New Research Improves Gastrointestinal Disease Diagnosis and Care

How does new research into eosinophilic gastrointestinal diseases illuminate new paths for diagnosis, treatment and understanding?

The journey through the complex landscape of pediatric gastroenterology has recently taken a significant turn with new research into eosinophilic gastrointestinal diseases (EGIDs) — conditions marked by inflammation in the gastrointestinal (GI) tract from the esophagus to the colon. Spearheading this expedition are Laura Quinn, MD, a pediatric gastroenterologist, and her mentor, Calies Menard-Katcher, MD, whose collaborative efforts have led to pivotal insights into the enigmatic world of EGIDs. The two focus particularly on eosinophilic gastritis (EoG) and eosinophilic duodenitis (EoD) — both rare conditions that until recently were poorly understood.

Driven by a deep-seated fascination with the dual roles of the gut, Dr. Quinn embarked on a meticulous journey through the digestive system to better understand the notable rise in allergic diseases over the past decade.

“I just find it really fascinating that your gut is tasked with two opposing jobs — absorbing food and then also keeping out things that are harmful,” Dr. Quinn explains.

Dr. Menard-Katcher, who served as Dr. Quinn’s research mentor, emphasized the serendipity of their work. “Dr. Quinn’s timing coincided really well with larger conversations around consensus and agreement in the eosinophilic GI world and how to define EGIDs,” Dr. Menard-Katcher notes. “This allowed for real-time contributions to the field.”

A shift in perspective

In the team’s research, published in the February 2024 issue of the American Journal of Gastroenterology, Dr. Quinn employed a broad array of International Classification of Diseases (ICD) codes to ensure a comprehensive capture of potential cases, followed by a meticulous manual review of patients’ charts to identify potential cases of EGIDs (1). This approach distinguished between EoG, EoD and low-grade tissue eosinophilia based on the location and intensity of eosinophil infiltration. Dr. Quinn described the patient identification process as uniquely rigorous, which ensured the integrity and reliability of their findings.

“We did see increased diagnosis rates for eosinophilic gastritis and enteritis as a whole,” Dr. Quinn says. “This either indicates a growing prevalence of these conditions or increases in recognition and detection.”

The revelation of increased diagnosis rates for eosinophilic gastritis and enteritis brought to light by Dr. Quinn and her team’s research marks a pivotal moment in the field of gastroenterology. It also underscores a potential shift in the epidemiological landscape of EGIDs by challenging the conventional understanding that the small intestine is more frequently implicated in EGIDs than the stomach, suggesting a broader spectrum of gastrointestinal involvement. This shift in understanding has the potential to inform more targeted and effective treatment approaches for EGIDs.

Additionally, the team found that patients with EGIDs have different disease patterns over time, and certain characteristics may predict which patients are more likely to relapse or develop disease complications. These findings can help guide individualized treatment approaches in the clinical setting.

Insights for providers

By providing a detailed landscape of EGIDs through a decade’s worth of data, the study underscores the potential for advancing evidence-backed treatments for these rare conditions. This forward-looking approach highlights the essential role of ongoing research and underscores the importance of collaboration across various medical specialties, including gastroenterologists, allergists/immunologists, pathologists and laboratory medicine specialists. Such teamwork is pivotal in forging comprehensive strategies for EGID management, contributing to the broader spectrum of patient care and treatment innovation.

Furthermore, their work emphasizes the importance of multidisciplinary efforts in both understanding and managing EGIDs effectively. Recommendations for healthcare providers to maintain a vigilant approach toward patients with a history of allergies and GI symptoms highlight the need for early and accurate diagnoses.

“Identifying EGIDs early, especially in patients with a known history of allergies, is crucial,” Dr. Menard-Katcher says. “It allows for timely intervention and can significantly alter the patient’s treatment trajectory.”

The study’s contributions extend to influencing global research initiatives, such as the design of phase 3 trials for related conditions, showcasing the significant impact collaborative research can have on the medical field. By pushing the boundaries of EGID research and emphasizing a unified approach to patient care, the findings from this study not only enhance our understanding of these complex diseases but also aim to improve patient outcomes through innovative treatment options and a multidisciplinary care framework, such as the Gastrointestinal Eosinophilic Disease Program.

Citations

1. Quinn LA, Burger C, Nguyen B, et al. Natural Histories and Disease Complications in a Cohort of 151 Children With Gastric or Duodenal Eosinophilia. Am J Gastroenterol. Published online February 5, 2024. doi:10.14309/ajg.0000000000002644.