| Eosinophilic gastrointestinal disorders (EGIDs) describe a group of conditions characterized by abnormal infiltrate of the GI tract by eosinophils causing inflammation. Classification depend on the location and pattern of involvement, including eosinophilic esophagitis (EoE), eosinophilic gastritis, eosinophilic gastroenteritis, eosinophilic enteritis and eosinophilic colitis. Although commonly thought of as a 'Western' disease, it is not unfound in Asia and may be under-diagnosed in the locality. Clinical presentation of EGIDs is often nonspecific with significant overlap with other GI conditions and thus high clinical vigilance is essential. Endoscopically, typical features could be found in rings, furrows and exudates in cases of EoEs, but there are no distinctive features for the other EGIDs. Other investigations such as blood tests for peripheral eosinophilia and imaging findings are therefore informative as an adjunct. Nevertheless, endoscopy remains the cornerstone of diagnosis due to the role of obtaining tissue for histological evaluation, as well as detection of complications such as stricture formation. Adequate sampling even over apparently normal mucosa is recommended. Treatment is generally recommended in all cases and the overall principle is similar except for the case of EoE, where an inital trial of proton-pump inhibitor (PPI) should be considered. Otherwise pharmacological therapy in the form of topical or systemic steroid, or steroid-sparing immunosuppressants is the treatment of choice. Alternatively, patient may respond to dietary treatment, or a combination of both. Surgery might be indicated to manage strictures, with biologics such as IL-4 inhibitor have emerged as a potential promising form of therapy for severe cases. |
