Eosinophilic Disorders

Washington DC AllergistAlthough there are several types of diseases that are classified as eosinophilic disorders, we will mainly focus on eosinophilic gastrointestinal disorders since they are the most common.  Other eosinophilic disorders that we see and help treat include:  hypereosinophilic syndrome, Churg-Strauss Syndrome (eosinophilic granulomatosis with polyangiitis), eosinophilic pneumonia, eosinophilic leukemia, eosinophilic fasciitis, and eosinophilic cystitis.

Eosinophilic Gastrointestinal Disorders

Definition:

Eosinophilic esophagitis and eosinophilic gastroenteritis are conditions in which excessive numbers of eosinophils (a type of white blood cell) are deposited in the lining of the esophagus (a muscular tube carrying food from the mouth to the stomach) and the stomach and intestines respectively.  The eosinophils release certain proteins which can damage the lining of the gastrointestinal tract and cause difficulty in swallowing and/or abdominal discomfort and pain.

These conditions have been diagnosed more frequently in the last decade, partly due to increased awareness about the conditions and partly due to their increased incidence.  Though the exact cause of these diseases is still under investigation, they are seen more often in people who also have atopic conditions like food and environmental allergies, eczema, seasonal allergies, and asthma.

Symptoms:

Eosinophilic esophagitis:

Adults:  Difficulty in swallowing, the feeling that food gets stuck in the esophagus, heartburn, nausea, vomiting, abdominal or chest pain, regurgitation of food, etc.

Children:  Feeding difficulties, vomiting, poor weight gain, heartburn, abdominal or chest pain, difficulty in swallowing, etc.

Eosinophilic gastroenteritis:

Adults:  Abdominal or chest pain, nausea, vomiting, diarrhea, difficulty swallowing, poor appetite, bloating, blood in stools, etc.

Children:  Abdominal or chest pain, vomiting, feeding difficulties, failure to thrive, diarrhea, etc.

Diagnosis:

Endoscopy (visualization of the inside of the esophagus via a flexible tube with a light source and a camera at the end) can reveal narrowing of the lumen, vertical furrows, scar tissue in the form of rings and whitish patches in the esophagus in patients with eosinophilic esophagitis.  Endoscopy (upper and/or lower) is used to look at the stomach and intestines in patients suspected of having eosinophilic gastroenteritis, but unlike eosinophilic esophagitis, there are generally no characteristic findings, however, it is mostly performed to obtain a biopsy.  Confirmation of the diagnosis of both eosinophilic esophagitis and eosinophilic gastroenteritis requires demonstration of excessive eosinophils under a microscope in a specimen obtained by a biopsy of the lining inside the esophagus and/or stomach/intestines.

Patients will also need skin prick tests, patch tests, and/or blood tests with the common food allergens for the evaluation of a possible food allergy.  Milk, soy, wheat, egg, and fish are the most commonly implicated food allergens.  Environmental allergies to dust mites, molds, pollens, and pets often play a role in the disease.  Many individuals with eosinophilic esophagitis notice that their esophageal symptoms get worse during the pollen seasons.  Environmental allergy skin testing is thus often part of the evaluation.

Laboratory tests should be obtained which usually include a CBC with differential, stool sample, and serum IgE level (the antibody associated with allergic conditions).

Treatment:

  1. Identification of the possible food triggers and eliminating them from the patient’s diet can reduce ongoing inflammation and prevent damage to the esophagus, stomach, and intestines.  In case of multiple food allergen sensitivities, one may need to start with elemental diets containing broken down proteins and gradually reintroducing one new food at a time while closely monitoring the symptoms.
  2. Many patients benefit from taking medications to reduce gastric acid (stomach acid) production.  The class of medications most often used are called  proton pump inhibitors (PPI’s) and may include medications by the names of Aciphex (rabeprazole), Dexilant (dexlansoprazole), Nexium (esomeprazole), Prevacid (lansoprazole), Prilosec (omeprazole), and Protonix (pantoprazole).
  3. Patients who do not respond to PPI’s may need corticosteroids topically.  Medications like Fluticasone and Budesonide which are inhaled into lungs to treat asthmatic individuals can be modified and ingested to treat the inflammation inside the esophagus, stomach, and intestines.
  4. Some patients need bursts of prednisone by mouth for a few weeks to control acute and severe flare-ups of the disease activity, which can occur from time to time.

Though eosinophilic gastrointestinal disorders are chronic and relapsing conditions without a known cure, the quality of life of the patients can be greatly improved by a combination of targeted dietary modifications and judicious use of medications.  The board certified allergists of Black and Kletz Allergy have had a great deal of experience helping diagnose and treat (along with your gastroenterologist) eosinophilic gastrointestinal disorders such as eosinophilic esophagitis and eosinophilic gastroenteritis.  If you are experiencing any of the above symptoms and/or have been diagnosed with any eosinophilic disorder, please contact us for an appointment at any one of our 3 convenient locations in the Washington, DC, Northern Virginia, and Maryland metropolitan (DMV) area.  You can alternatively click Request an Appointment and we will get answer you within 24 hours of the next business day to schedule you an appointment.  Black and Kletz Allergy strives to provide excellent care to our patients in a friendly professional setting in any one of our office locations in Washington, DC, McLean, VA (Tysons Corner, VA), or Manassas, VA.