • Malnutrition and anemia (low blood counts)
  • Fatigue
 

Who gets eosinophilic colitis?
Eosinophilic colitis may affect both adults and children. It often presents in the first six months of life, however, it can be diagnosed at any age.

 

What causes eosinophilic colitis?
In most cases, the cause of eosinophilic colitis is unknown. Those with a personal or family history of allergic disorders may be at higher risk of developing eosinophilic colitis.

 

How is eosinophilic colitis diagnosed?
Eosinophilic colitis is diagnosed by a lower endoscopy or colonoscopy. This involves placement of a lighted tube into the anus, rectum and large intestine. Tissue biopsies of the large intestine are necessary to make the diagnosis.

A pathologist will review these biopsies to help determine if there are higher-than-normal levels of eosinophils present. Presently, there is no consensus on how many eosinophils in the large intestine are considered to be “too high,” and this can sometimes make diagnosis difficult. A doctor will use symptoms, visual evidence noted during the endoscopy and the pathology report to arrive at a diagnosis.

 

What is the treatment for eosinophilic colitis?
In infancy, there are no consensus guidelines for the treatment of eosinophilic colitis but sometimes changing formulas may help. In older individuals, the disease is typically chronic, although it may respond to anti-inflammatory, immunosuppressive or diet therapy.

Medications may be prescribed to treat symptoms and may include systemic steroids, topical steroids administered by enema or suppository, anti-inflammatory medications, and iron supplements for patients who are deficient.

In order to evaluate the efficacy of the treatment, periodic endoscopies with biopsies will be necessary.

What is eosinophilic gastroenteritis?
Eosinophilic gastroenteritis is a rare disease in which a type of white blood cell, the eosinophil, accumulates in multiple areas of the gastrointestinal tract (e.g., the stomach and the small intestine) and causes injury and inflammation to those organs. Common symptoms include:

  • Vomiting, nausea
  • Difficulty feeding and/or gaining weight
  • Poor growth
  • Abdominal pain
  • Anemia (low red blood cell counts)
  • Diarrhea/constipation
  • Fatigue
 

Who gets eosinophilic gastroenteritis?
Eosinophilic gastroenteritis can affect both adults and children. People with eosinophilic gastroenteritis commonly have other allergic disorders, and there may be some genetic tendency to develop the disease.

 

What causes eosinophilic gastroenteritis?
In many cases, it is not known what causes eosinophilic gastroenteritis. Food and/or environmental allergies may play a role in the development of this disease.

 

How is eosinophilic gastroenteritis diagnosed?
An endoscopy with biopsies is the only definitive way to diagnose eosinophilic gastroenteritis. A doctor will perform an upper endoscopy and/or a lower endoscopy (a colonoscopy) depending upon symptoms. An upper endoscopy involves a small, lighted tube being directed through the esophagus, stomach and part of the small intestine, while a lower endoscopy involves placement into the anus, rectum and large intestine. Small tissue samples will be taken and a pathologist will review these biopsies to help determine if there are higher-than-normal levels of eosinophils present. A doctor will use symptoms, visual evidence noted during the endoscopies and the pathology report to arrive at a diagnosis.

 

What is the treatment for eosinophilic colitis?
Eosinophilic gastroenteritis is often treated by dietary management or steroids. Dietary management may include elimination diets, in which suspected foods or common food allergens are removed, and elemental diets in which all food protein is removed and nutrition is provided through specialized formula. Topical or systemic steroids and/or other medications may be prescribed depending upon which areas of the gastrointestinal tract are involved and the severity of symptoms. Iron supplements may also be prescribed.

In order to evaluate the efficacy of the treatment, periodic endoscopies with biopsies will be necessary.

 

*This material was developed in collaboration with APFED and CURED, two of CEGIR’s partner Patient Advocacy Groups.