• Eosinophilic Gastroenteritis—Child

    Definition

    Eosinophilic gastroenteritis (EGE) is the buildup of white blood cells called eosinophils in the stomach and intestine linings. EGE can lead to inflammation, tissue damage, ulcers, and polyps. Damage to the tissue can make it difficult to absorb nutrients from food.
    EGE may occur in periods without symptoms and periods when symptoms are severe.

    Causes

    It is not clear what causes EC. It is likely a blend of genetics and the environment.
    Eosinophils are part of the immune system response to problems in the body. Part of their normal function is to cause inflammation that helps trap harmful material. With EGE, eosinophils build up when it is not needed or remains longer than needed and causes unnecessary inflammation. It is not clear what causes the buildup. It may be linked to the presence of an allergen.

    Risk Factors

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

    Symptoms

    Symptoms may include:
    • Severe abdominal pain
    • Bloating
    • 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 medical history. A physical exam will be done. EGE is hard to diagnose with simple tests. However, some tests may be able to rule out other diseases with similar symptoms.
    Tests to rule out other conditions may include:
    • Blood tests
    • Allergy tests
    • Endoscopy—a lighted tube with a camera is used to look at the stomach and small intestine
    A biopsy is the only way to confirm EGE. During a biopsy, tissue samples from an endoscopy are studied under a microscope to confirm a diagnosis.
    Upper GI Endoscopy
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    Treatment

    EGE cannot be cured. For some people, removing cow’s milk and soy from the diet might manage symptoms. This is mainly true for infants.
    Treatment focuses on managing symptoms to decrease damage to tissue. Treatment options may include:

    Dietary Changes

    Foods that cause symptoms will need to be avoided. Proteins, such as soy, nuts, eggs, or milk are common allergens. A dietitian can help to guide dietary needs. Some complications include:
    • If all proteins need to be removed, then only the building blocks called amino acids can be consumed. Liquid formulas may be needed. In some cases, a feeding tube may be used.
    • A nutritional support program may be needed to support growth. This may include vitamins and supplements.

    Medications

    Medications are used to manage EGE and treat complications. These may include:
    • Oral steroids to reduce inflammation during symptom flare ups
    • Medications to boost, change, or suppress the effects of the immune system
    • Medications to reduce stomach acid
    • Iron pills to treat anemia
    Medications to manage allergies or asthma may also be needed.

    Surgery

    If the opening from the stomach to the small intestine becomes too narrow or blocked, then surgery will be needed to fix it.

    Prevention

    There are no current guidelines to prevent EGE because the cause is unknown.

    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

    About eosinophilic gastroenteritis (EGE). The Southeast Eosinophilic Disease Center of Atlanta, Inc. website. Available at: https://www.seedcenteratl.org/about-eosinophilic-gastroenteritis-ege. Accessed June 15, 2017.

    Eosinophilic gastroenteritis. American Partnership for Eosinophilic Disorders website. Available at: http://apfed.org/about-ead/egids/ege. Updated November 11, 2014. Accessed June 15, 2017.

    Eosinophilic gastroenteritis. EoE Resource website. Available at: http://www.eosinophilicesophagitisresource.org/eosinophilic-gastroenteritis. Accessed June 15, 2017.

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