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Eosinophilic Esophagitis and Gastroenteritis

  • Food Allergy (T Green, Section Editor)
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Abstract

Eosinophilic gastrointestinal disease (EGID) can be classified as eosinophilic esophagitis (EoE) when the eosinophilia is limited to the esophagus or as eosinophilic gastritis (EG) if it is limited to the gastric tract, eosinophilic colitis (EC) if it is limited to the colon, and eosinophilic gastroenteritis (EGE) if the eosinophilia involves one or more parts of the gastrointestinal tract. EoE is by far the most common EGID. It is a well-defined chronic atopic disease due to a T helper type 2 (Th2) inflammation triggered often by food allergens. EoE diagnosis is done if an esophageal biopsy shows at least 15 eosinophils per high power field (eos/hpf). Globally accepted long-term therapies for EoE are the use of swallowed inhaled steroids or food antigen avoidance. The treatment of EoE is done not only to control symptoms but also to prevent complications such as esophageal stricture and food impaction. EGE cause non-specific gastrointestinal (GI) symptoms and are diagnosed if esophagogastroduodenoscopy (EGD)/colonoscopy show eosinophilia in one or more parts of the GI tract. They are rare diseases with an unclear pathogenesis, and they are poorly defined in terms of diagnostic criteria and treatment. Before initiating treatment of any EGE, it is imperative to conduct a differential diagnosis to exclude other causes of hypereosinophilia with GI localization. EGE are often poorly responsive to therapy and there is no commonly accepted long-term treatment. EG has many characteristics similar to EoE, including the fact that it is often due to a food allergen-driven Th2 inflammation; transcriptome analysis however shows that it is more a systemic disease and has a different gene signature than EoE. EC is a benign form of delayed food allergy in infant and is instead a difficult-to-treat severe inflammatory condition in older children and adults. EC in the latter groups can be a manifestation of drug allergy or autoimmune disease. Overall EGE, EC, and EG are rare and are a diagnosis of exclusion until more common causes of eosinophilia have been excluded.

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Abbreviations

EoE:

Eosinophilic esophagitis

EGID:

Eosinophilic gastrointestinal disease

EG:

Eosinophilic gastritis

EGE:

Eosinophilic gastroenteritis

EC:

Eosinophilic colitis

GERD:

Gastroesophageal reflux disease

PPI:

Proton pump inhibitor

hpf:

High power field

HES:

Hypereosinophilic syndrome

TSLP:

Thymic stromal lymphopoietin

PGD2:

Prostaglandin D2

DSG-1:

Desmoglein-1

PAMPs:

Pathogen-associated molecular patterns

DAMPs:

Danger-associated molecular patterns

DC:

Dendritic cells

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Acknowledgments

Institutional Support from the Department of Pediatrics, The Children’s Hospital of Philadelphia, and the Joint Center for Gastroenterology and Nutrition of CHOP-HUP and the CHOP Food Allergy Family Research Fund are gratefully acknowledged.

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Conflict of Interest

Dr. Spergel reports grants from the NIH and DBV Technology and personal fees from Dannone. In addition, he has a patent EPIT for treatment for EoE pending. Dr. Cianferoni declares no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Division of Allergy and Immunology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, 3615 Civic Center Boulevard, Philadelphia, PA, 19104-4399, USA

    Antonella Cianferoni & Jonathan M. Spergel

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  1. Antonella Cianferoni
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  2. Jonathan M. Spergel
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Correspondence to Antonella Cianferoni.

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Cianferoni, A., Spergel, J.M. Eosinophilic Esophagitis and Gastroenteritis. Curr Allergy Asthma Rep 15, 58 (2015). https://doi.org/10.1007/s11882-015-0558-5

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