ABOUT
EG/EoD

Eosinophilic gastritis and/or eosinophilic duodenitis (EG/EoD) is characterized by CHRONIC GASTROINTESTINAL (GI) SYMPTOMS as well as ACTIVATED EOSINOPHILS AND MAST CELLS that play a key role in disease pathogenesis1-4

CLINICAL PRESENTATION

The clinical presentation of EG/EoD (sometimes referred to as eosinophilic gastroenteritis, or EGE) is nonspecific, and patients are often misdiagnosed with another GI condition such as irritable bowel syndrome (IBS), functional dyspepsia (FD), or gastroesophageal reflux disease4,5

EG/EoD can affect patients of any age and sex4,6

Many patients do not exhibit additional clinical clues, such as peripheral eosinophilia or concomitant allergic conditions4,6,7

More serious signs such as GI bleeding, weight loss, or malabsorption may occur but are rare5,8

A CONSTELLATION OF NONSPECIFIC GI SYMPTOMS9

Patients may not know how to thoroughly describe their symptoms, including impact to daily living, so it is important to ask them about these details during their diagnostic evaluation

Characteristic symptoms of EG/EoD (percentage of patients)a

Many patients with EG/EoD who self-assessed using a validated patient-reported outcome (PRO) questionnaire reported in a clinical study experiencing all or most of these symptoms, while others experienced only a subset10

Other potential symptoms

Patients are often symptomatic for a long time prior to diagnosis of EG/EoD—11 years on average— so they may develop adaptive behaviors that lead them to downplay their symptoms4,13

Patients previously diagnosed with eosinophilic esophagitis (EoE) who have GI symptoms distal to the esophagus may have concomitant EG/EoD; a recent retrospective study of 45 such patients found that 53% met diagnostic criteria for EG/EoD14

A symptom diary can help your patients keep a detailed account of their symptoms, providing you with a more complete picture of their disease

ROLE OF EOSINOPHILS AND MAST CELLS

Activated eosinophils and mast cells in the GI tract drive the pathogenesis of EG/EoD2,3,15

Eosinophils and mast cells
are present at low levels in healthy GI tissue and communicate with multiple other cell types, including epithelial, neuronal, smooth muscle, and other immune cells9,16-18

In eosinophilic gastrointestinal diseases (EGIDs) like EG/EoD and eosinophilic esophagitis (EoE), aberrant accumulation and activation of eosinophils and/or mast cells in the GI tract drive inflammation3,9,19

Inflammation driven by eosinophils and mast cells results in alterations in normal GI physiology, which may manifest as chronic nonspecific GI symptoms such as abdominal pain, diarrhea, early satiety, bloating, and nausea/vomiting5,7,9,15-17,20

In a prospective study of 405 individuals, over 90% of patients diagnosed with EG/EoD had been previously diagnosed with at least one functional GI disorder such as IBS or FD – conditions characterized by nonspecific symptoms in which eosinophils and mast cells may also play a pathogenic role4,15-17

See how activated eosinophils and mast cells can cause chronic gastrointestinal symptoms and drive EG/EoD pathogenesis2,3

