Introduction to Eosinophilic Esophagitis and Gastroenteritis

I’m a little surprised that my very first blog is not about the topic that consumes my life 24/7. Most people, including me, would think it would be about photography, cameras and all things wedding related. It’s actually about a love that started a long time ago, one that started with the birth of my first and only child.

I want to use this blog as a resource to help other families that are going through a similar process as us. It is a place for questions and answers, enlightenment and support and most of all information because there is little to find on the vast internet about these newly discovered diseases- eosinophiliac esophagitis and gastroenteritis.

Before I share a little background about my 17 year old daughter and why we now think her diagnosis began long before this past year of testing, I would like to help those of you that aren’t familiar with these conditions to understand what they are called, their symptoms, statistics and treatment. I say treatment because there is no cure.

The content out there about these diseases is very confusing and conflicting. I know when my daughter was going through the process of being tested and diagnosed in the spring of 2011 it was extremely overwhelming searching for answers until I stumbled across another man’s blog about his daughter. I found helpful and comforting to know the long testing (years) is not uncommon, nor is the frustration of lack of resources. As we continue to one of the few sites in the country to pursue treatment, I will keep you informed of her journey. I will best describe our experience in easy to use terms to avoid further confusion while explaining tests and related procedures.

Now without further ado here is the bread and butter about Eosinophilic Esophagitis and Gasteroenteritis.

Key Medical Terms:


Eosinophils (pronounced: ee-oh-sin-oh-phils):  

Above: A normal peripheral smear of blood containing an Eosinophil  with red blood cells.

These specialized types of white blood cells (WBC) are present in normal healthy individuals.  They are found in the blood at typical concentrations of 1-3%. As part of the immune system they assist with parasites and certain infections. They are found in areas of the brain, the lower intestinial tract, ovary, uterus, spleen, lynph nodes.

They are also associated with hay fever, asthma and other allergic reactions.

Places Eosinophils are not typically found are the lung, skin, esophagus and some other internal organs. The presence of eosinophils in these organs is associated with disease.

Eosinophilic Esophagitis (pronounced: ee-oh-sin-oh-phil-lic  ee-sapho-gi-tis)   

This is the presence of Eosinophils in the esophagus mucosal lining. A minimum of 15 eosinophils per high power field are required to make the diagnosis. The sample that is analyzed to determine the concentration is collected during an Endoscopy via a biopsy.

Eosinophilic Esophagitis, or more commonly called EE, is newly discovered, only in the past four years. Complications include food getting stuck in the esophagus due to restrictions caused by rings or furrows because of  changes in the esophagus. Symptoms besides food impactation are heartburn and difficulty swallowing.

Treatment of EE may include cortisteroids, esophagus stretching, food restrictions due to allergies or the implementation of a feeding tube in severe cases. However, there are a small percentage of patients that do not have any food allergies. Most treatments are tailored specifically to the patient.

Although mostly in children, it can be found in adults and is being diagnosed more commonly and can be mistaken for GERD (Gastroesophageal reflux disease) in some cases. Conflicting data states that it is predominantly white males. Occurance is 1 in 10,000.

Current studies are being done at specialty hospitals in Ohio, Pennsylvania and Colorado looking into whether this has a genetic correlation.

Eosinophilic Gastroenteritis (pronounced: ee-oh-sin-oh-phil-lic  gas-tro-enter-i-tis): This is the increased presence of Eosinophils in the gastrointestinal (GI) tract. The stomach is most commonly affected followed by the small intestine and the colon. The sample that is analyzed to determine the concentration is collected during an Endoscopy via a biopsy for the stomach  and upper small intestine. A colonoscopy is used for the lower small intestine and colon.

This disease is also newly discovered, only 300 documented medical cases since 1937. Symptoms include nausea, vomiting, diarreha, weight loss and abdominal distention..

Treatment may include corticosteroids. Typical persons affected are 30-50 year olds with slightly higher incidence in men.

So you or your child need to undergo some tests for diagnosis? These will be done and may be required as often as quarterly or yearly for some individuals to track disease progress and treatment.  

Endoscopy (also called an Upper GI study)- Typically a twilight anesthesia is given so the patient is sedated but not unconscious. This type of anesthesia allows for easy wakening and a “sleepy” state by the patient to be responsive to the doctors simple requests. Most often they use a IV to administer the drug. During the endoscopy they may do biopsies of the esophagus, stomach, and small intestine (upper). Procedure is done in an outpatient facility, normally by a GI doctor but will require someone to drive you home afterwards. No eating or drinking 8 hours before the procedure. Total test time is 15-20 minutes but leave enough time for the required thirty minutes of observation afterwards and the preparation before.

Colonoscopy- Typically general anesthesia is given so the patient is sedated. During the colonoscopy they may do biopsies of the small intestine (lower), large intestine, colon and rectum. .  Procedure is done in an outpatient facility, normally by a GI doctor but will require someone to drive you home afterwards. Laxatives are given to clear out the system the day before the test. No eating for 24 hours. Drinking is minimal 8 hours before the procedure. Total test time is approximately 30 minutes but observation afterwards and the preparation before totaling about 2-3 hours.

Blood Tests- Complete Blood Count (CBC) which is a panel of the blood that includes but is not limited to the counts of red blood cells, white blood cells and platelets. They give an exact count of the number of cells and may reveal an increase of the peripheral blood count of Eosinophils.

They may also undergo the following tests:  (my daughter did)

Barium Enema – To test for Chron’s

HIDA Scan (cholescintigraphy)- To test gallbladder

CT Scan of Abdomen- To see organs and thickening of abdomen wall

Sonogram Abdomen - To see organs and look at gall bladder

Barium Swallow Study- To watch barium pass from esophagus to intestines (Scheduled next week)

IBS Blood Panel-A new blood test from Prometheus that helps differentiate between Irritable Bowel Syndrome and other GI disorders (To be scheduled in future- needs Board approval)

Some helpful links:

NJ/PA/DE Support group for Eosinophilic Diseases


Pictures of Rings, Furrows & Biopsies


Andrew's Blog About Ruthie

The International Gastrointesinal Eosinophil Researchers (TIGERS)

Campaign Urging Research for Eosinophilic Disease (CURED)

American Partnership for Eosinophilic Disorders

Quick Facts about Eosinophil Gastrointestinal Diseases (EGID's)

Coming up Next: The first 2yrs- What it meant then and what it means now.