A growing number of children and adults suffer from a chronic and complex group of disorders described as Eosinophilic (ee-oh-sin-oh-fill-ick) Gastrointestinal Disorders (EGID). These disorders are characterized by having above normal amounts of eosinophils, a type of white blood cell, in one or more specific places anywhere in the digestive system.
|Glossary of Terms (from APFED)|
Eosinophils (e-oh-sin-oh-fils), a type of white blood cell, are an important part of the immune system, helping us fight off certain types of infections, such as parasites. Many different problems can cause high numbers of eosinophils in the blood including allergies (food and environ-mental), certain infections (caused by parasites), eosinophil associated gastrointestinal disorders, leukemia, and other problems. When eosinophils arrive to fight a parasite or allergen, they break open and the granules, containing the toxins, spill out (this is called “degranulation”). The toxins, which are meant kill parasites, infiltrate and damage the surrounding tissue.
Eosinophilic disorders are further defined by the area of the body affected. For instance, eosinophilic esophagitis is associated with abnormally high numbers of eosinophils in the esophagus. “itis” means inflammation. While visual inflammation is not always present, inflammation may be apparent under the microscope. Eosinophilic disorders may include the following:
- Eosinophilic Esophagitis (EE): high numbers of eosinophils occurring in the esophagus.
- Eosinophilic Gastritis (EG): high numbers of eosinophils in the stomach.
- Eosinophilic Gastroenteritis (EGE): affects the stomach and small intestine.
- Eosinophilic Colitis (EC): describes the occurrence of high numbers of eosinophils in the large intestine.
What are the Symptoms of EGID?
Symptoms vary widely, depending on the area affected. Symptoms include: •
- Nausea or Vomiting
- Failure to thrive (poor growth or weight loss)
- Abdominal or chest pain
- Reflux that does not respond to usual therapy (which includes proton pump inhibitors, a medicine which stops acid production)
- Dysphagia (Difficulty swallowing)
- Food impactions (food gets stuck in the throat)
- Gastroparesis (Delayed emptying of the stomach)
- Anorexia (poor appetite)
- Blood in the stool
- Difficulty sleeping
Since none of these symptoms are specific for EGID, and many occur at times in healthy children or adults, the diagnosis is generally sought only after the symptoms have failed to resolve. Eosinophilic disorders can mimic the symptoms of other diseases like inflammatory bowel disease, food allergies, irritable bowel syndrome and reflux, among others.
How are Eosinophilic Disorders Diagnosed?
Endoscopy and biopsy is the ONLY way to confirm the diagnosis of EGID. During an endoscopy, the gastroenterologist looks at the GI tract through an endoscope and takes multiple small samples (biopsies) which the pathologist reviews. A high number of eosinophils (counted per high power field) suggest the diagnosis of EGID. The pathologist will also look for the location of the eosinophils, changes in the tissue layers, and degranulation (spilling of the contents of the eosinophils). Eosinophils may be normally found in small numbers in all areas of the GI tract except the esophagus. GERD (reflux) is associated with low numbers of eosinophils in the esophagus. With eosinophilic esophagitis, the number of eosinophils seen is much higher and remains elevated on medication for reflux. Once the diagnosis of EGID is confirmed, food allergy testing is typically recommended to guide treatment. Tests for food allergies include skin prick testing, patch testing and Radioallergosorbent test (RAST).
Can EGID be Cured?
There is no “cure” for EGID, but treatment can help alleviate symptoms and prevent further damage to the gastrointestinal (GI) tract. Treatment of eosinophilic disorders will vary based on the location of the eosinophils, severity of symptoms, and other medical problems the child/adult may have. In most cases, dietary measures and medications can significantly improve problems related to the underlying eosinophilic disease. Your doctor will help guide you through the various treatment options to find a therapy that is best for you and your family.
Portions © American Partnership for Eosinophilic Disorders 2008, Reproduced with permission. For more detailed descriptions, see http://apfed.org/egid.htm