Clinical Characteristics, Diagnostic Challenges, and Therapeutic Outcomes in Non-eosinophilic Esophagitis Eosinophilic Gastrointestinal Diseases in Comparison with Eosinophilic Esophagitis: A Retrospective Cohort Study
-
Azizollah Yousefi
,
Saeed Sepehry Vafa
,
Mina Mirzad
,
Fatemeh Elham Mahjoub
,
Behnam Shahsavand
,
Ebrahim Babaee
,
Fereshteh Karbasian
,
Mohammad Nabavi
,
Mohammad Hasan Bemanian
,
Sima Shokri
,
Saba Arshi
,
Morteza Fallahpour
Abstract
Eosinophilic gastrointestinal diseases (EGIDs) are chronic, TH2-mediated conditions. Eosinophilic esophagitis (EoE) is the most common type, while non-EoE EGIDs affect other gut segments.
This retrospective study of 111 patients (50 EoE and 61 non-EoE) from 2011 to 2022 compared the clinical aspects of these 2 types.
Dysphagia and food impaction dominated in EoE, while abdominal pain, nausea, and diarrhea were more common in non-EoE EGIDs. Atopic comorbidities were frequent. Diagnostic delays>1 year were more common in EoE (72% vs 47.5%). The overall clinical response rate was 88.29%, with most patients using food avoidance (90.99%) and proton pump inhibitors (94.59%). Clinical relapses occurred in 38.88% over the mean follow-up of 4.62 years and were unaffected by therapy type. Failure to thrive was seen in 26.7%, with no significant intergroup difference.
This study highlights a prolonged diagnostic delay in EoE vs non-EoE EGIDs. Both groups showed similar, favorable response rates, underscoring a need for greater awareness. Prospective studies with standardized measures are required to optimize management.
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6. Kaijser R. Allergic disease of the gut from the point of view of the surgeon. Arch Klin Chir. 1937;188:36-64.
7. Klein NC, Hargrove RL, Sleisenger MH, Jeffries GH. Eosinophilic gastroenteritis. Medicine (Baltimore). 1970;49(4):299-319.
8. Amil-Dias J, Oliva S, Papadopoulou A, Thomson M, Gutiérrez-Junquera C, Kalach N, et al. Diagnosis and management of eosinophilic esophagitis in children: An update from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2024;79(2):394-437.
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11. Kagalwalla AF, Sentongo TA, Ritz S, Hess T, Nelson SP, Emerick KM, et al. Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2006;4(9):1097-102.
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13. Lecouffe-Desprets M, Groh M, Bour B, Le Jeunne C, Puéchal X. Eosinophilic gastrointestinal disorders associated with autoimmune connective tissue disease. Joint Bone Spine. 2016;83(5):479-84.
14. Walker MM, Potter M, Talley NJ. Eosinophilic gastroenteritis and other eosinophilic gut diseases distal to the oesophagus. Lancet Gastroenterol Hepatol. 2018;3(4):271-80.
15. Walker MM. Inflammation, Genetics, Dysbiosis, and the Environment: New Paradigms for Diagnosis in Complex Chronic Gut Syndromes. J Clin Gastroenterol. 2016;50 Suppl 1:S4-5.
16. Li KW, Ruan GC, Liu S, Xu TM, Ma Y, Zhou WX, et al. Long-term prognosis and its associated predictive factors in patients with eosinophilic gastroenteritis. World J Gastroenterol. 2024;30(2):146-57.
17. Olsen EM, Petersen J, Skovgaard AM, Weile B, Jørgensen T, Wright CM. Failure to thrive: the prevalence and concurrence of anthropometric criteria in a general infant population. Arch Dis Child. 2007;92(2):109-14.
18. Redd WD, Dellon ES. Eosinophilic Gastrointestinal Diseases Beyond the Esophagus: An Evolving Field and Nomenclature. Gastroenterol Hepatol (N Y). 2022;18(9):522-8.
19. 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(1):54-8.
20. Egritas Gurkan O, Ozturk H, Karagol HIE, Ceylan K, Duztas DT, Ekinci O, et al. Primary Eosinophilic Gastrointestinal Diseases Beyond Eosinophilic Esophagitis in Children. J Pediatr Gastroenterol Nutr. 2021;72(2):294-9.
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22. Body mass inder-for-age (BMI-for-age) in child [Available from: https://www.who.int/toolkits/child-growth-standards/standards/body-mass-index-for-age-bmi-for-age.
