Eosinophilic gastrointestinal disorders, a new epidemic.

PURPOSE OF REVIEW: Eosinophilic gastrointestinal disorders (EGID) are on the rise and impose a significant burden on patients. EGID other than eosinophilic esophagitis (EoE) remain diagnostically and therapeutically challenging.

RECENT FINDINGS: We revised the current knowledge on primary EGID. Epithelial barrier dysfunction and type 2 inflammation are key elements in EoE pathogenesis, whereas the mechanisms underlying distal EGID are elusive. Clinical presentations of EGID vary by disease location and depth of tissue involvement. Diagnosis relies on biopsy, although eosinophilic histologic thresholds - particularly for distal forms - remain imperfect, and secondary causes must be rigorously excluded. Treatment of EoE is supported by validated clinical endpoints and includes proton pump inhibitors, topical corticosteroids, elimination diets, and the interleukin-4Rα blocker dupilumab. In contrast, management of non-EoE EGID lacks standardisation and relies predominantly on systemic corticosteroids, immunomodulators, dietary therapy, and limited emerging evidence for biologics.

SUMMARY: EGID comprise a heterogeneous spectrum of primary diseases with eosinophilic infiltration of the gut. EoE is the most extensively studied among EGID, whereas non-EoE EGID-including eosinophilic gastritis, enteritis, and colitis-remain rare, understudied. The development and validation of disease-specific clinical outcome measures are awaited to design robust clinical trials and advance therapeutic options for non-EoE EGID.