Eosinophilic Gastrointestinal Disease Explained

An Eosinophilic Gastrointestinal Disease (EGID) is a digestive system disease where eosinophils are found in above-normal amounts in one or more places in the digestive system and/or blood.

Eosinophils are a normal cellular component of the blood and certain tissues, including spleen, lymph nodes, thymus, and the submucosal areas of the gastrointestinal, respiratory, and genitourinary tracts. Counts of 0 to 450 eosinophils per cubic millimeter of blood are considered within normal limits. Eosinophilic disorders occur when eosinophils are found in above-normal amounts in various parts of the body.

When the body wants to attack a substance, eosinophils respond by moving into the area and releasing a variety of toxins. When the body produces too many eosinophils, they can cause chronic inflammation and result in tissue damage.

There are many diseases where eosinophils have been found elevated in the blood or different tissues. General categories of disease range from allergic disorders to endocrine disorders. EGIDs can be divided into primary and secondary types. The primary type is has allergic and non-allergic forms. The allergic type is associated with food allergies while the non-allergic form occurs when no obvious cause can be found.

Diagnoses are made based on where the elevated levels of eosinophils are found. Click below to read more at the Mayo Clinic.

Symptoms

  • Pain
  • Swelling
  • Skin Rash
  • Hives
  • Reflux
  • Choking
  • Difficulty Swallowing
  • Nausea
  • Vomiting
  • Loss of Appetite
  • Stools Containing Blood and/or Mucus
  • Abdominal Cramping
  • Diarrhea
  • Pseudopolyps
  • Protein Loss
  • Anemia
  • Malabsorption
  • Developmental Delay
  • Bleeding
  • Nutritional Deficiencies

Treatment Options

Since there is no known cure for EGIDs, management of the condition is needed in order to prevent severe damage to the digestive system (and to the organs in the case of Hypereosinophilic syndrome) caused by the high numbers of eosinophils. Because symptoms vary so widely and may mimic other conditions, it is important to have accurate information and awareness of EGIDs.

Dietary Treatment

For those who are unable to obtain enough nutrition from food alone, amino acid-based formula may be needed as a supplement. Some primary disease types may require the avoidance of foods and complete reliance on an amino acid-based formula. These may be consumed normally or pumped through a special feeding tube (naso-gastric, gastrostomy, or jejunostomy tubes).

For the most severe flare-ups or for those who experience problems from all foods and formulas, feeding through a blood vessel (TPN) may be the only remaining option.

Medication

Pain medication may be needed for specific symptoms. This disease may cause severe bleeding or nutritional deficiency that it may be life-threatening if not treated with appropriate medications.

Comorbid Diseases with Elevated Eosinophils

Allergic Disorders

Allergic rhinoconjunctivitis (hay fever) in the nasal muscosa, asthma in the lung, other allergic conditions

Drug Reactions

Allergic reactions to a drug in blood or tissues where it is concentrated

Infectious Diseases

Parasitic infections (helminthiasis − worms), fungal infections, and some other types of infections

Blood Diseases

Hematologic disorders including hypereosinophilic syndrome, leukemias, lymphomas, tumors, mastocytosis, and atheroembolic disease

Immunologic Diseases and Reactions

Hyper-IgE syndrome, Omenn’s syndrome, thymomas, transplant rejections and other conditions

Endocrine Diseases

Hypoadrenalism 

Elevated Eosinophils With Organ Involvement

Skin and Subcutaneous

Atopic dermatitis (eczema), bullous pemphigoid, pemphigus vulgaris, dermatitis herpetiformis, drug-induced lesions, urticaria, eosinophilic panniculitis, angioedema with eosinophilia, Kimura’s disease, Shulman’s syndrome, Well’s syndrome, eosinophilic ulcer of the oral mucosa, eosinophilic pustular folliculitis, recurrent cutaneous necrotizing eosinophilic vasculitis

Pulmonary

Drug/toxin-induced eosinophilic lung disease, Loeffler’s syndrome, allergic bronchopulmonary aspergillosis, eosinophilic pneumonia, Churg-Strauss syndrome, eosinophilic granuloma, pleural eosinophilia

Gastrointestinal

Gastroesophageal reflux, parasitic infections, fungal infections, Helicobacter pylori infections, inflammatory bowel disease (ulcerative colitis and Crohn’s disease), food allergic disorders, protein-induced enteropathy and protein-induced enterocolitis, allergic colitis, celiac disease, pemphigus vegetans (MR) and primary eosinophilic esophagitis, gastroenteritis, colitis, rare tumors (leiomyomatosis), connective tissue diseases, and vasculitic diseases

Neurologic Disorders

Organizing chronic subdural hematoma membranes, central nervous system infections, ventriculoperitoneal shunts, drug-induced adverse reactions

Cardiac

Secondary to systemic disorders such as the hypereosinophilic syndrome or the Churg-Strauss syndrome, certain congenital heart conditions such as septal defects, aortic stenosis

Renal

Eosinophiluria (eosinophils in the urine) is associated with infections or interstitial nephritis and eosinophilic cystitis

Eosinophils In Detail

The eosinophil is a specialized cell of the immune system. This pro-inflammatory white blood cell generally has a nucleus with two lobes (bilobed) and cytoplasm filled with approximately 200 large granules containing enzymes and proteins with different (known and unknown) functions.

Eosinophils are formed exclusively in the bone marrow, where they spend about 8 days in the process of maturation before moving into the blood vessels. They travel through the vessels for 8 to 12 hours before they finally arrive at destination tissues, where they remain for 1 to 2 weeks. Interleukin 5 (IL-5) appears to be the major growth factor for this type of cell.

The functions of the eosinophil are varied, some of which are very similar to other white blood cells. They are implicated in numerous inflammatory processes, especially allergic disorders. In addition, eosinophils may have a physiological role in organ formation (e. g. postgestational mammary gland development).

Eosinophilic functions include moving to inflamed areas, trapping substances, killing cells, antiparasitic and bactericidal activity, participating in immediate allergic reactions, and modulating inflammatory responses.

Eosinophils can be either helpful or harmful. At one extreme, such as in the illness erythema toxicum, eosinophils play the role of a beneficial modulatory element or an innocent bystander. At the other extreme, represented by conditions like Loeffler’s disease and idiopathic hypereosinophilic syndrome, eosinophils are linked with permanent pathologic changes.

Eosinophilic Esophagitis Image