Why does inflammation occur?
The exact cause of the disease is unknown. It is believed that the basis is an excessive reaction of the immune system to food proteins and other irritants: special signaling substances attract eosinophils to the wall of the organ, where they secrete enzymes and damage the tissue. A significant proportion of patients also have other allergic diseases - asthma, rhinitis, atopic dermatitis, food allergies. However, ordinary skin tests often do not help to find the culprit product, because the reaction here develops more slowly and according to a different mechanism than with an immediate allergy.
- Excessive immune reaction to food proteins
- Accumulation of eosinophils in the organ wall
- Frequent combination with asthma and allergic rhinitis
- Skin tests are not very informative
- The exact cause has not been definitively established
Forms and symptoms
The picture depends on the depth of the wall lesion. The mucous form is the most common: pain in the upper abdomen, nausea, vomiting, bloating, diarrhea, loss of appetite, and due to loss of protein and blood, edema and anemia develop. In the muscular form, the wall thickens, the passage narrows, and signs of obstructed passage of food appear: vomiting of food, a feeling of fullness, cramping pain. The rarest form, with damage to the outer layer, results in accumulation of fluid in the abdominal cavity and enlargement of the abdomen. In children, the disease can manifest as retardation in weight and height.
- Pain in the upper abdomen
- Nausea and vomiting after eating
- Bloating, diarrhea
- Early satiety and loss of appetite
- Weight loss, growth retardation in children
- Anemia and edema due to protein loss
- Fluid in the abdomen in a rare form
Diagnostics
The main study is gastroscopy with the obligatory taking of several biopsies from different parts of the stomach and duodenum, even if the mucous membrane looks normal: changes are focal and invisible to the eye. The diagnosis is confirmed by an increased number of eosinophils in the tissue. Not everyone has elevated eosinophils in the blood, so a normal test does not rule out the disease. Be sure to exclude parasitic infections, which give a similar picture, as well as drug reactions and other intestinal diseases. If necessary, colonoscopy and abdominal tomography are performed.
- Gastroscopy with multiple biopsies
- Counting eosinophils in biopsies
- Clinical blood test with eosinophils
- General IgE, consultation with an allergist
- Stool tests for parasites
- Albumin and total protein
- Colonoscopy and tomography according to indications
Treatment
The first line in many cases is a diet that excludes the most common food allergens, which is selected together with a doctor and gradually expanded, monitoring your well-being and the results of a control biopsy. For severe symptoms, drug therapy is used: a short course of drugs that suppress eosinophilic inflammation and drugs that reduce acidity are prescribed. All medications are selected by a doctor, since long-term uncontrolled use has side effects. If the lumen is narrowed and obstructed, endoscopic or surgical intervention may be required. Self-directed strict diets without control are dangerous due to nutritional deficiencies.
- Elimination diet under medical supervision
- Gradual expansion of the diet with response assessment
- Anti-inflammatory therapy as prescribed
- Drugs that reduce stomach acidity
- Treatment of concomitant allergies and asthma
- Endoscopic or surgical treatment for narrowing
- Monitoring nutrition and weight, if necessary, help from a nutritionist
Observation and lifestyle
The disease progresses in waves, so scheduled visits to a gastroenterologist and control gastroscopy are needed to assess the effect of treatment - focusing only on well-being is not enough. It is useful to keep a diary of food and symptoms: it often helps to notice the connection between exacerbations and certain foods. It is important to treat concomitant allergic diseases and not ignore asthma. When planning a pregnancy and before long courses of medications, it is worth discussing tactics with your doctor in advance. The prognosis for life is favorable, and the quality of life largely depends on discipline in nutrition and observation.
- Routine examinations by a gastroenterologist
- Control gastroscopy with biopsy
- Diary of food and symptoms
- Treatment of concomitant allergies
- Weight control and dietary adequacy
- Discussing pregnancy plans with your doctor