EG/EoD MAY BE A COMMON CAUSE OF CHRONIC GI SYMPTOMS4

References:  1. Gonsalves N. Eosinophilic gastrointestinal disorders. Clin Rev Allergy Immunol. 2019;57(2):272-285. doi:10.1007/s12016-019-08732-1.  2. Reed CC, Genta RM, Youngblood B, et al. Mast cell level and clinical correlates in patients with eosinophilic gastritis and gastroenteritis [abstract]. Gastroenterology. 2020;158(6 suppl 1):S838-S839. doi:10.1016/S0016-5085(20)32773-6.  3. Youngblood BA, Brock EC, Leung J, et al. Monoclonal antibody reduces eosinophil and mast cell infiltration in a transgenic mouse model of eosinophilic gastroenteritis. JCI Insight. 2019;4(19):e126219. doi:10.1172/jci.insight.126219.  4. Talley NJ, Kamboj AP, Chey WD, et al. Endoscopy and systematic biopsy of patients with chronic gastrointestinal symptoms leads to high discovery rate of patients who meet histologic criteria for eosinophilic gastritis and/or eosinophilic duodenitis. Presented at: Digestive Disease Week Virtual; May 22, 2021.  5. Chehade M, Kamboj AP, Atkins D, Gehman LT. Diagnostic delay in patients with eosinophilic gastritis and/or duodenitis: a population-based study. J Allergy Clin Immunol Pract. 2021;9(5):2050-2059.e20. doi:10.1016/j.jaip.2020.12.054.  6. Egan M, Furuta GT. Eosinophilic gastrointestinal diseases beyond eosinophilic esophagitis. Ann Allergy Asthma Immunol. 2018;121(2):162-167. doi:10.1016/j.anai.2018.06.013.  7. Alhmoud T, Hanson JA, Parasher G. Eosinophilic gastroenteritis: an underdiagnosed condition. Dig Dis Sci. 2016;61(9):2585-2592. doi:10.1007/s10620-016-4203-5.  8. Licari A, Votto M, Scudeller L, et al. Epidemiology of nonesophageal eosinophilic gastrointestinal diseases in symptomatic patients: a systematic review and meta-analysis. J Allergy Clin Immunol Pract. 2020;8(6):1994-2003.e2. doi:10.1016/j.jaip.2020.01.060.  9. Pesek RD, Rothenberg ME. Eosinophilic gastrointestinal disease below the belt. J Allergy Clin Immunol. 2020;145(1):87-89.e1. doi:10.1016/j.jaci.2019.10.013.  10. Gonsalves N, Chehade M, Rothenberg ME, et al. Eosinophilic gastritis and eosinophilic duodenitis exhibit a similar clinical presentation, underscoring the need for collection of multiple biopsies from both the stomach and duodenum to evaluate for tissue eosinophilia. Poster presented at: Digestive Disease Week Virtual; May 21, 2021.  11. Jensen ET, Martin CF, Kappelman MD, Dellon ES. Prevalence of eosinophilic gastritis, gastroenteritis, and colitis: estimates from a national administrative database. J Pediatr Gastroenterol Nutr. 2016;62(1):36-42. doi:10.1097/MPG.0000000000000865.  12. Pesek RD, Reed CC, Muir AB, et al. Increasing rates of diagnosis, substantial co-occurrence, and variable treatment patterns of eosinophilic gastritis, gastroenteritis and colitis based on 10 year data across a multi-center consortium. Am J Gastroenterol. 2019;114(6):984-994. doi:10.14309/ajg.0000000000000228.  13. Bedell A, Taft T, Craven M, Guadagnoli L, Hirano I, Gonsalves N. Impact on health-related quality of life in adults with eosinophilic gastritis and gastroenteritis: a qualitative assessment. Dig Dis Sci. 2018;63(5):1148-1157. doi:10.1007/s10620-018-4978-7.  14. Peterson KA, Genta RM, Rasmussen HS, Youngblood BA, Kamboj AP. Gastroduodenal eosinophilia is under-appreciated in eosinophilic esophagitis (EoE) in patients with functional bowel symptoms: a real life experience. Poster presented at: Digestive Disease Week Virtual; May 21, 2021.  15. Sunkara T, Rawla P, Yarlagadda KS, Gaduputi V. Eosinophilic gastroenteritis: diagnosis and clinical perspectives. Clin Exp Gastroenterol. 2019;12:239-253. doi:10.2147/CEG.S173130.  16. Albert-Bayo M, Paracuellos I, González-Castro AM, et al. Intestinal mucosal mast cells: key modulators of barrier function and homeostasis. Cells. 2019;8(2):135. doi:10.3390/cells8020135.  17. Ramsay DB, Stephen S, Borum M, Voltaggio L, Doman DB. Mast cells in gastrointestinal disease. Gastroenterol Hepatol (N Y). 2010;6(12):772-777.  18. Reed C, Woosley JT, Dellon ES. Clinical characteristics, treatment outcomes, and resource utilization in children and adults with eosinophilic gastroenteritis. Dig Liver Dis. 2015;47(3):197-201. doi:10.1016/j.dld.2014.11.009.  19. Caldwell JM, Collins MH, Stucke EM, et al. Histological eosinophilic gastritis is a systemic disorder associated with blood and extra-gastric eosinophilia, Th2 immunity, and a unique gastric transcriptome. J Allergy Clin Immunol. 2014;134(5):1114-1124. doi:10.1016/j.jaci.2014.07.026.  20. Butuci M, Gebremeskel S, Wong A, et al. Activated mast cells and eosinophils are associated with increased inflammatory mediators in mucosal biopsies from EG and/or EoD patients with chronic gastrointestinal symptoms. Poster presented at: Digestive Disease Week Virtual; May 21, 2021.