Eosinophilic Esophagitis and Gastroenteropathies

Eosinophilic esophagitis (EE) is an emerging disease of the upper gastrointestinal tract. It has been estimated that 8-10% of children with reflux disease actually have eosinophilic esophagitis. The prevalence of the disease is thought to be around 4.26 per 10,000 children.

Eosinophils are white blood cells that are produced in the bone marrow and travel to various structures in the body, primarily gastrointestinal tract. In normal individuals there should be no eosinophils in the esophagus. The presence of eosinophils in the esophagus is an indication of inflammation. They may be present as a result of acid reflux, but they occur in far higher numbers in patients suffering of eosinophilic esophagitis.

Food allergy is the principal cause of eosinophilic esophagitis and there is a genetic element to the disease: 30-40% of parents of EE children have EE-related symptoms.

Symptoms often start in infancy, but are most prevalent in toddlers. Around 80% of patients are male. Symptom profile very similar to gastroesophageal reflux disease:

• feeding disorders;
• regurgitation;
• vomiting;
• epigastric pain;
• difficulty swallowing;
• food impaction (particularly in older children).

A definitive diagnosis can be made by counting eosinophils numbers in esophageal tissue biopsy specimens.

Exclusive feeding with amino acid-based formula has been shown to be the most effective way of treating eosinophilic esophagitis: patients are extremely sensitive to food antigens and not all hypoallergenic formulas are appropriate for successful treatment.

All eosinophilic gastroenteropathies are related to the location of eosinophilia in the gastrointestinal tract. Subtypes include – in addition to allergic eosinophilic esophagitis - allergic eosinophilic gastritis and allergic eosinophilic gastroenterocolitis.

They are food responsive and react to the usual foods e.g. milk, egg, wheat and soy. In patients with food-responsive eosinophilic gastroenteropathies, the pathophysiological mechanisms seem to include both IgE and cell-mediated reactions.

The symptoms caused by these disorders overlap with those caused by many other pathologic gastrointestinal processes: post prandial nausea, dysphagia, abdominal pain, vomiting and diarrhea. The depth and severity of the eosinophilic inflammation influences these symptoms.
The diagnosis requires confirmation of an eosinophilic infiltration in the gut by biopsy. All age groups may be affected including pre-term infants.