Definition

Eosinophilic gastritis (EG) is a buildup of white blood cells called eosinophils. It can lead to long term inflammation of the stomach. EG can make it hard for the body to get enough nutrients from food.

EG may occur in cycles. Symptom may fade or stop for a time, then they may flare up again.

Cause

Eosinophils are part of the immune system. They should only respond to an infection or injury. These cells release a chemical that causes inflammation. With EG, the inflammation starts or continues even though it is not needed. Over time this can lead to tissue damage, ulcers, and polyps in the colon.

It is not clear what causes EG. It is likely due to a blend of gene defects and the environment. It may also be linked to an allergic reaction.

Risk Factors

Factors that may increase your child’s chances of EG include:

  • Genetic problems
  • Family members with allergies or asthma
  • Food allergies
  • Seasonal allergies
  • Atopic dermatitis
  • Other eosinophilic gastrointestinal diseases

Symptoms

Symptoms may include:

  • Severe belly pain
  • Abdominal swelling
  • A feeling of fullness after eating a small amount
  • Heartburn
  • Nausea
  • Vomiting
  • Diarrhea, with or without blood
  • Fatigue
  • Problems feeding in infants

Complications may include:

  • Malnutrition
  • Weight loss
  • Anemia or iron deficiency from blood loss

Diagnosis

You will be asked about your child’s symptoms and past health. A physical exam will be done. EG is hard to diagnose with simple tests. Some tests may be able to rule out other conditions with similar symptoms.

Tests to rule out other conditions include:

  • Blood tests
  • Allergy tests
  • Endoscopy—a lighted tube with a camera is used to view the stomach lining

A biopsy is the only way to confirm EG. A sample of the stomach will be removed. It will be sent to a lab to look for eosinophils. This will be done through an endoscopy.

Upper GI Endoscopy
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Treatment

Treatment will focus on slowing or stopping inflammation and tissue damage. Treatment options may include:

Dietary Changes

Certain foods may cause symptoms. They will need to be avoided. Milk and soy are often problems for infants.

Proteins, such as soy, nuts, eggs, or milk are also common allergens. A dietitian can help with meal planning.

Other diet changes may include:

  • Some may have severe protein limits. Special liquid formulas may be needed to provide safer forms of protein. In some cases, a feeding tube may be used.
  • A nutrition plan may be needed to support growth. This may include vitamins and supplements.

Medicine

Medicine may help to manage EG. These may include:

  • Steroids—to reduce inflammation during symptom flare ups. May be given as pills or passed into the colon.
  • Medicine to boost, change, or suppress the immune system.

Medications are also used to treat complications. These may include:

  • Medicine to reduce stomach acid
  • Iron pills to treat anemia caused by lack of nutrient absorption or proteins

Medicine to manage allergies or asthma may also be needed.

Prevention

There are no current steps to prevent EG because the cause is not clear.

RESOURCES

American Partnership for Eosinophilic Disorders  http://apfed.org 

Healthy Children—American Academy of Pediatrics  https://www.healthychildren.org 

CANADIAN RESOURCES

Canadian Association of Gastroenterology  https://www.cag-acg.org 

Sick Kids—The Hospital for Sick Children  http://www.sickkids.ca 

References

Eosinophilic gastritis. National Organization for Rare Disorders (NORD) website. Available at: https://rarediseases.org/rare-diseases/eosinophilic-gastroenteritis/. Updated: 2018. Accessed January 11, 2019.

Eosinophilic gastritis. American Partnership for Eosinophilic Disorders website. Available at: http://apfed.org/about-ead/egids/eg. Accessed January 11, 2019.

Fahey LM, Liacouras CA. Eosinophilic Gastrointestinal Disorders. Pediatr Clin North Am. 2017 Jun;64(3):475-485.

Zhang M, Li Y. Eosinophilic gastroenteritis: A state-of-the-art review. J Gastroenterol Hepatol. 2017 Jan;32(1):64-72.

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