What is eosinophilic gastroenteropathy?

A.

Eosinophilic gastroenteritis (EG) is a rare, poorly understood disease that can involve any part of the digestive tract. It is characterized by infiltration of the involved areas by a type of white blood cell called an eosinophil. At least 80 percent of affected patients also have elevated levels of eosinophils in their bloodstream. The cause of EG is unknown, but theories include allergies to certain foods, undiagnosed parasitic infection of the bowel or a reaction to medication.

Symptoms of EG include nausea, vomiting, abdominal pain, diarrhea and/or weight loss. The diagnosis is confirmed when elevated eosinophils are found in the blood and no other explanation for the symptoms can be found. Specifically, stool studies are evaluated to rule out a parasitic infection. The medications that the patient is taking are also reviewed to ensure that they are not the cause. At some point, patients with these unexplained symptoms receive an upper and/or lower endoscopy. The findings can range from normal to ulcerated and swollen tissue. Biopsies reveal the characteristic infiltration of the layers of the bowel with eosinophils.

The treatment for EG starts with dietary changes. In some cases, an allergist performs skin tests to check for specific food allergies. If none is found, the next step is to eliminate different types of foods in turn, beginning with dairy products. The importance of the diet lies in the fact that many patients with EG report allergies to certain foods or a family history of allergy.

If modifying the diet doesn't help, another approach is antiparasitic medication, especially in patients who live in areas with high rates of parasitic infection. The last resort is treatment with steroids or immunosuppressive agents. Most patients treated with these medications improve within a few weeks, so the long-term outcome for someone with EG is generally good.