Eosinophilic Gastritis

What is Eosinophilic Gastritis?

Eosinophilic Gastritis is a very uncommon disorder characterized by an inordinately large amount of eosiniphils – a type of white blood cell – in the gastrointestinal tract. Eosiniphil cells are an important part of our general immune system, they help fight off certain types of infections particularly those caused by parasites. However, having a very large conglomeration of these cells in one area can cause adverse side effects. The -itis in Gastritis means that there is swelling that occurs, this swelling can cause chronic abdominal pain.

The disorder can affect people of any age range – infants to elder adults. It is quite often that a patient who is diagnosed with eosinophilic gastritis will show a family history of allergic disorders, like asthma, food allergies or allergies to mold, dander or other environmental factors. Because this disease is not common, a patient afflicted with it can go for years without a correct diagnosis. While this disease has not been something that has been diagnosed often in the past, it seems to be an emerging affliction. It is estimated that 1 in 2000 people may be affected.

Possible Cuases of Eosinophilic Gastritis

Unfortunately there is no definitive cause to pinpoint when diagnosing eosinophilic gastritis. What seems to be a common trend among patients is a high percentage of food or seasonal allergies. As with the allergies themselves, avoiding contact with the things that trigger the allergies can offer relief for the disease as well.

Symptoms

The symptoms of eosinophilic gastritis can be varied and can include, but are not limited to:

  • weight loss
  • diarrhea
  • bloody stools
  • loss of appetite
  • abdominal pain
  • vomiting and nausea
  • difficulty swallowing and the sensation of food getting lodged in throat
  • heartburn
In some patients the symptoms will be severe and occur frequently, causing missed time at work or school or missed social events. In other patients they can show up in a milder form, less often. There may also be instances of slow or poor growth or swelling in the extremities. There may be a persistent, severe reflux which will not improve with use of antacids. More than 50% of these patients will show a high level of eosiniphils in their blood.

Diagnosis

Because of the wide and varied symptoms this disease is often misdiagnosed and treated as something else. If you find yourself undergoing treatment for acid reflux or irritable bowel syndrome with little or no relief, it might be time to test for this disease. In order to properly diagnose eosinophilic gastritis, a history of symptoms consistent with the disease as well as an extremely high number of eosiniphils in the wall lining of the gastrointestinal tract must be found. An endoscopy – a test wherein a small scope is inserted into the patient and used to take a look down into the stomach – can be performed to look for this.

As it seems as though there is a very strong link to food allergies to this disorder, the patient should undergo a food sensitivity evaluation. The recommended method for this is through a skin test. Should the skin test come back negative, then patch testing for foods can be done to check for food sensitivities that are delayed. As these tests are performed the patient should examine their diet and avoid the foods that are causing the sensitivity issues. The patient may also want to undergo skin testing for the typical seasonal environmental allergies if the symptoms seem to follow a seasonal pattern.

Treatment Options

Because eosinophilic gastritis is most commonly linked to allergy triggers, the best way to reduce symptoms is food avoidance Find which foods cause the triggers and remove them from your diet entirely. Occasionally this food avoidance does not entirely work for every patient. In these severe cases, a very basic diet may be necessary. In small children there are certain formulas that can be effective (Elecare and Neocate 1+) in improving the symptoms and lowering the amount of eosiniphils in the gastrointestinal tract.

Patients can try starting with a very simple diet and then waiting a period of time for the symptoms to disappear. Once they do a food can be added one at a time to see if it will trigger symptoms. If a food is clear, another can be then added every five days or so. It would be very important to get the advice of a nutritionist during this process to be absolutely certain that all other dietary needs are met during this time.

In very extreme cases, an elemental diet may be tried. An elemental diet is where a patient is taken off of all forms of protein. They would only consume an amino acid – the building blocks of protein – formula, with no partial or whole proteins. Salt, oils and simple sugars are allowed. But these formulas are often biter and difficult to drink and so a feeding tube may be needed. Elemental diets have been very effective in treating this disease, but because of the limitation of the diet itself it may not be an appropriate option for young adults and children who are still growing.

Because patients are often anemic and dehydrated, it can be important to remember to keep hydrated and take iron supplements.

If these dietary changes are not effective, it might be that steroids could provide relief. Although they will remove symptoms and provide a temporarily lull in the disease, as soon as the steroids are ceased, the symptoms often return. When using steroids, there are also side effects to consider:

  • mood changes
  • acne
  • increased infection risks
  • osteoporosis
There are other medications that can be administered including Singulair and cromolyn sodium. These often give mixed results. Currently there is more research being done in order to find more effective methods of treatment that don’t carry as many side effects as steroids do.

Prognosis

Eosinophilic gastritis doesn’t seem to limit life expectancy and there is no strong suggestion that it causes cancer. Remember, because this disease is so uncommon many patients have been struggling with it for years undiagnosed and untreated, while this was certainly an uncomfortable period for them, there have not seemed to be any additional long-term affects. Occasionally the condition is complicated because of swelling, which can make eating difficult or uncomfortable. Because this is a relatively “new” disease, long-term monitoring is still underway. More medications are being developed and tested that could possibly assist with future management.

How Will this Affect my Life?

When the condition is first diagnosed it can seem overwhelming and the effects of dietary changes can affect the entire family as it is often easier to change the eating habits of an entire family than of just one person.

Other friends and family may not understand the effects that unsafe food may have on someone with eosinophilic gastritis and may think that “just a little” can’t hurt. The holidays in particular can often be food focused events. A patient who is maintaining a food control over this issue may want to arrive to parties and gatherings with a full stomach in order to avoid being tempted to try ‘just a little’ of a dangerous food. For children there are options for birthdays and parties wherein food is not the focus.

Keeping a positive outlook and turning to family outings that focus on non-food activities can help alleviate some of the stress of the changes.

For more detailed information check out the list of topics about eosinophilic esophagitis.

You can also ask questions and communicate with others about the disorder by becoming a member of the free Eosinophilic Esophagitis Forum.