What is Eosinophilic Gastroenteritis?
Eosinophilic gastrointestinal disorders include three main types: eosinophilic esophagitis, eosinophilic gastroenteritis, and eosinophilic colitis.
Eosinophilic gastroenteritis is a condition that involves inflammation in the gastrointestinal tract, the path that food travels from the mouth to the anus. This condition was first identified by a person named Kaijser in 1937. It is characterized by different levels of infiltration of eosinophils, a type of white blood cell, into the gastrointestinal tract.
The Klein classification is a system used to describe the level of eosinophil infiltration into different layers of the stomach and intestines. These layers include the mucosal layer (the innermost layer), the muscle layer (which helps in churning and mixing of food), and the subserosal layer (the outermost layer).
What Causes Eosinophilic Gastroenteritis?
While we don’t have a lot of information, studies suggest that food allergies, conditions that cause inflammation, infections, cancer, and certain drugs can cause inflammation. The medications that can trigger this process include gold therapy, azathioprine, enalapril, carbamazepine, and antitumor necrosis factor.
Risk Factors and Frequency for Eosinophilic Gastroenteritis
Eosinophilic gastroenteritis is a condition that mostly affects females and is common in people aged 18 years or younger. In the United States, the condition affects about 5.1 out of every 100,000 people. This number is lower than a previous estimate of 28 out of every 100,000 people. However, the number of people with this disease appears to be growing over the past twenty years. Please note, the data on this condition might not be entirely accurate due to its rarity.
Signs and Symptoms of Eosinophilic Gastroenteritis
Eosinophilic gastroenteritis is a condition that can cause various symptoms, depending on how deep or widespread it is in the body. It’s also very crucial to have a detailed history and physical check-up to help distinguish it from other conditions that have similar symptoms. The symptoms can be divided based on the variant of the condition:
- The mucosal variant: This can cause nausea, vomiting, stomach pain, diarrhea, and weight loss.
- The muscular variant: This form of eosinophilic gastroenteritis can cause intestinal obstruction and perforation.
- The subserosal variant: This is not common, and it can cause fluid accumulation (ascites) in the belly and abdominal distention.
Testing for Eosinophilic Gastroenteritis
Eosinophilic gastroenteritis is a unique condition that can cause a range of symptoms. It’s quite hard to diagnose because the doctors must first rule out other illnesses that may lead to an increase in certain white blood cells called eosinophils, such as specific types of tuberculosis, parasite invasions, and tumors.
Typical laboratory test results for this condition may reveal an excess of eosinophils, low protein (hypoalbuminemia), high levels of a specific immune system protein (IgE), and iron deficiency anemia. In some cases, patients may show the presence of specific antibodies (known as antinuclear antibodies), and special crystals (known as Charcot Leyden crystals) in their stool.
Diagnosis is led mainly by an excess of eosinophils both in your blood test and in tissue samples taken from your gut during a procedure called an endoscopy. During an endoscopy, the doctor uses a special instrument to look inside your gut. You might not notice any abnormalities, or you might see redness and sores on the inner lining of your gut.
A CT scan, another type of imaging test, can be helpful in highlighting abnormalities in the wall of your gut, such as uneven narrowing, thickening, or accumulation of fluid (ascites). In this case, testing the ascitic fluid can reveal a rise in the count of eosinophils.
Treatment Options for Eosinophilic Gastroenteritis
Some research has suggested that implementing a diet that removes certain foods could be helpful for people who struggle with proper nutrient absorption. However, removing foods from the diet based solely on suspicion needs further investigation to better understand the effectiveness and long-term outcomes for adults.
Glucocorticoids (a type of steroid) are the main treatment for a condition called eosinophilic gastroenteritis. These drugs need to be gradually reduced over a two-week period. The aim of this gradual reduction is to manage severe symptoms rather than the disease at a tissue level, because scarring is less common in this condition compared to eosinophilic esophagitis (inflammation of the esophagus due to a type of white blood cell called eosinophils).
Various alternative treatments have been proposed according to several case reports. These include leukotriene inhibitors like montelukast (a drug used to control asthmatic symptoms), mast cell stabilizers like oral cromolyn (a medication that helps control allergic reactions), Interleukin-5 inhibitors (drugs that reduce certain proteins in the immune system), Ketotifen (an antihistamine), and drugs that suppress or slow down the body’s immune system. There are also biological agents which include medicines such as vedolizumab, mepolizumab (drugs which help control symptoms of severe asthma), and omalizumab (a medicine which reduces allergic reactions).
For children, the initial approach usually involves limiting or avoiding certain foods, and then starting treatment with steroids. However, it is important to continuously monitor children’s progress since some could relapse or develop a resistance to steroidal treatments.
What else can Eosinophilic Gastroenteritis be?
Eosinophilia is a condition that can be linked to several diseases. Some common ones include:
- Celiac Disease
- Inflammatory Bowel Disease
- Different types of infections such as parasitic, amebic, and fungal
- Connective tissue disorders
- Vasculitis
- Hypereosinophilic syndrome
In some instances, certain diseases like inflammatory bowel disease and lymphoma may appear similarly when viewed through medical imaging techniques, as they can look like eosinophilic gastroenteritis.
In children, other conditions to rule out are non-IgE mediated food allergies and infantile hypertrophic pyloric stenosis, along with the diseases mentioned earlier.
What to expect with Eosinophilic Gastroenteritis
Babies generally have a better chance of recovery than older kids when treated properly. However, the disease’s progression can differ between individuals. While some patients positively respond to treatment, others might progress to a condition called malabsorption, where the body has difficulty absorbing nutrients from food.
Possible Complications When Diagnosed with Eosinophilic Gastroenteritis
Complications of the disease are still unclear and more long-term research is needed to fully understand its progression. Some rare cases have reported acute calculus eosinophilic cholecystitis, an inflammation of the gallbladder, and respiratory issues in newborns with temporary eosinophilic colitis. Management-related complications could arise from long-term use of steroids and there’s a minor risk of ulceration from endoscopic biopsies.
Commonly Reported Complications:
- Unclear long-term effects
- Rare cases of acute calculus eosinophilic cholecystitis
- Respiratory problems in newborns with transient eosinophilic colitis
- Negative effects from long-term steroid use
- Rare risk of ulceration from endoscopic biopsies
Preventing Eosinophilic Gastroenteritis
The process of altering one’s diet for medical reasons involves replacing allergic foods with allergy-free ones, getting professional guidance on healthy eating, and monitoring progress regularly. However, the biggest challenge is ensuring that patients consistently stick to the new diet.
It’s important to note that young people with a condition called eosinophilic gastroenteritis, which involves inflammation of the stomach and intestine, often lack knowledge about transitioning to new health routines. Hence, educating both these young patients and their parents about the condition and how to manage it is vital.