23. Pineton de Chambrun G, Dufour G, Tassy B, Rivière B, Bouta N, Bismuth M, et al. Diagnosis, Natural History and Treatment of Eosinophilic Enteritis: a Review. Curr Gastroenterol Rep. 2018;20(8):37.
24. Jensen ET, Martin CF, Kappelman MD, Dellon ES. Prevalence of Eosinophilic Gastritis, Gastroenteritis, and Colitis: Estimates From a National Administrative Database. J Pediatr Gastroenterol Nutr. 2016;62(1):36-42.
25. Yamamoto M, Nagashima S, Yamada Y, Murakoshi T, Shimoyama Y, Takahashi S, et al. Comparison of Nonesophageal Eosinophilic Gastrointestinal Disorders with Eosinophilic Esophagitis: A Nationwide Survey. J Allergy Clin Immunol Pract. 2021;9(9):3339-49.e8.
26. Chehade M, Jones SM, Pesek RD, Burks AW, Vickery BP, Wood RA, et al. Phenotypic Characterization of Eosinophilic Esophagitis in a Large Multicenter Patient Population from the Consortium for Food Allergy Research. J Allergy Clin Immunol Pract. 2018;6(5):1534-44.e5.
27. Chehade M, Kamboj AP, Atkins D, Gehman LT. Diagnostic Delay in Patients with Eosinophilic Gastritis and/or Duodenitis: A Population-Based Study. J Allergy Clin Immunol Pract. 2021;9(5):2050-9.e20.
28. Dellon ES, Liacouras CA, Molina-Infante J, Furuta GT, Spergel JM, Zevit N, et al. Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Gastroenterology. 2018;155(4):1022-33.e10.
29. Lenti MV, Savarino E, Mauro A, Penagini R, Racca F, Ghisa M, et al. Diagnostic delay and misdiagnosis in eosinophilic oesophagitis. Dig Liver Dis. 2021;53(12):1632-9.
30. Votto M, Lenti MV, De Silvestri A, Bertaina F, Bertozzi M, Caimmi S, et al. Evaluation of diagnostic time in pediatric patients with eosinophilic gastrointestinal disorders according to their clinical features. Ital J Pediatr. 2023;49(1):9.
31. Paquet B, Bégin P, Paradis L, Drouin E, Des Roches A. High rate of failure to thrive in a pediatric cohort with eosinophilic esophagitis. Ann Allergy Asthma Immunol. 2016;116(1):73-4.e1.
32. Pineton de Chambrun G, Gonzalez F, Canva JY, Gonzalez S, Houssin L, Desreumaux P, et al. Natural history of eosinophilic gastroenteritis. Clin Gastroenterol Hepatol. 2011;9(11):950-6.e1.
33. Simon D, Straumann A, Wenk A, Spichtin H, Simon HU, Braathen LR. Eosinophilic esophagitis in adults--no clinical relevance of wheat and rye sensitizations. Allergy. 2006;61(12):1480-3.
34. Arias A, González-Cervera J, Tenias JM, Lucendo AJ. Efficacy of dietary interventions for inducing histologic remission in patients with eosinophilic esophagitis: a systematic review and meta-analysis. Gastroenterology. 2014;146(7):1639-48.
35. González-Cervera J, Arias Á, Redondo-González O, Cano-Mollinedo MM, Terreehorst I, Lucendo AJ. Association between atopic manifestations and eosinophilic esophagitis: A systematic review and meta-analysis. Ann Allergy Asthma Immunol. 2017;118(5):582-90.e2.
36. Arnim UV, Biedermann L, Aceves SS, Bonis PA, Collins MH, Dellon ES, et al. Monitoring Patients With Eosinophilic Esophagitis in Routine Clinical Practice - International Expert Recommendations. Clin Gastroenterol Hepatol. 2023;21(10):2526-33.
37. Chen PH, Anderson L, Zhang K, Weiss GA. Eosinophilic Gastritis/Gastroenteritis. Current Gastroenterology Reports. 2021;23(8):13.
38. Ridolo E, Melli V, De’ Angelis G, Martignago I. Eosinophilic disorders of the gastro-intestinal tract: an update. Clinical and Molecular Allergy. 2016;14(1):17.
2. Egan M, Furuta GT. Eosinophilic gastrointestinal diseases beyond eosinophilic esophagitis. Ann Allergy Asthma Immunol. 2018;121(2):162-7.
3. Kinoshita Y, Sanuki T. Review of Non-Eosinophilic Esophagitis-Eosinophilic Gastrointestinal Disease (Non-EoE-EGID) and a Case Series of Twenty-Eight Affected Patients. Biomolecules. 2023;13(9).
