Eosinophilic diseases of the gastrointestinal tract. Eosinophilic esophagitis, gastritis, enteritis and colitis in children (review)

   Relevance. The increasing incidence of eosinophilic gastrointestinal diseases among the pediatric population entails the need to understand the etiology and pathogenesis of this pathology in order to improve the quality of diagnosis and treatment of this group of diseases.

   Materials and methods. In the search engines PubMed, ScienceDirect, Wiley Online Library, SpringerLink, RusMed, eLibrary.ru A search was conducted for scientific papers by keywords: eosinophilic gastrointestinal diseases, eosinophilic esophagitis, eosinophilic gastritis, eosinophilic enteritis, eosinophilic colitis, eosinophilic infiltration, children, adolescents. The search depth was 12 years (2012–2024). The source search algorithm followed the principles of PRISMA. 515 foreign and domestic publications have been identified. The analysis includes 36 papers.

   Results. Currently, eosinophilic diseases of the gastrointestinal tract attract the close attention of scientists, which is associated with a significant increase in this pathology. Eosinophilic gastrointestinal diseases are a group of chronic immune-mediated diseases of the gastrointestinal tract characterized by gastrointestinal symptoms and pathological eosinophilic infiltration in the absence of secondary causes of eosinophilia with a depth of organ damage from the mucous membrane to the muscular and serous layer, which leads to severe violations of their structure and function. This group includes eosinophilic esophagitis, eosinophilic gastritis, eosinophilic enteritis and eosinophilic colitis. The presented review analyzes the results of modern scientific research on the epidemiology, pathophysiology and clinical features of eosinophilic gastrointestinal diseases in children. Diagnostic criteria are given. Modern approaches to the treatment of these diseases are considered. Most scientific publications are devoted to eosinophilic esophagitis, in the diagnosis and treatment of which a certain consensus has been reached. The management of children with eosinophilic gastritis, eosinophilic enteritis and eosinophilic colitis is particularly difficult, which determines the need for further study of the pathogenesis of these diseases.

   Conclusion: the number of scientific papers that have increased in recent years expands knowledge about eosinophilic gastrointestinal diseases in children, but it is worth striving to reach consensus on eosinophilic gastritis, eosinophilic enteritis and eosinophilic colitis.

1. Redd W.D., Dellon E.S. Eosinophilic Gastrointestinal Diseases Beyond the Esophagus: An Evolving Field and Nomenclature. J Gastroenterol Hepatol. 2022; 18 (9): 522–528. PMID: 36397988; PMCID: PMC9666791.

2. Dellon E.S., Gonsalves N., Abonia J.P. et al. International Consensus Recommendations for Eosinophilic Gastrointestinal Disease Nomenclature. J Clin Gastroenterol Hepatol. 2022; 20 (11): 2474–2484.e3. doi: 10.1016/j.cgh.2022.02.017.

3. Papadopoulou A., Amil-Dias J., Auth M.K.-Н., Chehade M. et al. Joint ESPGHAN/NASPGHAN Guidelines on Childhood Eosinophilic Gastrointestinal Disorders Beyond Eosinophilic Esophagitis. J Pediatr Gastroenterol Nutr. 2024; 78 (1): 122–152. doi: 10.1097/MPG.00000000000003877.

4. Shoda T., Taylor R.J., Sakai N. et al. Common and disparate clinical presentations and mechanisms in different eosinophilic gastrointestinal diseases. J Allergy Clin Immunol. 2024 Jun; 153 (6): 1472–1484. doi: 10.1016/j.jaci.2024.03.013.

5. Clinical recommendations “Eosinophilic esophagitis”. The Ministry of Health of the Russian Federation. 2022. [Electronic resource] URL: https://lyl.su/YJqZ (date of application 29.11.2025). (In Russ.)

6. Zakharova I.N., Osmanov I.M., Pampura A.N. et al. Eosinophilic esophagitis: still a difficult and rarely diagnosed condition. A clinical case. J Pediatrics. Consilium Medicum. 2021; 1: 57–62. (In Russ.) doi: 10.26442/26586630.2021.1.200838.

7. Coutry E., Papadopoulou A. Eosinophilic diseases of the gastrointestinal tract in childhood. J Ann is Inside. 2018; 73 Supplement 4: 18–28. doi: 10.1159/000493668.

