How Eosinophilic Gastritis and/or Eosinophilic Duodenitis Is Treated

Diet and medications are the primary treatments

Treatment for eosinophilic gastritis and/or eosinophilic duodenitis (EG/EoD), previously called eosinophilic gastroenteritis, is highly individualized. The mainstay of treatment is steroids, diet, and mast cell stabilizers as well as other anti-allergy medications. Because EG/EoD is not well understood or studied, diagnosis and treatment can be challenging.

If you have been dealing with the effects of this condition, the process of finding the treatment plan that controls your symptoms can feel frustrating at times because it's hard to predict which of the available therapies will work best for you, 

Additional novel treatments are under investigation, and these developments may help you manage your condition.

This article will discuss currently available therapies that are used to manage the symptoms of EG/EoD.

Young woman with a stomach ache.


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Home Remedies and Lifestyle

If you have EG/EoD, there's a high likelihood that you also have allergies. These may include food allergies, drug allergies, environmental allergiesasthma, eczema, or allergic rhinitis. Avoiding allergens (substances that trigger allergies) is a key part of managing allergy symptomd.

If you have a food allergy, treatment might start with making dietary changes to avoid the foods that you are allergic to.

A Dietitian May Help

People who have EG/EoD are often given special diets to follow. A dietitian can assist in helping you decide what to eat and in making sure your diet fits in with everything else going on in your life.

Supervised Diets

The dietary changes that are most often used for EG/EoD are elimination diets and an elemental diet. These diets should be supervised by a healthcare professional.

A change in diet alone doesn't always lead to remission, and having fewer symptoms (sometimes called clinical improvement) doesn’t always mean that there has been an effect on the inflammation caused by the disease.

Most patients don’t have any testing (such as endoscopy) to see if the inflammation has gone down after a change in diet.

Elimination Diets

In an elimination diet, certain foods that are known to be common allergens are briefly eliminated from the diet. There are various ways to undertake an elimination diet. The elimination diets commonly used in EG/EoD are the two-, four-, and six-food elimination diets. A certain number of common allergens (between two and six, or sometimes more) are discontinued for a period of time.

The eight most common food allergens are:

  • Egg
  • Fish
  • Milk
  • Peanut
  • Shellfish
  • Soy
  • Tree nuts
  • Wheat

While these are the most common, other foods can cause allergies as well, and you may be advised to eliminate additional foods from your diet.

Elimination diets should only be undertaken with the guidance of a dietitian. That will help prevent any vitamin and mineral deficiencies that may come about from eliminating several foods at once. Also, it will be important to track signs and symptoms when the foods are stopped to understand what the effects are on EG/EoD.

After a period of time, foods will be reintroduced into the diet, one at a time to see if any symptoms crop back up again when a particular food is added in.

True food allergies are treated by eliminating the allergy-triggering food from the diet in some or all of its forms. The allergenic food might need to be stopped long-term, beyond the period that’s needed to treat the symptoms of EG/EoD.

Some people who have EG/EoD might have a recurrence of symptoms when foods are added back to the diet.

Elemental Diets

An elemental diet involves the use of a liquid prescription nutritional formula. This diet can be used to remove the potential food proteins that may cause dietary allergies. 

This diet should only be used with the guidance of healthcare professionals.

An elemental diet might help improve symptoms. In children, especially, it’s important to get the disease under control in order to avoid problems with growth and development. One meta-analysis of several studies showed that this diet might reduce symptoms in as much as 75% of patients.

Challenges include:

  • Not getting enough calories and nutrients, and losing weight or being malnourished. This is especially true for children, who are still growing and who have different nutritional needs than adults.
  • Drinking your calories for the day can make you feel hungry and tired. That can lead to a reduced quality of life for some people who try this diet. It might be more difficult to attend work and school while on this diet.

Prescriptions

A number of medications are used to manage the symptoms of EG/EoD. but there are no treatments approved for EG/EoD by the Food and Drug Administration (FDA). 

Steroids

The medications that are used most often to treat EG/EoD are prescription corticosteroids. Steroids such as prednisone have been studied for EG/EoD. These drugs act systemically, affecting the entire body. This might be useful for those who have disease in multiple areas of the digestive tract or who have inflammation that extends all the way through the digestive wall (called serosal disease).

Forms of steroids that only act on the digestive system, such as budesonide, have also been used, but not as frequently—they are usually prescribed for people who can’t tolerate prednisone.

You might feel better a few weeks after starting steroids. The response rates reported in studies and case reports range widely, between 50 to 100%.

The goal of steroid treatment is to use the lowest dose possible for the shortest period of time. This is because steroids can have unwanted side effects, some of which can be serious. For children, in particular, there can be adverse effects on bones and growth.

Mast Cell Stabilizers

This class of drugs includes sodium cromoglycate, ketotifen, and suplatast. Case reports show that some patients may have a reduction of symptoms when receiving these drugs.

Mast cell stabilizers are sometimes used as “steroid-sparing” therapies in order to avoid corticosteroids. Sometimes they are also used in addition to steroids.

They may work by inhibiting the production of mast cells. Mast cells may be a part of the chain of events that leads to the overproduction of white blood cells that causes inflammation in the digestive system.

While these medications have been described in case reports and are being explored as a treatment for EG/EoD, they are not FDA-approved to treat the condition.

Leukotriene Receptor Antagonists

This class of drugs may be given along with steroids or alone. Montelukast is one of the leukotriene receptor antagonists medications that might be used to treat EG/EoD. Some reports show that it is effective for some patients. It can also be used for several months, unlike steroids, which are ideally only given for short periods of time.

Montelukast might be effective in helping symptoms for those who have disease in their duodenum (first part of the small intestine). However, if you have severe disease, such as disease that's complicated by strictures (narrowing of the digestive passages), it might not be as useful.

These medications have the effect of preventing the production of leukotrienes. Leukotrienes are released by the body during an allergic response. 

It's important to note that while these medications are being investigated, and have been used to treat symptoms, they are not FDA approved to treat EG/EoD.

Biologics

Biologics are medications that block specific inflammatory pathways in the body. They are being investigated for use in treating EG/EoD.

Biologics may work for EG/EoD by stopping one of the steps in the chain of events that leads to inflammation. These medications are given by injection or intravenously, which makes the process a little more challenging.

While biologic medications are currently under study for treating EG/EoD, none are FDA approved. The results of research and clinical trials may help determine their role in managing EG/EoD.

Summary

Steroids are often the first choice of medical therapy for EG/EoD. Other medications might be prescribed to reduce the use of steroids (and their effects). Dietary changes are also used, and while they can be challenging to implement, some people can find relief from symptoms of EG/EoD with dietary modifications.

A Word From Verywell

In order to have the best chance of managing your symptoms, you need to stay informed about advances taking place in the diagnosis and management of EG/EoD. Part of this includes talking to your healthcare team about what’s new or upcoming in treatments, as well as any opportunities to participate in clinical trials. Being an empowered patient often means asking questions, which can help in getting the disease under control and living a better quality of life.

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