4. Mansoor E, Saleh MA, Cooper GS. Prevalence of Eosinophilic Gastroenteritis and Colitis in a Population-Based Study, From 2012 to 2017. Clin Gastroenterol Hepatol. 2017;15(11):1733-41.
5. Spergel JM, Book WM, Mays E, Song L, Shah SS, Talley NJ, 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(3):300-6.
6. Kaijser R. Allergic disease of the gut from the point of view of the surgeon. Arch Klin Chir. 1937;188:36-64.
7. Klein NC, Hargrove RL, Sleisenger MH, Jeffries GH. Eosinophilic gastroenteritis. Medicine (Baltimore). 1970;49(4):299-319.
8. Amil-Dias J, Oliva S, Papadopoulou A, Thomson M, Gutiérrez-Junquera C, Kalach N, et al. Diagnosis and management of eosinophilic esophagitis in children: An update from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2024;79(2):394-437.
9. Dellon ES, Muir AB, Katzka DA, Shah SC, Sauer BG, Aceves SS, et al. ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Esophagitis. Am J Gastroenterol. 2025;120(1):31-59.
10. Papadopoulou A, Amil-Dias J, Auth MK, Chehade M, Collins MH, Gupta SK, et al. Joint ESPGHAN/NASPGHAN Guidelines on Childhood Eosinophilic Gastrointestinal Disorders Beyond Eosinophilic Esophagitis. J Pediatr Gastroenterol Nutr. 2024;78(1):122-52.
11. Kagalwalla AF, Sentongo TA, Ritz S, Hess T, Nelson SP, Emerick KM, et al. Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2006;4(9):1097-102.
12. Caldwell JM, Collins MH, Stucke EM, Putnam PE, Franciosi JP, Kushner JP, et al. Histologic eosinophilic gastritis is a systemic disorder associated with blood and extragastric eosinophilia, TH2 immunity, and a unique gastric transcriptome. J Allergy Clin Immunol. 2014;134(5):1114-24.
13. Lecouffe-Desprets M, Groh M, Bour B, Le Jeunne C, Puéchal X. Eosinophilic gastrointestinal disorders associated with autoimmune connective tissue disease. Joint Bone Spine. 2016;83(5):479-84.
14. Walker MM, Potter M, Talley NJ. Eosinophilic gastroenteritis and other eosinophilic gut diseases distal to the oesophagus. Lancet Gastroenterol Hepatol. 2018;3(4):271-80.
15. Walker MM. Inflammation, Genetics, Dysbiosis, and the Environment: New Paradigms for Diagnosis in Complex Chronic Gut Syndromes. J Clin Gastroenterol. 2016;50 Suppl 1:S4-5.
16. Li KW, Ruan GC, Liu S, Xu TM, Ma Y, Zhou WX, et al. Long-term prognosis and its associated predictive factors in patients with eosinophilic gastroenteritis. World J Gastroenterol. 2024;30(2):146-57.
17. Olsen EM, Petersen J, Skovgaard AM, Weile B, Jørgensen T, Wright CM. Failure to thrive: the prevalence and concurrence of anthropometric criteria in a general infant population. Arch Dis Child. 2007;92(2):109-14.
18. Redd WD, Dellon ES. Eosinophilic Gastrointestinal Diseases Beyond the Esophagus: An Evolving Field and Nomenclature. Gastroenterol Hepatol (N Y). 2022;18(9):522-8.
19. 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(1):54-8.
20. Egritas Gurkan O, Ozturk H, Karagol HIE, Ceylan K, Duztas DT, Ekinci O, et al. Primary Eosinophilic Gastrointestinal Diseases Beyond Eosinophilic Esophagitis in Children. J Pediatr Gastroenterol Nutr. 2021;72(2):294-9.
21. Guajardo JR, Plotnick LM, Fende JM, Collins MH, Putnam PE, Rothenberg ME. Eosinophil-associated gastrointestinal disorders: a world-wide-web based registry. J Pediatr. 2002;141(4):576-81.
22. Body mass inder-for-age (BMI-for-age) in child [Available from: https://www.who.int/toolkits/child-growth-standards/standards/body-mass-index-for-age-bmi-for-age.
23. Pineton de Chambrun G, Dufour G, Tassy B, Rivière B, Bouta N, Bismuth M, et al. Diagnosis, Natural History and Treatment of Eosinophilic Enteritis: a Review. Curr Gastroenterol Rep. 2018;20(8):37.
24. Jensen ET, Martin CF, Kappelman MD, Dellon ES. Prevalence of Eosinophilic Gastritis, Gastroenteritis, and Colitis: Estimates From a National Administrative Database. J Pediatr Gastroenterol Nutr. 2016;62(1):36-42.