8. Amil-Dias J., Oliva S., Papadopoulou A. et al. Diagnosis and treatment of eosinophilic esophagitis in children: updated information from the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2024; 79 (2): 394–437. doi: 10.1002/jpn3.12188.

9. Carrasco A.E.A.B., Machado R.S., Patricio F.R.S. et al. Histological features of eosinophilic esophagitis in children and adolescents. J Arq Gastroenterol. 2017; 54 (4): 281–285. doi: 10.1590/S0004-2803.201700000-44.

10. Agulló-García A., Cubero J.L., Lezaun A. et al. Clinical and anatomopathological features of eosinophilic esophagitis in children and adults. J Allergologia et Immunopathologia. 2020; 48 (6): 560–567. doi: 10.1016/j.aller.2020.03.009.

11. Chang J.W., Kliewer K., Haller E. et al. Development of a practical guide to implement and monitor diet therapy for eosinophilic esophagitis. J Clinical Gastroenterology and Hepatology. 2023; 21: 1690–1698. doi: 10.1016/j.cgh.2023.03.006.

12. Gutiérrez-Junquera C., Fernández-Fernández S., Cilleruelo M.L. et al. High prevalence of response to proton-pump inhibitor treatment in children with esophageal eosinophilia. J Pediatr Gastroenterol Nutr. 2016; 62 (5): 704–710. doi: 10.1097/MPG.00000000000001019.

13. Lucendo A.J., Arias Á., Molina-Infante J. Efficacy of proton pump inhibitor drugs for inducing clinical and histologic remission in patients with symptomatic esophageal eosinophilia : a systematic review and meta-analysis. J Clin Gastroenterol Hepatol. 2016; 14(1): 13–22.e1. doi: 10.1016/j.cgh.2015.07.041.

14. Dellon E.S., Sheikh A., Speck O. et al. Viscous topical application is more effective than nebulized steroid therapy, for patients with eosinophilic esophagitis. J Gastroenterology. 2012; 143 (2): 321–324.e1. doi: 10.1053/j.gastro.2012.04.049.

15. Moiseikova E.L., Kornienko E.A., Pavelets N.K et al. Eosinophilic lesions of the gastrointestinal tract in children: structure, clinical and endoscopic manifestations. Collection of materials of the XVI All-Russian scientific and practical conference “Vorontsov readings. St. Petersburg — 2023”. 2023: 47–50. (In Russ.)

16. Jensen E.T., Martin C.F., Kappelman M.D. et al. Prevalence of eosinophilic gastritis, gastroenteritis, and colitis: estimates from a National Administrative Database. J Pediatr Gastroenterol Nutr. 2016; 62 (1): 36–42. doi: 10.1097/MPG.0000000000000865.

17. Yamamoto M., Nagashima S., Yamada Y. et al. Comparison of nonesophageal eosinophilic gastrointestinal disorders with eosinophilic esophagitis: a nationwide survey. J Allergy Clin Immunol Pract. 2021; 9 (9): 3339–3349.e8. doi: 10.1016/j.jaip.2021.06.026.

18. Pesek R.D., Reed C.C., Muir A.B., et al. Increasing rates of diagnosis, substantial co-occurrence, and variable treatment patterns of eosinophilic gastritis, gastroenteritis, and colitis based on 10-year data across a multicenter consortium. Am J Gastroenterol. 2019; 114 (6): 984–994. doi: 10.14309/ajg.0000000000000228.

19. Zadeh-Esmaeel M.M., Rezaei-Tavirani M., Ali Ahmadi N. et al. Evaluation of gene expression change in eosinophilic gastroenteritis. J Gastroenterol Hepatol Bed Bench. 2019; 12 (3): 239–245. PMID: 31528308 PMCID: PMC6668767.

20. Pesek R.D., Reed C.C., Collins M.H. et al. Association between endoscopic and histologic findings in a multicenter retrospective cohort of patients with non-esophageal eosinophilic gastrointestinal disorders. J Dig Dis Sci. 2020; 65: 2024–2035. doi: 10.1007/s10620-019-05961-4.

21. Kennedy K., Muir A.B., Grossman A. et al. Modified oral entericcoated budesonide regimens to treat pediatric eosinophilic gastroenteritis, a single center experience. J Allergy Clin Immunol Pract. 2019; 7 (6): 2059–2061. doi: 10.1016/j.jaip.2019.01.053.

