EOSINOPHILIC GASTRITIS

Eosinophilic gastritis/gastroenteritis (EG/EGE) are inflammatory disorders characterized by eosinophilic infiltration of the stomach and/or duodenum most commonly. In some cases, inflammation of the esophagus, distal intestine, and colon may also be present. This inflammation occurs without any other known cause of tissue eosinophilia.

 

 

Eosinophilic gastritis/gastroenteritis (EG/EGE) should be suspected in a patient with abdominal pain, nausea, vomiting, early satiety, diarrhea, weight loss, or ascites associated with peripheral eosinophilia (eosinophil count >500 eosinophils/microL in the peripheral blood), and/or a history of food allergy or intolerance. 

 

Drug-induced peripheral eosinophilia should be excluded with a detailed review of past, current, and over-the-counter medications and dietary and herbal supplements. Dietary history should include the ingestion of raw or undercooked meat and history of residence in or recent travel to parasite endemic areas.

 

The diagnosis of EG/EGE is based on the presence of eosinophilic infiltration of the gastrointestinal tract on biopsy and/or eosinophilic ascitic fluid.

 

 

EG/EGE are rare disorders that can affect patients of any age, but typically presents in the third through fifth decades. Approximately one-half of patients have a history of allergic disease including asthma, defined food sensitivities, eczema, or rhinitis. 

 

 

In motivated patients who are symptomatic or have evidence of malabsorption, we suggest dietary therapy with an empiric elimination diet (eg, a six-food elimination diet), or an elemental diet. Dietary therapy should be pursued for a minimum of four to six weeks and under the guidance of a dietitian trained in eosinophilic gastrointestinal disorders.

 

We follow patients based upon their symptoms and the changes in peripheral eosinophilia. We perform a repeat endoscopy routinely to assess the response to treatment and/or degree of ongoing disease activity. If the dietary changes are successful at reducing symptoms and either the peripheral eosinophil count by >50 percent or tissue eosinophilia, then foods can be added back slowly in a systematic fashion from least allergenic to most allergenic. 

 

In patients who decline a dietary approach or whose symptoms do not improve after dietary therapy for six weeks, . Improvement usually occurs within two weeks regardless of the layer of bowel involved, the doctor will prescribe the appropriate medication.

 

Patients with gastrointestinal symptoms should be diagnosed and promptly treated.