25. Yamamoto M, Nagashima S, Yamada Y, Murakoshi T, Shimoyama Y, Takahashi S, et al. Comparison of Nonesophageal Eosinophilic Gastrointestinal Disorders with Eosinophilic Esophagitis: A Nationwide Survey. J Allergy Clin Immunol Pract. 2021;9(9):3339-49.e8.
26. Chehade M, Jones SM, Pesek RD, Burks AW, Vickery BP, Wood RA, et al. Phenotypic Characterization of Eosinophilic Esophagitis in a Large Multicenter Patient Population from the Consortium for Food Allergy Research. J Allergy Clin Immunol Pract. 2018;6(5):1534-44.e5.
27. Chehade M, Kamboj AP, Atkins D, Gehman LT. Diagnostic Delay in Patients with Eosinophilic Gastritis and/or Duodenitis: A Population-Based Study. J Allergy Clin Immunol Pract. 2021;9(5):2050-9.e20.
28. Dellon ES, Liacouras CA, Molina-Infante J, Furuta GT, Spergel JM, Zevit N, et al. Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Gastroenterology. 2018;155(4):1022-33.e10.
29. Lenti MV, Savarino E, Mauro A, Penagini R, Racca F, Ghisa M, et al. Diagnostic delay and misdiagnosis in eosinophilic oesophagitis. Dig Liver Dis. 2021;53(12):1632-9.
30. Votto M, Lenti MV, De Silvestri A, Bertaina F, Bertozzi M, Caimmi S, et al. Evaluation of diagnostic time in pediatric patients with eosinophilic gastrointestinal disorders according to their clinical features. Ital J Pediatr. 2023;49(1):9.
31. Paquet B, Bégin P, Paradis L, Drouin E, Des Roches A. High rate of failure to thrive in a pediatric cohort with eosinophilic esophagitis. Ann Allergy Asthma Immunol. 2016;116(1):73-4.e1.
32. Pineton de Chambrun G, Gonzalez F, Canva JY, Gonzalez S, Houssin L, Desreumaux P, et al. Natural history of eosinophilic gastroenteritis. Clin Gastroenterol Hepatol. 2011;9(11):950-6.e1.
33. Simon D, Straumann A, Wenk A, Spichtin H, Simon HU, Braathen LR. Eosinophilic esophagitis in adults--no clinical relevance of wheat and rye sensitizations. Allergy. 2006;61(12):1480-3.
34. Arias A, González-Cervera J, Tenias JM, Lucendo AJ. Efficacy of dietary interventions for inducing histologic remission in patients with eosinophilic esophagitis: a systematic review and meta-analysis. Gastroenterology. 2014;146(7):1639-48.
35. González-Cervera J, Arias Á, Redondo-González O, Cano-Mollinedo MM, Terreehorst I, Lucendo AJ. Association between atopic manifestations and eosinophilic esophagitis: A systematic review and meta-analysis. Ann Allergy Asthma Immunol. 2017;118(5):582-90.e2.
36. Arnim UV, Biedermann L, Aceves SS, Bonis PA, Collins MH, Dellon ES, et al. Monitoring Patients With Eosinophilic Esophagitis in Routine Clinical Practice - International Expert Recommendations. Clin Gastroenterol Hepatol. 2023;21(10):2526-33.
37. Chen PH, Anderson L, Zhang K, Weiss GA. Eosinophilic Gastritis/Gastroenteritis. Current Gastroenterology Reports. 2021;23(8):13.
38. Ridolo E, Melli V, De’ Angelis G, Martignago I. Eosinophilic disorders of the gastro-intestinal tract: an update. Clinical and Molecular Allergy. 2016;14(1):17.
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| Delayed diagnosis treatment outcome Eosinophilic colitis Eosinophilic esophagitis Eosinophilic gastroenteritis Eosinophilic gastrointestinal disease Food allergy | ||
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How to Cite
1.
Yousefi A, Sepehry Vafa S, Mirzad M, Mahjoub FE, Shahsavand B, Babaee E, Karbasian F, Nabavi M, Bemanian MH, Shokri S, Arshi S, Fallahpour M. Clinical Characteristics, Diagnostic Challenges, and Therapeutic Outcomes in Non-eosinophilic Esophagitis Eosinophilic Gastrointestinal Diseases in Comparison with Eosinophilic Esophagitis: A Retrospective Cohort Study. Iran J Allergy Asthma Immunol. 2026;:1-13.
