How Eosinophilic Gastritis and/or Eosinophilic Duodenitis Is Diagnosed

Eosinophilic gastritis and/or eosinophilic duodenitis (EG/EoD), previously often called eosinophilic gastroenteritis, affects the digestive tract and causes a variety of gastrointestinal symptoms.

The process of diagnosing EG/EoD may take quite some time because the signs and symptoms are often nonspecific. Patients unfortunately often live with digestive symptoms for many years and go through several rounds of testing with various healthcare professionals. In some cases, there may be a misdiagnosis of another digestive condition or there may not be a diagnosis made at all. 

In the past, there has not been a test that could definitively diagnose EG/EoD, though imaging, endoscopy, and biopsy are all helpful in the process. More recently, research showed that the use of an updated testing method may help in diagnosing EG/EoD.

An upper endoscopy (EGD) with 12 biopsies (samples of small pieces of tissue), which evaluates the volume of eosinophils present in the lining of the digestive tract, is now considered the gold standard for the diagnosis of EG/EoD. This test, along with an analysis of symptoms and other conditions a person may have, could lead a health care professional to properly diagnose ED/EoD in a more timely way.

It can be frustrating to undergo more testing, especially if an endoscopy or other tests were done in the past and didn’t provide any resolution. Patients may also need to raise awareness of the advances in research on ED/EoD with their healthcare team. It can be challenging to ask healthcare providers, and specialists in particular, to consider new research and more testing. However, taking the lead in one’s own care is empowering and may lead to improved management of symptoms and a better quality of life.

Upper Endoscopy With Biopsy

what to expect during an EGD

 Illustration by Emily Roberts, Verywell

Endoscopy tests can be helpful in the diagnosis process for a variety of reasons, especially because a biopsy (a small sample of tissue) can be taken from the digestive tract during this procedure. The most up-to-date testing protocol for EG/EoD recommends using this method. A comprehensive test recommends an upper endoscopy (EGD) with 12 biopsy samples. Even if you had this procedure in the past, it might be worth repeating using the updated comprehensive protocol, so be sure to discuss this with your healthcare provider.

During an EGD, you are sedated and a flexible tube with a light on the end is inserted into the body by a physician to see the inside of the digestive tract. For EG/EoD, most often that might be into the mouth, down through the esophagus, and into the stomach.

Some of the signs of the disease, such as bowel thickening and ulcers or inflammation, might be seen during an endoscopy. Other signs could be nodules and tissue that appears granular (granularity) or tears or bleeds easily (friable).

Biopsies taken from the digestive tract might show an increased amount of eosinophils when it is examined under a microscope. For diagnosing EG/EoD, the biopsies are collected from the stomach and upper part of the small intestine. All 12 samples all collected during a single procedure that typically takes under 30 minutes. If the samples show a higher than normal eosinophil count, your healthcare provider may consider EG/EoD. A diagnosis of EG/EoD may be made after taking into account these test results as well as your symptoms, physical exam, and history.

Physical Examination

It can take some time to accurately diagnose ED/EoD because its symptoms are nonspecific and it goes vastly underrecognized and underdiagnosed. A few different physicians may be involved, and it can take several appointments and different types of tests to get a diagnosis.

The physical examination that’s done during the diagnostic process for this condition can help add evidence to the presence of the disorder, but also rule out other potential causes.

The signs of the disease and how it affects various parts of the body may make it seem like everything that’s happening is unrelated at first. It may take a high suspicion for ED/EoD on the part of the physicians involved in diagnosing the problem to put everything together.

Some findings from a history and a physical exam could lead to more investigation, to see if the cause of the problems is ED/EoD. When significant digestive issues are present, it may also prompt a referral to a gastroenterologist. It is a gastroenterologist who will most likely be the main point of contact for treating and managing ED/EoD.

To help you prepare for diagnostic appointments with your healthcare provider—and for follow-up appointments to discuss results and next steps—use our downloadable Doctor Discussion Guide below. It'll help you learn relevant terminology, anticipate questions you may want to ask, and more.

Family History

As many as 20 percent of people with EG/EoD may have a family history of the disease. The genetic part of eosinophilia is still being investigated so that it can be better understood. For that reason, your healthcare team may ask if you have any family members who live with eosinophilic disorders.

Personal History

Physicians may ask you about allergies to food or environmental allergies (such as to pollen, mold, or pet dander). They will also want to know about skin conditions like eczema, and any problems in the respiratory tract like asthma or difficulty breathing.

There will also be questions about how your digestion is affected, which includes symptoms like abdominal pain, diarrhea, trouble swallowing, or indigestion. 

Lungs and Nose/Sinuses

The connection to allergies also may mean that signs and symptoms are found in the lungs and the sinuses. This can include wheezing upon breathing, nasal congestion, runny nose, sneezing, and itching (rhinitis). A physician may listen to your lungs and check the ears, nose, and throat to get a sense of the severity of these symptoms.