22. Li K., Gechong R., Shuang L. et al. Eosinophilic gastroenteritis: pathogenesis, diagnosis, and treatment. Chin Med J (Engl). 2023; 136 (8): 899–909. doi: 10.1097/CM9.000000000000002511.

23. Guo H., Ji X., Yang G. et al. Evaluation of gene expression change in eosinophilic gastroenteritis. Evaluation of gene expression change in eosinophilic gastroenteritis. Abnormal thymic stromal lymphopoietin expression in the gastrointestinal mucosa of patients with eosinophilic gastroenteritis. J Pediatr (Rio J). 2020; 96 (3): 350–355. doi: 10.1016/j.jped.2018.11.012.

24. Lee E.H., Yang H.R., Lee H.S. Quantitative analysis of distribution of the gastrointestinal tract eosinophils in childhood functional abdominal pain disorders. J Neurogastroenterol Motil 2018; 24: 614–627.

25. Nguyen N., Kramer R.E., Friedlander J.A. Videocapsule endoscopy identifies small bowel lesions in patients with eosinophilic enteritis. J Clin Gastroenterol Hepatol. 2018; 16: 64–65. doi: 10.1016/j.cgh.2017.08.043.

26. Pesek R.D., Reed C.C., Collins M.H. et al. Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR). Association between endoscopic and histologic findings in a multicenter retrospective cohort of patients with non-esophageal eosinophilic gastrointestinal disorders. J Dig Dis Sci. 2020; 65 (7): 2024–2035. doi: 10.1007/s10620-019-05961-4.

27. Licari A., Votto M., Scudeller L., et al. Epidemiology of Nonesophageal Eosinophilic Gastrointestinal Diseases in Symptomatic Patients : A Systematic Review and Meta-Analysis. J Allergy Clin Immunol Pract. 2020; 8 (6): 1994–2003.e2. doi: 10.1016/j.jaip.2020.01.060.

28. Zhang M., Li Y. Eosinophilic gastroenteritis: A state-of-the-art review. J Gastroenterol Hepatol. 2017; 32 (1): 64–72. doi: 10.1111/jgh.13463.

29. Uppal V., Kreiger P., Kutsch E. Eosinophilic gastroenteritis and colitis : a comprehensive review. J Clin Rev Allergy Immunol. 2016; 50 (2): 175–188. doi: 10.1007/s12016-015-8489-4.

30. Pineton de Chambrun G., Dufour G., Tassy B. et al. Diagnosis, natural history and treatment of eosinophilic enteritis : A review. J Curr Gastroenterol Rep. 2018; 20 (8): 37. doi: 10.1007/s11894-018-0645-6.

31. Berezhnaya I.V., Zakharova I.N., Osmanov I.M. et al. Eosinophilic gastrointestinal diseases. Eosinophilic enteritis in children. J Doctor.Ru. 2023; 22 (7): 7–12. (In Russ.) doi: 10.31550/1727-2378-2023-22-7-7-12.

32. Impellizzeri G., Marasco G., Eusebi L. et al. Eosinophilic colitis : A clinical review. J Digestive and Liver Disease, 2019; 51 (6): 769–773. doi: 10.1016/j.dld.2019.04.011.

33. Marichal T., Mesnil S., Bureau F. Homeostatic eosinophils: characteristics and functions. J The interface (Lausanne). 2017; 11 (4): 101. doi: 10.3389/fmed.2017.00101.

34. Raffaele A., Watteau F., Votto M. et al. Eosinophilic colitis in children: a new and elusive enemy? J Pediatr Surg Int. 2021; 37 (4): 485–490. doi: 10.1007/s00383-020-04832-8.

35. Akritas Gurkan O., Ozturk H., Karakol H.I. et al. Primary eosinophilic diseases of the gastrointestinal tract in addition to eosinophilic esophagitis in children. J Children’s gastroenterological diet. 2021; 72 (2): 294–299. doi: 10.1097/MPG.00000000000000002925.

36. Holguin L., Gallego-Types C., Toro Y. et al. Epidemiological, clinical and diagnostic characteristics of children with eosinophilic gastroenteropathy. A retrospective study of three healthcare institutions of high complexity. J St. Alerg Mexico. 2018; 65 (2): 148–159. doi: 10.29262/ram.v65i2.354.