Eosinophilic enteropathy (EE) is a disorder of the digestive system. In all people with EE, one type of white blood cells, called eosinophils, exists in higher-than-normal concentrations in some part of the body (often the esophagus). Eosinophils have an important role in the immune system: They release toxins to kill germs and parasites. But when there is an overabundance of eosinophils in the body, the toxins they release can cause uncomfortable and even debilitating symptoms in the digestive system. EE is usually associated with allergies, and many people with EE are sensitive to a great many foods.
Types of EE:
EE is generally classified based on the part of the body affected by eosinophilia (higher-than-normal concentration of eosinophils). Major types of EE include:
- Esophagus: Eosinophilic Esophagitis
- Stomach: Eosinophilic Gastritis
- Small Intestine: Eosinophilic Enteritis
- Stomach and Small Intestine: Eosinophilic Gastroenteritis
- Large Intestine: Eosinophilic Colitis
Frequency of Eosinophilic Disorders:
EE is considered rare, although there are indications that, like other allergic conditions, EE is becoming more common. Studies have generally estimated that between 1 to 4 in 10,000 people may have eosinophilic esophagitis. But one 2007 study, which offered participants a biopsy and physical exam, found that as many as 1% of the population may have sufficient symptoms and test results to be diagnosed with eosinophilic esophagitis. (Some people have mild symptoms and don't seek medical attention, while others may be misdiagnosed.) Eosinophilic gastrointestinal disorders are rarer than eosinophilic esophagitis.
Signs and Symptoms:
EE can cause many painful symptoms throughout the digestive tract. Vomiting, nausea, and abdominal pain are common symptoms. Symptoms are slightly different depending on which part of the digestive system is affected.
Eosinophilic esophagitis can cause difficulties in swallowing, reflux-like symptoms, and heartburn.
Eosinophilic gastritis, enteritis, and gastroenteritis can cause abdominal pain, diarrhea, anemia, malnutrition, and bloody stool.
Diagnosing EE: What to Expect at the Doctor's Office:
Diagnosing EE begins with a medical history. Doctors might suspect EE if treatment for symptoms like reflux or heartburn hasn't worked.
The only definitive diagnostic test for EE is an endoscopy, or a biopsy of some part of the digestive tract. Doctors will analyze the concentration of eosinophils in the tissues of the esophagus, stomach, or intestine and will look for other symptoms caused by eosinophilic activity, like polyps or inflammation.
Allergic Triggers and EE:
EE is often associated with IgE-mediated allergies. In most cases, EE is associated with food allergies, although environmental allergens (to pollen or pets, for example) can also play a role. For this reason, after a confirmed diagnosis of EE, allergists generally perform food allergy testing and testing for other allergies.
Medication and Diet:
Treatment for eosinophilic disorders can be roughly divided into two categories -- diet and medication. Avoiding food allergens can help some patients, but in many cases, more drastic dietary changes are necessary for at least a matter of weeks. In these cases, doctors may recommend elemental diets: formulas of proteins broken down into their component amino acids to make them especially easy to digest.
Other Treatment for Eosinophilic Esophagitis:
Dilation of the esophagus is another treatment option for eosinophilic esophagus patients with esophageal strictures, but because dilation's helpful effects may not last more than several months, dietary and medication therapies are usually the first steps.
Living with Eosinophilic Disorders:
There are several major challenges to living with EE -- managing the painful symptoms, coping with a restricted diet, and in some cases, dealing with elemental diets that may be unpalatable and are certainly boring and repetitive.
In some cases, removing a few allergens from the diet makes a major difference in the course of EE. However, for some people, it's necessary to remove numerous foods from the diet. This can create three major issues. First, and most immediately, a severely restricted diet may cause difficulties in getting sufficient nutrients and calories. Second, finding foods that are safe for a diet with multiple allergies can be frustrating and challenging. And finally, severely restricted diets compound the normal social pressures of living with food allergies, especially for children.
While none of these issues are simple, there are some tools that you may find helpful. First, connect with one of the major organizations providing support, resources, and information to the EE community. The American Partnership for Eosinophilic Disorders (APFED) and Campaign Urging Research for Eosinophilic Disease (CURED) both offer a wealth of information on their websites and may be able to help you get in touch with other families or resources in your area.
Second, consider working with a nutritionist or dietitian with specific expertise in restricted diets. Your allergist or gastroenterologist may have a recommendation for such a professional in your area. APFED offers a resource for families whose doctors may have recommended an elemental diet.
Finally, managing the social and emotional aspects of a restricted diet are similar for EE patients and for people with other food allergies, although many people with EE have to contend with many food allergies. You may find some of these resources useful:
- Tips for Safe Holidays with Food Allergies
- Preschool and Food Allergies
- Managing Allergy-Related Stress
Feldman, Mark, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th Ed. Philadelphia: Saunders Elsevier, 2006.
Gonsalves, Nirmala. "Food Allergies and Eosinophilic Gastrointestinal Illness." Gastroenterology Clinics. Mar. 2007 36(1): 75-91.