Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Eosinophilic gastroenteritis

Nirmala Gonsalves, MD
Section Editor
Lawrence S Friedman, MD
Deputy Editor
Shilpa Grover, MD, MPH, AGAF


Eosinophilic gastroenteritis (EGE) belongs to a group of diseases that includes eosinophilic esophagitis, gastritis, enteritis, and colitis, collectively referred to as "eosinophilic gastrointestinal disorders" [1].

This topic will review the clinical manifestations, diagnosis, and management of EGE. Eosinophilic esophagitis is discussed in detail, separately. (See "Clinical manifestations and diagnosis of eosinophilic esophagitis".)


Eosinophilic gastroenteritis (EGE) is an inflammatory disorder characterized by eosinophilic infiltration of the stomach and duodenum, and in some cases, the esophagus and colon without any known cause of eosinophilia.


There are limited data on the prevalence of eosinophilic gastroenteritis (EGE). The prevalence of EGE in the United States is estimated to be 22 to 28 per 100,000 persons [2]. EGE can affect patients of any age, but typically presents in the third through fifth decades and has a peak age of onset in the third decade [3-5]. A slight male predominance has been reported.


The pathogenesis of eosinophilic gastroenteritis (EGE) is not well understood. Multiple epidemiologic and clinical features suggest an allergic component [3,6,7]. In addition, patients with EGE have elevated serum immunoglobulin E (IgE) levels [7-10]. (See 'Clinical manifestations' below and 'Laboratory findings' below.)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Mar 02, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Rothenberg ME. Eosinophilic gastrointestinal disorders (EGID). J Allergy Clin Immunol 2004; 113:11.
  2. Spergel JM, Book WM, Mays E, et al. Variation in prevalence, diagnostic criteria, and initial management options for eosinophilic gastrointestinal diseases in the United States. J Pediatr Gastroenterol Nutr 2011; 52:300.
  3. Talley NJ, Shorter RG, Phillips SF, Zinsmeister AR. Eosinophilic gastroenteritis: a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues. Gut 1990; 31:54.
  4. Foroughi S, Foster B, Kim N, et al. Anti-IgE treatment of eosinophil-associated gastrointestinal disorders. J Allergy Clin Immunol 2007; 120:594.
  5. Min KU, Metcalf DD. Eosinophilic gastroenteritis. Immunol Allergy Clin North Am 1991; 11:799.
  6. Yun MY, Cho YU, Park IS, et al. Eosinophilic gastroenteritis presenting as small bowel obstruction: a case report and review of the literature. World J Gastroenterol 2007; 13:1758.
  7. Caldwell JH, Tennenbaum JI, Bronstein HA. Serum IgE in eosinophilic gastroenteritis. Response to intestinal challenge in two cases. N Engl J Med 1975; 292:1388.
  8. Klein NC, Hargrove RL, Sleisenger MH, Jeffries GH. Eosinophilic gastroenteritis. Medicine (Baltimore) 1970; 49:299.
  9. Katz AJ, Goldman H, Grand RJ. Gastric mucosal biopsy in eosinophilic (allergic) gastroenteritis. Gastroenterology 1977; 73:705.
  10. Landres RT, Kuster GG, Strum WB. Eosinophilic esophagitis in a patient with vigorous achalasia. Gastroenterology 1978; 74:1298.
  11. Chehade M, Magid MS, Mofidi S, et al. Allergic eosinophilic gastroenteritis with protein-losing enteropathy: intestinal pathology, clinical course, and long-term follow-up. J Pediatr Gastroenterol Nutr 2006; 42:516.
  12. Chen MJ, Chu CH, Lin SC, et al. Eosinophilic gastroenteritis: clinical experience with 15 patients. World J Gastroenterol 2003; 9:2813.
  13. Gonsalves N, Doerfler B, Yang G, et al. A prospective clinical trial of six food elimination diet or elemental diet in the treatment of adults with eosinophilic gastroenteritis (abstract). Gastroenterology 2009; 136:S1861.
  14. Ko HM, Morotti RA, Yershov O, Chehade M. Eosinophilic gastritis in children: clinicopathological correlation, disease course, and response to therapy. Am J Gastroenterol 2014; 109:1277.
  15. Prussin C, Lee J, Foster B. Eosinophilic gastrointestinal disease and peanut allergy are alternatively associated with IL-5+ and IL-5(-) T(H)2 responses. J Allergy Clin Immunol 2009; 124:1326.
  16. Hogan SP, Mishra A, Brandt EB, et al. A critical role for eotaxin in experimental oral antigen-induced eosinophilic gastrointestinal allergy. Proc Natl Acad Sci U S A 2000; 97:6681.
  17. Desreumaux P, Bloget F, Seguy D, et al. Interleukin 3, granulocyte-macrophage colony-stimulating factor, and interleukin 5 in eosinophilic gastroenteritis. Gastroenterology 1996; 110:768.
  18. Talley NJ, Kephart GM, McGovern TW, et al. Deposition of eosinophil granule major basic protein in eosinophilic gastroenteritis and celiac disease. Gastroenterology 1992; 103:137.
  19. Schoonbroodt D, Horsmans Y, Laka A, et al. Eosinophilic gastroenteritis presenting with colitis and cholangitis. Dig Dis Sci 1995; 40:308.
