Eosinophilic Esophagitis
Eosinophilic esophagitis (EoE) is a chronic immune disorder of the esophagus, the tube connecting your mouth to your stomach. EoE has been diagnosed in increasing numbers in recent years; currently, the prevalence in the USA is around 1 in 700. EoE can affect both adults and children, but it is most common in men in their 20s and 30s.
What is Eosinophilic Esophagitis?
Eosinophils are a type of white blood cell. In a normal immune response, eosinophils induce inflammation to fight pathogens by releasing specific chemical compounds. However, this inflammatory response, when in excess or misdirected, such as in an allergic reaction, can end up causing tissue damage and bothersome symptoms.
The esophagus normally doesn’t have any eosinophils in its tissues. Eosinophilic esophagitis is an allergic condition in which certain triggers cause eosinophils to migrate to the esophagus, resulting in inflammation. Over time, this chronic inflammation can lead to scarring and narrowing or damage to your esophagus.
What Causes Eosinophilic Esophagitis?
As an allergic condition, EoE is often found alongside other allergies, such as hay fever, asthma, or skin allergies such as atopic dermatitis. Doctors don’t know the exact cause of EoE, but it is believed that a combination of environmental and genetic factors contributes to the development of this condition.
An allergen in food can trigger an immune reaction and the accumulation of eosinophils, as seen in EoE. This reaction is not the same as a typical food allergy, which usually occurs soon after eating the food and causes classical allergy symptoms such as rash, swelling, vomiting, or, in severe cases, anaphylaxis, difficulty breathing. The symptoms of EoE may develop over a few days, which makes it difficult to identify the triggering food.
Symptoms of Eosinophilic Esophagitis
Originally, EoE was thought to be part of another condition known as gastroesophageal reflux disease (GERD), as they share many symptoms. Now they’re considered to be two distinct diseases.
The main symptom of EoE in adults is difficulty swallowing food, known as dysphagia. Food impaction, when food becomes stuck in the esophagus after swallowing, is also a common symptom. Other symptoms of EoE in adults include:
- Chest pain or heartburn that doesn’t respond to heartburn medication
- Regurgitation of swallowed food
In addition to dysphagia and food impaction, children with EoE may also demonstrate:
- Nausea and vomiting
- Abdominal pain
- Weight loss and poor growth
- Aversion or intolerance to feeding
Diagnosis and Treatment of Eosinophilic Esophagitis
Diagnosing eosinophilic esophagitis involves a physical examination of your esophagus using an endoscope (a long, thin camera inserted into the throat to visualize your esophagus) and taking a biopsy to look for the presence of eosinophils. It is also important to rule out other causes of eosinophils in the esophagus, such as GERD, celiac disease, or Crohn’s disease.
If your symptoms, endoscopy, and biopsy all confirm a diagnosis of EoE, managing your symptoms may involve:
- Eliminating certain foods from your diet to identify your triggers, starting with the common food allergens, including soy, dairy, wheat, and egg
- Medications, usually a proton pump inhibitor (PPI), but you may require stronger drugs such as a steroid oral liquid or a monoclonal antibody injection (biologic medication) if PPIs are ineffective
- Endoscopic dilation, which involves stretching a severely narrowed esophagus to improve swallowing
EoE is a chronic condition. It doesn’t have a cure, but the symptoms can be treated.
EoE is usually primarily managed by a gastroenterologist, although ear, nose, and throat (ENT) specialists also play an integral role, as they’re usually the first to see someone complaining of dysphagia. Allergists are also often required to help manage these cases effectively as EoE often goes hand in hand with other allergic conditions.