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 Eosinophilic Diseases, consistent medical management is essential to prevent chronic inflammation and tissue damage across the body. Whether affecting the digestive tract, lungs, or vital organs, the high concentration of eosinophils can lead to long-term complications if left unchecked. Because symptoms vary significantly and often mimic other conditions, raising awareness and ensuring access to accurate information is critical for early diagnosis and effective care.
Medication
Dupixent. Approved in 2022, this was the first-ever treatment for EoE.
Unlike traditional steroids, Dupixent is a biologic. It’s an injection given under the skin once a week. It works by blocking two specific proteins in your body, Interleukin-4 and Interleukin-13, which are the main ‘conductors’ of the Type 2 inflammation that causes the esophagus to thicken and narrow.
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Who it’s for: Adults and children as young as 1 year old (weighing at least 15 kg).
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The Goal: It’s designed for long-term maintenance to keep inflammation down and prevent food from getting stuck.
Eohilia. This is the first and only oral medication for EoE.
It’s a specialized liquid formulation of a steroid called budesonide. What makes it unique is its ‘thixotropic’ property, meaning it’s liquid when you shake it, but it becomes thick and ‘sticky’ when you swallow it. This allows the medicine to coat the walls of the esophagus effectively as it goes down.
Who it’s for: Patients 11 years of age and older
The Goal: It is currently approved for a 12-week course of treatment to reduce esophageal inflammation and improve daily swallowing symptoms.
Shared Decision Making
When you have an eosinophilic disease, picking a treatment can feel overwhelming. In the past, doctors just told patients what to do. Today, there is a better way called Shared Decision Making (SDM). Shared Decision Making turns healthcare into a team effort. You and your doctor work as equal partners to find the best plan for you.
The Two Experts
A good treatment plan requires two types of experts:
The Doctor: Knows the medical science, test results, and different drug or diet options.
You: Know your own body, your daily schedule, and what matters most to your family.
For example, a doctor can explain how a strict elimination diet works. But only you can decide if that diet fits into your daily routine and school life.
How it works
Step 1: Team up. The doctor explains all of your treatment options.
Step 2: Compare. You look at the pros and cons of each choice together. You can ask about side effects, costs, and how well each option works.
Step 3: Decide. You choose the treatment that manages the illness and fits your lifestyle.
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.
