Increasing Treatment Options for EGID Care

Currently, the standard of care for the most common eosinophilic gastrointestinal disorder (EGID)—eosinophilic esophagitis (EoE)—includes proton pump inhibitor therapy and glucocorticosteroids under the care of a gastroenterologist. Newly FDA-approved therapies, such as Dupixent and EOHILIA, are emerging as more common second-line therapies for this condition.

EoE is no longer considered a rare condition, though eosinophilic gastritis (EoG), eosinophilic enteritis (EoN), and eosinophilic colitis (EoC) remain rare diseases for now. Although EoE has consensus diagnostic criteria and FDA-approved treatments, EoG, EoN and EoC are the focus of research efforts to establish consensus diagnostic criteria and effective treatment and management options.

“Our growing research discoveries are providing an unprecedented opportunity to rapidly apply strides in our understanding to improve the care of patients with these diseases,” says Marc E. Rothenberg, MD, PhD, founder and director of the Cincinnati Center for Eosinophilic Disorders and Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR).

Managing EGID and Complex Cases

As chronic conditions, EGIDs require nuanced management to achieve and maintain remission. Though these conditions are lifelong, the disease activity and symptoms can be effectively managed by dedicated healthcare providers.

“We have decades of experience with complex cases, which we readily accept. It is the synergy of our clinical and research expertise that empowers us to provide leading treatment strategies for both routine and challenging cases,” says Vincent A. Mukkada, MD, Cincinnati Center for Eosinophilic Disorders gastroenterologist and medical director of Gastroenterology, Hepatology, and Nutrition. “We welcome patient referrals and offer second opinion services. What we offer at the Cincinnati Center for Eosinophilic Disorders is a chance to get an integrated treatment plan with good communication among all the team members and cutting-edge services at the forefront of applying research to patient benefit.”

One cutting-edge management option is transnasal endoscopy (TNE) for children. The Cincinnati Center for Eosinophilic Disorders is proud to offer TNE, which is a new, faster and cost-effective way to do endoscopy without the need for anesthesia.

Advancing EGID Diagnosis

As clinicopathologic conditions, EGIDs are currently diagnosed on the basis of pathology results in the appropriate clinical context. However, beyond cell counts, structural features of gastrointestinal pathology aid in EGID diagnosis, especially for EoG, EoN and EoC, as these segments of the gastrointestinal tract have resident eosinophils at baseline.

Recently developed and/or validated Histology Scoring Systems (HSS) encourage pathologists to evaluate more than eosinophilic inflammation and reduce our dependence on a single feature for diagnosis. In its guidance for industry-developed drugs to treat EoE, the FDA recommends that evaluations include the eight features contained in the HSS: eosinophil density, basal zone hyperplasia, eosinophil abscesses, eosinophil surface layering, dilated intercellular spaces, surface epithelial alteration, dyskeratotic epithelial cells, and lamina propria fibrosis. This work is an essential step toward improving the outcomes of patients with EGIDs.

Having pathologists experienced in EGID recognition and diagnosis reduces time to accurate diagnosis and effective treatment. The Cincinnati Center for Eosinophilic Disorders second opinion services can include pathology slide reading and reports.

“I helped to create the EoE, EoG and EoD HSS, which systematically evaluate gastrointestinal biopsies for EGIDs. These parameters help understand the severity of disease and are now accepted standards for research studies aimed to develop new therapeutic endpoints,” says Margaret A. Collins, MD, Cincinnati Center for Eosinophilic Disorders pathologist and leader of the CEGIR Pathology Core.

(Published November 2025)

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