Eosinophilic gastrointestinal disorders.

Eosinophilic gastrointestinal disorders (EGID) are frequently encountered by the practicing allergist/immunologist. This is due to the occurrence of the disorders in atopic subjects and because research has indicated that atopy-related genes, inflammatory cells, and mediators play a role in the pathogenesis of the disorders. The role of the allergist/immunologist includes making the diagnosis by eliciting the symptoms in the history and defining the atopic phenotype of the subject with regard to food and environmental allergens, using skin testing and possibly patch tests. Obtaining a tissue diagnosis with an esophagogastroduodenoscopy is essential for the diagnosis and may direct treatment with topical steroids, diet, or novel therapeutic agents, e.g., anti-IL-5 monoclonal antibodies. The allergist/immunologist also contributes to the management and design of therapeutic interventions and the long-term follow-up of the patients. This is important because the EGID have a chronic course marked by resolutions and relapses. This review takes a practical approach to the identification and management of the EGID by the allergist/immunologist.