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A Message From Dr Marc Rothenberg

A Message From Dr. Marc Rothenberg:

Eosinophil associated gastrointestinal disorders (EGID) are a series of growing medical problems characterized by excessive levels of eosinophils in various parts of the gastrointestinal tract. Specifically, these problems include eosinophilic esophagitis, characterized by elevated levels of eosinophils in the esophagus; eosinophilic gastritis, characterized by elevated eosinophils in the stomach; eosinophilic enteritis, characterized by elevated eosinophils in the small intestine; and eosinophilic colitis, characterized by excessive eosinophils in the colon. When eosinophils accumulate in multiple parts of the gastrointestinal tract, this problem is called eosinophilic gastroenteritis. These medical problems cause a variety of difficulties including abdominal pain, reflux, difficulty growing, weight loss, vomiting, difficulty swallowing, diarrhea, and anemia (low hemoglobin or red blood cell count). EGID patients typically suffer from various combinations of these problems making the clinical appearance very diverse and often very severe. In some cases, the presence of EGID is discovered in patients who have no clinical symptoms (following endoscopy for other causes), further complicating the clinical presentation. Sadly, at present, many patients with EGID suffer for a number of years before a diagnosis of EGID is made. Our excellent team of caring professionals at the Cincinnati Center for Eosinophilic Disorders is committed to educating parents, patients and physicians throughout the world about the proper diagnosis and best treatment of these problems.

EGID is becoming recognized more and more throughout the world. In fact, recent studies in Cincinnati have shown that one type of EGID, eosinophilic esophagitis, is even more common than other well known diseases that affect the gastrointestinal tract such as Crohn’s Disease and Cystic Fibrosis. To address this growing medical problem, we have assembled a world renown group of holistic health care providers including allergists, gastroenterologists, pathologists, psychologists, nutritionists, nurses and researchers who work together to provide the best care for patients with EGID. We unite our best efforts to provide highly personalized care to each person we treat.

At Cincinnati Children’s Hospital, our state of the art research team has prioritized finding the best treatment and eventual CURE for EGID. As such, we have determined that most EGID sufferers are allergic individuals who have sensitization to multiple food and airborne allergens. Because of the link with allergy, most patients with EGID have been found to benefit by removing their exposure to the offending allergens. Unfortunately, this often means very restricted diets for EGID sufferers, sometimes necessitating a formula diet and feeding through artificial tubes allowing for proper caloric and nutritional intake. Research involves collecting comprehensive information from patients and their families including environmental exposures and the presence of other diseases and symptoms in patients and their family members. This has led to the finding that EGID often runs in families. We are currently studying the environmental and genetic factors that are responsible for this familial association.

We extend our care in a holistic approach by collecting genetic material (DNA) from patients and their family members. Using data from the human genome project, and state of the art DNA chips, we are rapidly characterizing the spectrum of factors involved in the cause of the disease. For example, we are identifying the specific factors that control the formation and activation of eosinophils. In particular, the proteins that regulate eosinophil growth (interleukin-5 also know as IL-5) and accumulation (eotaxin) have been identified and drugs that interfere with their function are being tested in pre-clinical models, as well as patients. Research studies also involve testing the effect of dietary modifications and the optimal application of currently available medications for EGID therapy. Notably, we are finding that medicines used to treat allergies, such as asthma inhalers, can benefit EGID sufferers. Our research team is working in conjunction with the F.D.A. and various companies to carry out clinical trials designed to find a rapid and effective treatment for EGID. Our current findings are promising and cutting edge.

Our research team has also found that under normal conditions, eosinophils are white blood cells that account for only a small fraction of the cells in the blood (1-3%) and gastrointestinal tract. However, in EGID, the level of eosinophils can become very prominent, sometimes representing the predominant cell in the gastrointestinal segment and/or blood. Importantly, in EGID, eosinophils not only accumulate in the gastrointestinal tract, but they become activated, resulting in tissue damage and inflammation. Each eosinophil is loaded with 200 drops (granules) of toxic chemicals and these toxins are released in the gastrointestinal tract of patients with EGID. As a result, the patient’s tissue is severely damaged, and thus does not function properly. The occurrence of eosinophil accumulation and activation can only be monitored by endoscopy which involves placing a fiber optic tube into the intestinal tract. Individuals with this problem have to undergo frequent surgical procedures (each typically associated with general anesthesia). We are committed to regulating this cellular activity and finding the most efficient and pain free treatment possible.

We are grateful to the C.U.R.E.D Foundation for raising funds for our research aimed at finding the best treatment and CURE. The team at our center joins me in committing our best efforts to finding a CURE. We hope that our joint efforts will result in ameliorating the pain of the tens of thousands of people throughout the world who suffer from EGID.

Statement from Dr. Rothenberg
Director, Division of Allergy and Immunology
Professor of Pediatrics
Cincinnati Children’s Hospital Medical Center
University of Cincinnati College of Medicine
3333 Burnet Avenue, ML7028
Cincinnati OH 45229

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