Diagnosis and Treatment of Eosinophilic Gastrointestinal Disorders

Abstract

Eosinophilic gastrointestinal disorders are a heterogeneous group of disorders defined primarily by an eosinophil-rich inflammatory infiltration of the gastrointestinal mucosa in the absence of other known causes for eosinophilia. In this review, the pathogenesis, clinical symptoms, diagnosis, and treatment of eosinophilic esophagitis (EE) are discussed. As the most common eosinophilic gastrointestinal disorder, EE is associated with food or inhalant hypersensitivity in up to 80% of EE patients. CD4 T cell production of Th2 cytokines interleukin-5 (IL-5) and IL-13 are important in the pathogenesis of these disorders. Clinical characteristics of patients with EE include nausea, vomiting, abdominal pain, dysphagia, food impaction, and feeding disorders. Diagnostic criteria include presence of symptoms consistent with esophageal dysfunction and peak eosinophil count of >15 eosinophils per one high powered field. Gastroesophageal reflux disease must be eliminated diagnostically by the absence of responsiveness to proton pump inhibitors or normal pH monitoring of the distal esophagus. The most common treatment modalities for EE include dietary elimination and oral or topical steroids to decrease esophageal inflammatory responses. Treatment interventions typically require 4–12 weeks to determine efficacy. Leukotriene inhibitors are not as efficacious as steroid therapy. Mepolizumab (anti-IL-5) and omalizumab (anti-IgE) are newer therapies currently under investigation. Future therapeutic agents may target the proinflammatory cytokines involved in the pathogenesis of disease, but more randomized controlled studies are needed to evaluate the benefits and harms of various therapeutic approaches.