Skin Conditions

Allergies can affect the skin, and for some people that might be the primary sign of an allergic reaction. Some of the problems that might be seen on the skin include dermatitis or eczema. A dermatologist might be involved if there are significant skin problems that need treatment.

Labs and Tests

During the diagnosis period, blood, urine, and stool tests may be done, but most lab tests aren't thought to provide much evidence about whether or not EG/EoD is the true diagnosis. They still serve a purpose, however.

Stool tests can help rule out certain types of infections — such as with a bacteria like Clostridium difficile — and by looking for parasites.

Blood tests may show a slight increase of a type of white blood cell (eosinophils) and a type of antibody (immunoglobulin E) that are associated with allergies and EG/EoD. Proteins called cytokines, such as eotaxin-3 and interleukin-5, might also be found in higher-than-normal amounts.


Some imaging tests may help in the process of diagnosing EG/EoD. Abdomen sonography may confirm if there is fluid buildup in the abdomen (ascites). This test might also show if any of the walls of the bowel have become thickened because of inflammation.

Barium studies might also be used during the diagnostic process. In these studies, a barium solution is given as a drink or an enema, and X-rays are taken. These are also not going to provide a definitive diagnosis, but they can be helpful in finding any thickened bowel walls or loops of bowel that are suspicious.

The most useful imaging test will likely be abdominal computed tomography (CT). In this form of imaging, you lie on a table and a scanner takes multiple X-rays to help find if there is any thickening of the bowel walls or narrowing of the inside of the intestine and ascites.

Differential Diagnoses

Your physician will consider whether these other conditions may be contributing to your symptoms instead.

Bacterial or Parasitic Infections

Certain types of infections can cause symptoms similar to EG/EoD. These can include parasites such as Enterobius vermicularis (pinworms), Ancylostoma caninum (hookworms), Ascaris, Anisakis, Eustoma rotundatum, TrichurisSchistosoma, and others.

For that reason, it’s important to discuss with your healthcare professional any risk factors you have for a parasitic infection, such as working on a farm or coming from an area where such infections are more common.

Inflammatory Bowel Diseases (IBD)

EG/EoD has many signs and symptoms in common with the various forms of IBD (Crohn’s disease, ulcerative colitis, and indeterminate colitis). Some of these include inflammation in the digestive tract, thickening of the bowel wall, and symptoms such as diarrhea and abdominal pain.

It is, however, possible for people to have a diagnosis of both IBD and an eosinophilic disease. There is an increased prevalence of eosinophilic esophagitis in patients with IBD.

Endoscopic evaluation with biopsies of the entire GI tract can rule out IBD.


Two medications that have been the subject of case reports as causing a condition similar to EG/EoD are Vasotec (enalapril) and Lopid (gemfibrozil). 

Vasotec is an angiotensin-converting enzyme (ACE) inhibitor given to treat high blood pressure, diabetic kidney disease, or heart failure. Lopid is given to reduce cholesterol and triglycerides (fatty acids) in the blood. 

Once the drugs were stopped, the symptoms, such as diarrhea and cramping, went away, so eosinophilic disease wasn’t actually present.


EG/EoD has signs and symptoms that can point to many other conditions, so it can take time to reach a correct diagnosis. In the past, there has not been a test that could definitively diagnose EG/EoD, though imaging, endoscopy, and biopsy are all helpful in the process. More recently, research showed that the use of an updated testing method may help in diagnosing EG/EoD.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Peterson KA, Genta RM, Kamboj AP, Singh B, Rasmussen HS, Dellon ES. S1330 high discovery rate of previously undiagnosed patients with eosinophilic gastritis and duodenitis using a systematic endoscopic biopsy protocol: screening data analysis from enigma, a randomized controlled trial. Am J Gastroenterol. 2020;115(1):S669-S670.

  2. Uppal V, Kreiger P, Kutsch E. Eosinophilic gastroenteritis and colitis: a comprehensive review. Clin Rev Allergy Immunol. 2016;50(2):175-188. doi:10.1007/s12016-015-8489-4

  3. Kinoshita Y, Oouchi S, Fujisawa T. Eosinophilic gastrointestinal diseases—pathogenesis, diagnosis, and treatment. Allergol Int. 2019;68(4):420-429. doi:10.1016/j.alit.2019.03.003.

  4. Shih HM, Bair MJ, Chen HL, Lin IT. Eosinophilic gastroenteritis: brief review. Acta Gastroenterol Belg. 2016;79(2):239-244. 

  5. Fan YC, Steele D, Kochar B, Arsene D, Long MD, Dellon ES. Increased prevalence of esophageal eosinophilia in patients with inflammatory bowel disease. Inflamm Intest Dis. 2019;3(4):180-186. doi:10.1159/000497236. 

  6. Barak N, Hart J, Sitrin MD. Enalapril-induced eosinophilic gastroenteritis. J Clin Gastroenterol. 2001;33(2):157-158. doi:10.1097/00004836-200108000-00014

By Amber J. Tresca
Amber J. Tresca is a freelance writer and speaker who covers digestive conditions, including IBD. She was diagnosed with ulcerative colitis at age 16.