Eosinophilic Disorders

Eosinophilic disorders are characterized by increased levels of eosinophils in one or more places in the digestive tract. Eosinophils are white blood cells that play a role in fighting parasites and allergic reactions. The esophagus, stomach, small intestine and large intestine (colon) may be affected.

There are three types of eosinophilic disorders:

Eosinophilic esophagitis. Eosinophilic esophagitis (EoE) affects the esophagus.
Eosinophilic gastroenteritis. Eosinophilic gastroenteritis (EGE) refers to the stomach and small intestine.
Eosinophilic colitis. Eosinophilic colitis (EC) refers to the large intestine (colon).

Eosinophilic esophagitis (EoE) is the most common eosinophilic disorder. EoE is characterized by elevated eosinophils in the esophagus. EoE is believed to be an allergic reaction most likely to food. There is some evidence to suggest that the allergic substance may be present in the environment. Many patients with EoE also suffer from other allergic diseases, including asthma, eczema and sinus disease.

The symptoms of eosinophilic esophagitis vary and include:

Abdominal pain
Choking episodes
Dysphagia (sensation of food stuck in the esophagus)
Failure to thrive
Heartburn
Refusing to feed
Vomiting

These symptoms may be misdiagnosed as gastroesophageal reflux disease (GERD).

Eosinophilic gastroenteritis (EGE) is a rare condition that damages the stomach. Eosinophils accumulate in the stomach and cause inflammation.

The symptoms of eosinophilic gastroenteritis (EGE) include:

Abdominal pain
Anemia
Fatigue
Malnutrition
Nausea
Poor growth
Vomiting
Weight loss

Eosinophilic colitis (EC) occurs when eosinophils build up in the colon. They can cause injury and inflammation to different layers of colon tissues.

The symptoms of eosinophilic colitis (EC) include:

Abdominal pain
Anemia
Diarrhea, which may be bloody
Difficulty feeding
Fatigue
Malnutrition
Poor growth
Vomiting
Weight loss

Diagnosis of Eosinophilic Disorders

A pediatric gastroenterologist can perform the following exams and tests to help make a diagnosis:

Upper endoscopy. If your child has an eosinophilic disorder, an upper gastrointestinal (GI) endoscopy may show vertical lines or white specks on the lining of his or her esophagus. A diagnosis of EoE is made by obtaining a biopsy (small tissue sample) during the upper GI endoscopy. In patients with EoE, the biopsy will reveal many eosinophils in the esophageal lining.
pH tests. A pH study can help diagnose and manage eosinophilic disorders and GERD. Three different types of pH tests are used to determine if stomach acid is traveling into the esophagus:
- pH probe
- Impedance probe study
- Bravo probe
Allergy testing. A pediatric specialist may consider testing children who have been diagnosed with eosinophilic esophagitis for food and environmental allergies.

Treatments

Treatments for eosinophilic disorders include a range of options, such as:

Medicines. A pediatric gastroenterologist may prescribe an acid-blocking medicine or anti-inflammatory medicine such as a corticosteroid.
Dietary changes. A pediatric specialist may also recommend changes to your child’s diet. Dietary changes should only be done under the supervision of your child's doctor. You and your child will meet with a pediatric dietician. Options include:
- Avoiding foods the child is specifically allergic to
- Avoiding foods that commonly cause allergies (for example, milk, wheat, soy and eggs)
- Other diet modifications as recommended by your child's doctor
Repeat upper GI endoscopy. Your child's pediatric gastroenterologist may schedule a repeat upper GI endoscopy to assess healing of the esophagus. It is important you maintain these appointments.

Key Points to Remember

Eosinophilic esophagitis (EoE) is sometimes misdiagnosed as gastroesophageal reflux disease (GERD).
Medicines and dietary changes can make your child feel better.
An increased level of eosinophils may also affect other parts of the digestive tract. Eosinophilic gastroenteritis (EGE) refers to the stomach and small intestine and eosinophilic colitis (EC) refers to the large intestine (colon).

Support Services & Resources

Visit the websites below to find support groups and services and learn more about eosinophilic disorders.

Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.

Learn More About Riley Support Services

GIKids

This website from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition provides education and information about eosinophilic disorders and eosinophilic esophagitis.

Asthma and Allergy Foundation of America

This website offers resources for patients and families living with eosinophilic asthma.

American Academy of Allergy, Asthma & Immunology

This website provides an overview of eosinophilic esophagitis and other allergy-related information.

American Partnership for Eosinophilic Disorders

This website offers resources to improve the lives of patients and families living with eosinophilic disorders.

Food Allergy Research & Education

This website delivers extensive information about food allergies for patients and families coping with related conditions, including eosinophilic esophagitis.

Eosinophilic Disease Program

The Eosinophilic Disease Program at Riley at IU Health provides family-centered clinical care and education to children and families living with food allergies and eosinophilic gastrointestinal disorders (EGIDs).