Pediatric Eosinophilic Gastrointestinal Disorders

What are Pediatric Eosinophilic Gastrointestinal Disorders?

Eosinophilic gastrointestinal disorders (EGIDs) are rare health conditions where white blood cells, called eosinophils, build up in the digestive system. Eosinophils play an important role in the body's response to allergic reactions, asthma and parasitic infections. But too many eosinophils can cause swelling, inflammation and discomfort.

Eosinophil disorders are rare, affecting around 1 in 1,500 children. However, they can affect how your child eats, grows and develops. EGIDs are often seen in children with other allergic disorders, such as asthma, eczema and food allergies.

What are the different types of Pediatric Eosinophilic Gastrointestinal Disorders?

The location of your child’s inflammation determines which kind of EGID they have. They can happen in the esophagus, large intestine or stomach and small intestine. There are three types of gastrointestinal eosinophilic disorders:

Eosinophilic colitis

Eosinophilic colitis (EC) is swelling caused by too many eosinophils gathering in the large intestine. EC can cause problems with your child’s stool, such as diarrhea.

Eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is inflammation caused by high amounts of eosinophils in the esophagus. If left untreated, it can lead to growth failure as it causes difficulty in swallowing foods and narrowing — and even scarring — of the esophagus over time.

Eosinophilic gastroenteritis

Eosinophilic gastroenteritis (EGE) is inflammation caused by an abundance of eosinophils collecting in the stomach or small intestine. The swelling can stop the small intestine from appropriately digesting and absorbing nutrition, which can lead to problems with growth and development.

Eosinophilic gastritis

Eosinophilic gastritis (EG) affects only the stomach and can cause long-term stomach pain, vomiting, and feeding problems, which can affect your child’s growth and development.

What are the signs and symptoms of Pediatric Eosinophilic Gastrointestinal Disorders?

• Abdominal pain (in combination with another allergy condition, such as eczema, allergic rhinitis, asthma or food allergies)
• Bloating
• Chest pain
• Choking or gagging on certain foods
• Diarrhea
• Difficulty swallowing (dysphagia)
• Feeding difficulties
• Food impaction in food pipe (esophagus)
• Oral aversion and picky eaters
• Slow growth
• Vomiting

How are Pediatric Eosinophilic Gastrointestinal Disorders diagnosed?

There are several tests to diagnose eosinophilic disorders. A doctor will review your child's medical history and conduct a physical exam. They might also perform one or more of the following tests:

• Allergy tests. Your child’s doctor may put a small prick in your child’s skin to see whether they develop a hive or take a blood sample to send to a lab for testing. These allergy tests can tell your child’s doctor what your child is allergic to.
• Colonoscopy. For this test, doctors use a thin, flexible tube with a small camera attached to it — called a scope — to examine your child’s colon, rectum and part of the small intestine.
• EGD. Doctors insert a scope through your child’s mouth, down the esophagus, to the stomach and small intestine.
• Flexible sigmoidoscopy. Using a scope, your child’s care team will examine their lower colon and rectum.

During a colonoscopy, EGD, and flexible sigmoidoscopy, your child’s care team will also do a biopsy, which means they will collect a small portion of tissue to look for eosinophils under a microscope. Doctors may order these tests for your child throughout treatment, as well, to make sure it is working.

Not every child needs all of these tests. Your child’s physician will tell you exactly what the next steps are.

What causes Pediatric Eosinophilic Gastrointestinal Disorders?

Eosinophilic disorders occur when an allergic disorder, such as asthma or hay fever, triggers the immune system to produce an excess of a certain type of white blood cells called eosinophils. Children with food-related allergies often develop these disorders. EGIDs also sometimes run-in families.

How is Pediatric Eosinophilic Gastrointestinal Disorders treated?

Your child’s care team will work to remove triggers from your child’s diet. They will also offer treatments to help eliminate the swelling in your child’s digestive system.

Treatments to remove triggers include three main types of nutrition plans:

• Allergen elimination. Also known as a six-food elimination diet, this nutrition plan removes common trigger foods such as milk, soy, eggs, peanuts, wheat and seafood from your child's diet for a while. Then, your child will reintroduce these foods one by one to help identify which are causing the inflammation in their digestive system.
• Targeted elimination. This nutrition plan is determined by allergy testing and eliminates any and all foods your child may be allergic to from their diet.
• Elemental. This liquid formula diet is made up of essential vitamins, minerals, and broken-down proteins. For example, if your child is allergic to a cow milk protein, the elemental formula has a safe version of that protein for your child to ingest. With formula, your child can still get the nutrients they need to grow strong and healthy.

Treatments to reduce or eliminate swelling in your child’s digestive system might include:

• Proton pump inhibitors. These oral medications reduce stomach acid and help with inflammation
• Swallowed topical steroids. Swallowing steroid medication can reduce inflammation in the esophagus.
• Esophageal dilatation. This treatment for EoE involves stretching a narrowed part of your child’s esophagus using an endoscope.