How Eosinophilic Gastritis and/or Eosinophilic Duodenitis Is Treated

Diet and medications are the primary treatments

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Treatment for eosinophilic gastritis and/or eosinophilic duodenitis (EG/EoD), previously often called eosinophilic gastroenteritis, is highly individualized. Because it is underdiagnosed and currently not a common disorder, there aren’t results from big trials to draw on for guidance. Much of what is known about the disease comes from individual case reports and small studies.

This article will explore treatment for EG/EoD, including dietary changes and medications including steroids, mast cell stabilizers, leukotriene receptor antagonists, and biologics.

Young woman with a stomach ache.


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Home Remedies and Lifestyle

People who live with EG/EoD are often also diagnosed with allergies. These may include food allergies, environmental allergies (such as to pollen), drug allergies, asthma, eczema, or allergic rhinitis. Avoiding allergens (substances that trigger allergies) is a key part of managing allergies.

If there is a food allergy, treatment might start with making diet changes. In some cases, a systematic approach to removing foods from the diet might help in finding a food allergy if one hasn’t been diagnosed yet.

A Dietitian May Help

Diet is complicated and understanding how it affects health can be challenging to untangle. People with EG/EoD are often given special diets to follow. This affects not only what they eat, but also their lifestyle, such as going out to eat and attending parties.

A dietitian can assist not only in deciding what to eat, but in making sure that a diet fits in with everything else going on in life. In addition, it can be helpful to have a professional second set of eyes to look over diet, nutrition, and symptoms to understand what changes are working.

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. However, a change in diet alone doesn't always lead to remission. 

Elimination Diets

In an elimination diet, certain foods are removed from the patient’s diet. There are various ways to undertake an elimination diet. What is commonly used in EG/EoD are the two-, four-, and six-food elimination diets.

In these diets, foods that are known to be common allergens are removed from the diet. A certain number of them (between two and six, or sometimes more, as the name of the diet suggests) are discontinued for a period of time.

The most common eight 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. For that reason, there may also be additional foods removed from the diet.

In a true food allergy, the treatment is eliminating that food from the diet in some or all of its forms. In that case, the allergenic food might need to be stopped long-term, beyond the period that’s needed to treat the symptoms of EG/EoD.

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. In that way, it can be seen if any symptoms crop back up again when a particular food is added in.

Some people with EG/EoD might, unfortunately, have symptoms come back when foods are added back to the diet. Other types of diets might also be used to treat EG/EoD, as specified by a physician and/or a dietitian.

Elemental Diets

An elemental diet involves the use of nutritional formula. Patients that are prescribed this diet as a treatment will receive their food in the form of liquid nutrition. This strategy is used because it can remove all the potential food proteins that may cause allergies from the diet. 

This diet can be challenging for many reasons. It should only be used with the help of healthcare professionals. This is because it would be easy to not get enough calories and nutrients and wind up 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 lead to feeling 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, which is another reason support is so crucial.

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.

However, 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. This means that it is more difficult to understand how changes in diet affect EG/EoD. 

Prescriptions

A number of medications are also used to treat EG/EoD.

Steroids

A corticosteroid is a prescription medication that is most often used to treat EG/EoD. 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 their bones and growth.

Steroids such as prednisone have been studied for EG/EoD. These drugs act systemically, that is to say, they affect the entire body. This might be useful for those who have disease in multiple areas of the digestive tract.

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

In some cases, patients might feel better a few weeks after starting steroids. However, the response rates reported in studies and case reports could be anywhere between 50% to 100%. Steroids are still used frequently to get the disease under control.

Patients that have inflammation that extends all the way through the digestive wall (called serosal disease) might do better with steroids.

Mast Cell Stabilizers

This class of drugs includes sodium cromoglycate, ketotifen, and suplatast. Case reports show that some patients may find their symptoms are reduced when receiving these drugs. It may be because these drugs inhibit the creation 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.

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

Leukotriene Receptor Antagonists

This class of drugs may be given along with steroids or alone. They have the effect of preventing the creation of leukotrienes. Leukotrienes are released by the body during an allergic response. 

Montelukast is one of the 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, for those with severe disease, such as when strictures (narrowing of the digestive passages) are present, it might not be as useful.

Biologics

Biologics are medications that block specific inflammatory pathways in the body. They are being investigated for use in treating EG/EoD. Some of the biologics being used or studied include Xolair (omalizumab), Cinqair (reslizumab), Remicade (infliximab), and Nucala (mepolizumab). 

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 them more challenging to administer to patients.

Surgery

Surgery is not an effective treatment for EG/EoD. Because the condition can occur anywhere in the digestive tract, surgery won’t help in the long term. 

However, in some cases, the disease is not diagnosed and treated effectively, and patients experience complications such as bowel obstructions (blockages) or perforations (holes).

Surgery might be used to treat these problems, but timely diagnosis and treatment can help avoid unnecessary surgery. Obstructions caused by the bowel wall becoming too thick due to EG/EoD may respond to steroids.

Summary

Steroids are often given as the first choice of medical therapy for EG/EoD. Other medications might be given in order to avoid the use of steroids (and their effects). Dietary changes are also used and while they can be challenging to implement, some patients can find relief from symptoms.

A Word From Verywell

EG/EoD is not well understood or studied. That makes diagnosis and treatment challenging. While there are several different treatment choices available, it’s not known which treatment will work best for which patient.

More treatments are under investigation, which will help with awareness of EG/EoD as well as diagnosis and treatment for those living with the condition.

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