13 May 2026
Eosinophilic gastrointestinal diseases (EGIDs) are divided into 2 main groups: eosinophilic esophagitis (EoE) and eosinophilic gastroenteropathies (EGEs).
Although rare, EGEs represent a significant challenge for affected patients, their families, and healthcare professionals. Proper knowledge, understanding, and management of these conditions are essential. In this article, we will provide a comprehensive overview of what Eosinophilic Gastroenteropathies are, their causes, symptoms, diagnosis, and the treatments currently available.
What are Eosinophilic Gastroenteropathies
Eosinophilic gastroenteropathies identify a group of rare inflammatory diseases affecting the gastrointestinal tract, characterized by the accumulation of eosinophils, a type of blood cell involved in the immune response, in parts of the gastrointestinal tract.
EGEs are classified both according to the intestinal segment involved — gastritis, gastroenteritis, colitis, proctocolitis — and according to the distribution of eosinophils in the tissues — serosal, mucosal, or muscular. Among these, the mucosal form is the most common, while the muscular form is less frequent.
Given the rarity of EGEs, it is essential to exclude other causes of tissue eosinophilia before confirming a diagnosis. These include parasitic infections, inflammatory bowel diseases, connective tissue disorders, drug allergies, and lymphoproliferative disorders.
Diagnosis
The diagnosis of EGE is mainly based on three criteria: the presence of nonspecific gastrointestinal symptoms, eosinophilic infiltration in one or more segments of the gastrointestinal tract, and the exclusion of other causes of gastrointestinal eosinophilia.
To confirm the diagnosis, an esophagogastroduodenoscopy (EGD) and a colonoscopy are generally performed, together with biopsy sampling. These procedures make it possible to identify the presence of eosinophils in different parts of the gastrointestinal tract. One complicating aspect of the diagnosis is that eosinophils are normally present in the lamina propria of many intestinal segments, especially in the cecum and appendix, which may make it difficult to distinguish between normal and pathological conditions. For this reason, eosinophil thresholds per high-power field (HPF) vary depending on the region examined.
Follow-up for patients with EGE is strictly clinical, endoscopic, and histological, in order to monitor disease progression and response to therapy.
Symptoms
In cases of suspected EGE, symptoms may vary depending on the part of the gastrointestinal tract involved. If the stomach is affected, patients may experience vomiting, heartburn, and a feeling of early satiety. When the small intestine is involved, symptoms may include diarrhea, abdominal pain, bloating, weight loss, and obstructive symptoms. If the colon is involved, abdominal pain and mucus-bloody diarrhea may occur. These symptoms may coexist with systemic signs such as malabsorption, iron-deficiency anemia, and protein-losing hypoalbuminemia. In addition, signs of marked peripheral hypereosinophilia and the presence of allergic comorbidities, such as atopic dermatitis, asthma, and allergic rhinitis, may strengthen the diagnostic suspicion of EGE.
Avaliable treatments
In the treatment of EGE, corticosteroids are frequently used and have proven particularly effective in patients with a mucosal eosinophilic pattern.
The dosage is gradually reduced until the minimum effective dose is reached before discontinuing treatment. Prolonged use of systemic steroids requires mandatory supplementation with calcium and vitamin D, regular eye examinations, and the use of proton pump inhibitors (PPIs) to prevent gastric and duodenal ulcers. Oral budesonide is often used as maintenance therapy or to induce remission, due to its reduced side effects. Immunosuppressants, such as azathioprine, are considered for long-term disease control.
An elimination diet is recommended, especially in cases of malabsorption and poor growth, or to reduce the need for corticosteroids. Hydrolyzed or elemental formulas are available to patients through prescription under a Therapeutic Plan and are fully borne by the family, distributed by the local pharmacies of the relevant Local Health Authority.
At referral centers, it is also possible to participate in clinical trials testing experimental drugs that have not yet been approved in Europe for routine use.
Drug therapy for EGE is covered by the Regional Health Service (SSR) with a prescription issued by the general practitioner, pediatrician, or disease manager, who may be the gastroenterologist or pediatric gastroenterologist.
The role of ESEO Italia
Through awareness-raising, research, and scientific promotion, ESEO Italy is committed to improving the quality of life of patients and their families by providing a point of reference for social and socio-healthcare support. The association works tirelessly to promote greater awareness of these conditions, facilitate access to information, and provide updates on the latest developments in disease treatment and management.
