Mount Sinai Center for Eosinophilic Disorders (MSCED)
The Mount Sinai Center for Eosinophilic Disorders (MSCED) is a comprehensive program dedicated to the diagnosis, management, and long-term care of eosinophilic gastrointestinal disorders (EGIDs).
EGIDs are chronic inflammatory diseases that often occur when a type of white blood cell, called an eosinophil, builds up in the inner lining of the digestive tract. This accumulation causes tissue irritation, swelling, and a range of uncomfortable gastrointestinal symptoms. These conditions are deeply tied to allergic responses and can affect both children and adults.
Conditions We Treat:
Our specialized team cares for patients with all types of EGIDs, which affect different parts of the digestive system:
- Eosinophilic esophagitis (EoE): Inflammation in the esophagus (the food pipe).
- Eosinophilic gastritis (EG): Inflammation affecting the stomach.
- Eosinophilic enteritis (EoN): Inflammation affecting the small intestine.
- Eosinophilic colitis (EoC): Inflammation affecting the large intestine (colon).
Symptoms of EGIDs
Because these disorders share symptoms with many other common digestive issues, such as standard acid reflux, gastritis, irritable bowel syndrome (IBS), or inflammatory bowel disease (IBD), a precise, expert evaluation is essential for an accurate diagnosis. Symptoms vary based on the patient’s age and which organ is affected.
Eosinophilic Esophagitis (EoE) Symptoms
EoE specifically affects the esophagus, also known as the food pipe. Common signs include:
- Difficulty swallowing foods (dysphagia)
- Food getting stuck in the esophagus (food impaction)
- Heartburn, regurgitation, and acid-reflux symptoms
- Esophageal spasms and chest or abdominal pain
- Nausea and vomiting, especially in children
- Precautionary eating habits, such as prolonged chewing, taking unusually small bites, or needing to drink liquids with every bite of food
In children, nonspecific symptoms like stomach pain and vomiting can sometimes be mistaken for standard acid reflux, also known as gastroesophageal reflux disease (GERD). Left untreated, chronic inflammation can cause poor growth or "failure to thrive" in pediatric patients, though this is fully reversible once the underlying inflammation is properly treated.
Symptoms of EGIDs Below the Esophagus
When eosinophils build up in the stomach, small intestine, or colon, symptoms match the affected organs:
- Stomach and small intestine: Persistent stomach pain, nausea, vomiting, and early satiety (feeling full too quickly after eating).
- Small intestine and colon: Abdominal pain or cramping, chronic diarrhea, unexplained weight loss, and occasionally blood in the stools.
Because these symptoms mirror conditions like standard gastritis, irritable bowel syndrome, or inflammatory bowel disease, a comprehensive diagnostic evaluation is essential.
Specialized Treatment Options
While there is currently no permanent cure for EGIDs, highly effective medical and dietary therapies are available to control tissue inflammation, ease symptoms, and prevent long-term complications like esophageal narrowing or scarring.
1. Dietary Management
Because food proteins are a primary trigger for eosinophilic inflammation, specialized dietary therapy is a cornerstone of our program. Our clinical nutrition team works closely with families to develop structured elimination diets. This process involves systematically removing common food triggers, such as dairy (cow's milk), wheat/gluten, soy, eggs, peanuts, tree nuts, fish, or shellfish, to identify and eliminate the source of the allergic response before safely reintroducing foods one by one.
2. Medical Therapies
When prescription management is required to lower tissue swelling and protect the digestive tract, there are several medical options:
- Biologic therapy: Dupilumab is an FDA-approved prescription biologic medication for EoE in adults and pediatric patients aged 12 and older. It is administered as a weekly subcutaneous injection (just under the skin) to target the specific proteins driving the allergic inflammation.
- Topical corticosteroids: Swallowed medications (such as fluticasone or budesonide) are frequently prescribed. Instead of inhaling the medicine into the lungs, the patient swallows it to directly coat the esophagus, reducing swelling and irritation.
- Proton pump inhibitors (PPIs): These standard acid-suppressing medications decrease acid-induced irritation and, for some patients, significantly reduce allergic inflammation in the esophagus.
Diagnostic Monitoring
Because the symptoms of EoE and other EGIDs can look different in each person, how you feel does not always show the state of the disease inside your body. Some patients may feel healthy on the outside, even when their tissues are actively inflamed.
To safely monitor the disease, protect the digestive tract from long-term complications, such as scarring or narrowing of the esophagus, and ensure your treatment plan is working effectively, our specialists recommend routine follow-up care:
- Upper endoscopy: Performed routinely (typically every one to two years, depending on your individual care plan) to directly evaluate the lining of the digestive tract and collect microscopic tissue samples to measure eosinophil levels.
- Endoluminal functional lumen imaging probe (EndoFLIP): This is done at the time of endoscopy and measures the internal diameter and pressure in the esophagus. The procedure indicates the stiffness or flexibility of the esophageal wall, helping doctors identify abnormalities that may not be visible during standard endoscopy.
Our Multidisciplinary Approach
At the Mount Sinai Center for Eosinophilic Disorders, we believe that managing complex eosinophilic disorders requires a collaborative team approach. We work closely with the Division of Pediatric Gastroenterology and the Jaffe Food Allergy Institute to provide seamless, coordinated care across gastroenterology, allergy, and nutrition. Together, our team partners with you to establish a clear diagnosis and build a supportive, long-term care plan tailored to your or your child's life.