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Eosinophilic Gastrointestinal Disorders Clinic
 Eosinophilic esophagitis (EE) is a recently recognized disease entity that is thought to be driven, in part, by allergic stimuli. In January 2004, Drs. Seema Aceves, John Bastian (Allergy, Immunology) and Dr. Ranjan Dohil (Gastroenterology) initiated an integrated Pediatric Allergy and Gastroenterology clinic dedicated to the care of children with eosinophilic gastrointestinal disorders.
Similar to other allergic disorders such as asthma and allergic rhinitis, allergic gastrointestinal diseases such as eosinophilic esophagitis are increasing in incidence. Both food and aero-allergens have been implicated in eosinophilic gastrointestinal processes. Usual treatments for these disorders include allergen avoidance, as with elimination diets or elemental formula, and topical or systemic steroid therapy. Treatment with anti-IL-5, an intravenous agent, is currently under investigation.
Children with eosinophilic esophagitis and/or gastroenteritis are evaluated by the clinical team at Rady Children’s Hospital-San Diego, undergo testing for appropriate allergens that may play a causative a role in their disease process, educated on their disease and potential therapeutic interventions, and offered an integrated care plan. Our clinical team consist of Pediatric Allergy, Immunology (Drs. Aceves and Bastian), Pediatric Gastroenterology (Dr. Dohil), Pediatriac Nutritionist (Elizabeth English), and a Pediatric Nurse Coordinator (Carrie Arii). Clinical trial involvement is offered to patients who are interested and meet appropriate criteria.
 Contact Information:
The Eosinophilic Gastrointestinal Disorders Clinic meets three times a month. For further information about the clinic, please contact our nurse coordinator, Carrie Arii at 858-966-1700 ext.4214.
 Clinical Trials Currently Enrolling EE Patients in San Diego:
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Characteristics and inflammatory markers in children with eosinophilic esophagitis: a prospective study. Contact Dr. Aceves at 858-966-5961 or our clinic nurse coordinator, Carrie Arii, RN at 858-966-1700 x-4214.
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A randomized double-blind parallel group clinical trial to assess safety, tolerability pharmacokinetics, and pharmacodynamics of intravenous mepolizumab in pediatric subjects with eosinophilic esophagitis. Contact our clinical trials coordinator, Mehrzad Milburn, RN, at 858-966-8155 for further information.
 Current or Upcoming EE Publications from San Diego:
Wagelie-Steffen A., Aceves S.S. Eosinophilic disorders in children. Current Allergy and Asthma Reports, 6(6):475-82. 2006.
Aceves S.S., Newbury R.O., Dohil R.D., Schwimmer J., Bastian J.F. Distinguishing eosinophilic esophagitis in children: clinical, endoscopic, and histologic features of an emerging disorder. J Clin Gastroenterology. In press, 2006
Aceves S.S., Newbury, RO, Dohil, R, Bastian, JF, Broide, DH. Esophageal remodeling in pediatric eosinophilic esophagitis. In press, 2006
Konikoff MR, Noel RJ, Blanchard C, Kirby C, Jameson S, Buckmeier B, Akers R, Cohen MB, Collins MH, Assa’ad AH, Aceves SS, Putnam PE, Rothenberg ME. A randomized double-blind placebo-controlled trial of fluticasone propionate for pediatric eosinophilic esophagitis. Gastroenterology. 131:1381-91. 2006
Aceves S.S., Dohil, R, Newbury, RO, Bastian, JF. Topical viscous budesonide suspension for treatment of eosinophilic esophagitis. J of All Clin Immunol. 116(3):705-6. 2005
 Some Recent EE Literature:
Baxi S, Gupta SK, Swigonski N, Fitzgerald JF. Clinical presentation of patients with eosinophilic inflammation in the esophagus. Gastrointestinal Endoscopy, In press
Blanchard C, Wang N, Stringer KF, Fulkerson PC, Abonia JP, Jameson SC, Kirby C, Konikoff MR, Collins MH, Cohen MB, Akers R, Hogan SP, Assa’ad AH, Putnam PE, Aronow BJ, Rothenberg ME. Eotaxin-3 and a uniquely conserved gene-expression profile in eosinophilic esophagitis. J Clin Invest. 116:536-47. 2006
Gonsalves N, Policarpio-Nicolas M, Zhang Q, Rao S, Hirano I. Histopathologic variability and endoscopic correlates in adults with eosinophilic esophagitis. Gastrointest Endosc. 64:313-9. 2006
Gupta SK, Fitzgerald JF, Kondratyuk T, HogenEsch H. Cytokine expression in normal and inflamed esophageal mucosa: a study into the pathogenesis of allergic eosinophilic esophagitis. Journal Ped Gastroenterol. 42:22-6. 2006
Kagalwalla AF, Sentongo TA, Ritz S, Hess T, Nelson SP, Emerick KM, Melin-Aldana H, Li BU. Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol. 4:1097-102. 2006
Liacouras CA, Spergel JM, Ruchelli E, Verma R, Mascarenhas M, Semeao E, Flick J, Kelly J, Brown-Whitehorn T, Mamula P, Markowitz JE. Eosinophilic esophagitis: a 10 year experience in 381 children. Clin Gastroenterol Hepatol. 3:1198-1206. 2005
Ngo P, Furuta G, Antonioli DA, Fox V. Eosinophils in the esophagus- peptic or allergic eosinophilic esophagitis? Case series of three patients with esophageal eosinophilia. Am J Gastroenterol. 101:1666-70. 2006
Remedios M, Campbell C, Jones DM, Kerlin P. Eosinophilic esophagitis in adults: clinical, endoscopic, histologic findings and response to treatment with fluticasone propionate. Gastrointest Endosc. 63:3-12. 2006
Spergel JM, Andrews T, Brown-Whitehorn TF, Beausoleil JL, Liacouras CA. Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests. Ann Allergy Asthma Immunol. 95:336-43. 2005.
Straumann A, Spichtin HP, Grize L, Bucher KA, Beglinger C, Simon HU. Natural history of primary eosinophilic esophagitis: a follow-up on 30 adult patients for up to 11.5 years. Gastroenterology. 125:1660-9. 2003.
 Internet Resources:
More information about eosinophilic gastrointestinal disorders can be found at the following websites:
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