Eosinophilic Gastrointestinal Disorders
Eosinophilic gastrointestinal disorders (EGIDs) are a group of diseases in which eosinophils build up in the gastrointestinal tract. These disorders include
- Eosinophilic esophagitis (EoE), which involves the esophagus. This is the most common type of EGID.
- Eosinophilic gastritis, which involves the stomach
- Eosinophilic gastroenteritis, which affects both the stomach and small intestine
- Eosinophilic colitis, which affects the colon, or large intestine
In healthy people, small numbers of eosinophils may be found in all areas of the gastrointestinal tract except the esophagus. However, people with EGIDs have high eosinophil counts in the gastrointestinal tract. To understand eosinophil, we need to look at the cells in our blood. Part of our blood is made up of white cells that circulate through the body and help fight infection. One type of white cell is called the eosinophil. These particular cells are involved in our body's allergic reactions. For example, eosinphils are believed to be activated in people with asthma.
The diagnosis of EGIDs, particularly EoE, is increasing in both adults and children. Health experts believe that this increase reflects changes in diagnostic practice as well as an actual increase in the number of cases. According to the Registry for Eosinophilic Gastrointestinal Disorders, EoE may affect up to one in 1,000 people.
For most patients, EGIDs are life-long conditions. Early treatment and continued followup are important to decrease the long-term effects of these diseases. Cause
Health experts are working to understand the factors that influence development of EGIDs. These disorders sometimes run in families, and scientists have identified several genetic variations associated with EoE.
Symptoms of EGIDs vary from person to person and depend on where in the gastrointestinal system eosinophils accumulate. Many signs of EGIDs closely resemble those of other gastrointestinal disorders, such as inflammatory bowel diseases.
Common EGID symptoms include
- Trouble swallowing
- A feeling that food is stuck in the throat or chest
- Chest or abdominal pain
- Heartburn or acid reflux that does not improve after taking appropriate medicine
- Poor appetite
Currently, the only clear-cut way for doctors to diagnose an EGID is by conducting an endoscopy with biopsy. In this procedure, a doctor uses an endoscope—a thin tube with a camera and light on the end—to look at the gastrointestinal tract and take small tissue samples called biopsies. A pathologist reviews the biopsies, looking for high levels of eosinophils and signs of tissue damage. Treatment
Treatment with diet changes and/or medicines can alleviate EGID symptoms and prevent further damage to the gastrointestinal tract. Treatment options vary depending on the location of eosinophils and the severity of symptoms.
Many people with EoE respond well to diet changes, and dietary restrictions also may be helpful in treating those with other forms of EGID. Sometimes, doctors will advise a six food elimination diet in which patients avoid all common allergenic foods, including milk, eggs, wheat, soy, nuts, and seafood.
Some people with EoE require a stricter diet called an elemental diet, which does not contain any whole or partial proteins for the immune system to recognize and respond to. People on an elemental diet consume prescription liquid formulas that contain amino acids (the building blocks of proteins), fats, sugars, vitamins, and minerals. Some people find it difficult to drink enough of the formula to maintain proper nutrition and may require tube feedings directly into the stomach.
Once EGID symptoms are under control, certain foods may be slowly added back into the diet under the guidance of a doctor and dietician. Medicines
Because dietary management of EGIDs can be challenging, some patients choose medicines to treat their EGID. The Food and Drug Administration has not yet approved any medications for the treatment of EGIDs, but doctors may use certain drugs “off-label” to treat these disorders. Corticosteroids used to control asthma, such as fluticasone propionate or budesonide, may help suppress inflammation in people with EoE. While people with asthma typically take these medicines with an inhaler or nebulizer, those with EoE swallow the drugs so that the medicine comes in direct contact with the esophagus. Studies have shown that these drugs can resolve symptoms completely in some people with EoE, although symptoms return when medicine is stopped.
People with other types of EGIDs may take corticosteroids designed for delivery to specific parts of the gastrointestinal tract. In more severe cases, doctors may prescribe oral corticosteroids, such as prednisone, which deliver medicine to the whole body.
Courtesy: National Institute of Allergy and Infectious Diseases