  20. Haberkern CM, Christie DL, Haas JE. Eosinophilic gastroenteritis presenting as ileocolitis. Gastroenterology 1978; 74:896.
  21. Matsushita M, Hajiro K, Morita Y, et al. Eosinophilic gastroenteritis involving the entire digestive tract. Am J Gastroenterol 1995; 90:1868.
  22. Cello JP. Eosinophilic gastroenteritis--a complex disease entity. Am J Med 1979; 67:1097.
  23. MacCarty RL, Talley NJ. Barium studies in diffuse eosinophilic gastroenteritis. Gastrointest Radiol 1990; 15:183.
  24. Man F, Chiocca JC. Achalasia due to eosinophil infiltration: fact or fiction? Dig Dis Sci 1993; 38:1561.
  25. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 20-1992. A 24-year-old man with asthma and bouts of epigastric pain, nausea, and vomiting. N Engl J Med 1992; 326:1342.
  26. Chang JY, Choung RS, Lee RM, et al. A shift in the clinical spectrum of eosinophilic gastroenteritis toward the mucosal disease type. Clin Gastroenterol Hepatol 2010; 8:669.
  27. Lee CM, Changchien CS, Chen PC, et al. Eosinophilic gastroenteritis: 10 years experience. Am J Gastroenterol 1993; 88:70.
  28. Lee M, Hodges WG, Huggins TL, Lee EL. Eosinophilic gastroenteritis. South Med J 1996; 89:189.
  29. Leinbach GE, Rubin CE. Eosinophilic gastroenteritis: a simple reaction to food allergens? Gastroenterology 1970; 59:874.
  30. Walker NI, Croese J, Clouston AD, et al. Eosinophilic enteritis in northeastern Australia. Pathology, association with Ancylostoma caninum, and implications. Am J Surg Pathol 1995; 19:328.
  31. Fauci AS, Harley JB, Roberts WC, et al. NIH conference. The idiopathic hypereosinophilic syndrome. Clinical, pathophysiologic, and therapeutic considerations. Ann Intern Med 1982; 97:78.
  32. Blackshaw AJ, Levison DA. Eosinophilic infiltrates of the gastrointestinal tract. J Clin Pathol 1986; 39:1.
  33. Spergel JM, Shuker M. Nutritional management of eosinophilic esophagitis. Gastrointest Endosc Clin N Am 2008; 18:179.
  34. Kagalwalla AF, Sentongo TA, Ritz S, et al. Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol 2006; 4:1097.
  35. American Gastroenterological Association medical position statement: guidelines for the evaluation of food allergies. Gastroenterology 2001; 120:1023.
  36. Tan AC, Kruimel JW, Naber TH. Eosinophilic gastroenteritis treated with non-enteric-coated budesonide tablets. Eur J Gastroenterol Hepatol 2001; 13:425.
  37. Siewert E, Lammert F, Koppitz P, et al. Eosinophilic gastroenteritis with severe protein-losing enteropathy: successful treatment with budesonide. Dig Liver Dis 2006; 38:55.
  38. Elsing C, Placke J, Gross-Weege W. Budesonide for the treatment of obstructive eosinophilic jejunitis. Z Gastroenterol 2007; 45:187.
  39. Van Dellen RG, Lewis JC. Oral administration of cromolyn in a patient with protein-losing enteropathy, food allergy, and eosinophilic gastroenteritis. Mayo Clin Proc 1994; 69:441.
  40. Pérez-Millán A, Martín-Lorente JL, López-Morante A, et al. Subserosal eosinophilic gastroenteritis treated efficaciously with sodium cromoglycate. Dig Dis Sci 1997; 42:342.
  41. Melamed I, Feanny SJ, Sherman PM, Roifman CM. Benefit of ketotifen in patients with eosinophilic gastroenteritis. Am J Med 1991; 90:310.
  42. Katsinelos P, Pilpilidis I, Xiarchos P, et al. Oral administration of ketotifen in a patient with eosinophilic colitis and severe osteoporosis. Am J Gastroenterol 2002; 97:1072.
  43. Bolukbas FF, Bolukbas C, Uzunkoy A, et al. A dramatic response to ketotifen in a case of eosinophilic gastroenteritis mimicking abdominal emergency. Dig Dis Sci 2004; 49:1782.
  44. Neustrom MR, Friesen C. Treatment of eosinophilic gastroenteritis with montelukast. J Allergy Clin Immunol 1999; 104:506.
  45. Schwartz DA, Pardi DS, Murray JA. Use of montelukast as steroid-sparing agent for recurrent eosinophilic gastroenteritis. Dig Dis Sci 2001; 46:1787.
  46. Quack I, Sellin L, Buchner NJ, et al. Eosinophilic gastroenteritis in a young girl--long term remission under Montelukast. BMC Gastroenterol 2005; 5:24.
  47. Daikh BE, Ryan CK, Schwartz RH. Montelukast reduces peripheral blood eosinophilia but not tissue eosinophilia or symptoms in a patient with eosinophilic gastroenteritis and esophageal stricture. Ann Allergy Asthma Immunol 2003; 90:23.
  48. Shirai T, Hashimoto D, Suzuki K, et al. Successful treatment of eosinophilic gastroenteritis with suplatast tosilate. J Allergy Clin Immunol 2001; 107:924.
  49. Prussin C, James SP, Huber MM, et al. Pilot study of anti-IL-5 in eosinophilic gastroenteritis (abstract). J Allergy Clin Immunol 2003; 11:A.
  50. Kim YJ, Prussin C, Martin B, et al. Rebound eosinophilia after treatment of hypereosinophilic syndrome and eosinophilic gastroenteritis with monoclonal anti-IL-5 antibody SCH55700. J Allergy Clin Immunol 2004; 114:1449.