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Non-esophageal eosinophilic gastrointestinal disorders
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of non-esophageal eosinophilic gastrointestinal disorders are prepared by our editorial team based on guidelines from the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN/NASPGHAN 2024).
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Screening and diagnosis
Terminology: as per ESPGHAN/NASPGHAN 2024 guidelines, use the term non-esophageal eosinophilic gastrointestinal disorders to describe chronic inflammatory disorders of the gastrointestinal tract beyond the esophagus characterized clinically by the presence of gastrointestinal symptoms and histologically by eosinophilic predominant inflammation of the gastrointestinal tract, in the absence of an identifiable secondary cause.
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Diagnostic criteria
Differential diagnosis
Diagnostic investigations
General principles
As per ESPGHAN/NASPGHAN 2024 guidelines:
Consider obtaining an initial evaluation in patients with symptoms suggestive of non-esophageal eosinophilic gastrointestinal disorders individualized based on history, clinical examination, and associated laboratory testing.
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Consider using an algorithm to guide the diagnostic approach of pediatric and adolescent patients with symptoms suggestive of non-esophageal eosinophilic gastrointestinal disorders.
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Blood tests
Fecal calprotectin
Food allergy tests
Diagnostic imaging
Diagnostic procedures
Endoscopy and biopsy: as per ESPGHAN/NASPGHAN 2024 guidelines, guide the choice of endoscopic examinations of the gastrointestinal tract by symptoms, laboratory, and radiographic findings.
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Ascitic fluid analysis
Medical management
General principles: as per ESPGHAN/NASPGHAN 2024 guidelines, consider individualizing initial treatment in pediatric patients with non-esophageal eosinophilic gastrointestinal disorders based on symptoms, impact on growth and development, and other comorbid features with an attempt to involve patients and parents/caregivers in shared decision-making.
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Corticosteroids
Acid suppressive therapy
Combination therapy
Agents with no evidence for benefit
Nonpharmacologic interventions
Dietary modifications
As per ESPGHAN/NASPGHAN 2024 guidelines:
Consider offering empiric elimination diets in selected patients with non-esophageal eosinophilic gastrointestinal disorders.
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Avoid obtaining food allergy tests to guide dietary restriction therapy in patients with non-esophageal eosinophilic gastrointestinal disorders.
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Therapeutic procedures
Surgical interventions
Follow-up and surveillance
Laboratory follow-up
As per ESPGHAN/NASPGHAN 2024 guidelines:
Consider using peripheral eosinophilia when consistently associated with mucosal eosinophilia in individual patients as an adjunct to monitor non-esophageal eosinophilic gastrointestinal disorder disease activity.
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Consider obtaining blood tests to monitor treatment responses in selected cases.
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Endoscopic follow-up