Eosinophilic Esophagitis

Eosinophilic esophagitis inflammation that happens in the esophagus, i.e. the "food pipe." The esophagus becomes inflamed and does not contract properly. It can get narrowed and develop rings or abscesses.  The symptoms happen when your immune system makes white blood cells in reaction to an allergen. The white blood cells are called eosinophils.

The condition is called eosinophilic esophagitis, or EE or EoE. It can happen at any age and is commonly seen in white males.

Causes

EoE is often caused by an allergic reaction to certain foods or environmental allergens. 

Symptoms

Symptoms of EoE vary from person to person and may include:

• Gastroesophageal reflux (heartburn)

• Trouble swallowing

• Chest pain

• Abdominal pain

• Vomiting

• Food getting stuck in the throat due to narrowing (this is a medical emergency)

• Stunted growth or poor weight gain in children

Risk factors

People with atopic dermatitis, asthma, or food or environmental allergies have a much greater chance of developing EoE it. Some other conditions can cause eosinophils to increase in number in the esophagus. Your healthcare provider will need to evaluate you for these possible conditions. Family history of EoE is also a risk factor for the condition. 

Diagnosis

Your healthcare provider will take your medical history and will likely want to test you for allergies. He or she will probably request an endoscopy by a gastroenterologist, a specialist in digestive (stomach and swallowing) disorders. This is an outpatient procedure that involves passing a thin, flexible endoscope with a camera through your mouth and down your throat to look at your esophagus. The gastroenterologist will check for physical signs of inflammation and an increased number of eosinophils. To confirm the diagnosis, your gastroenterologist will likely need to take a biopsy, or tissue sample, from your esophagus.

Treatment

For treatment, you will need to work closely with an allergist and/or a gastroenterologist. They’ll help you figure out what substances or foods to avoid. No specific medicines can cure EoE, although certain medicines, such as corticosteroids and proton pump inhibitors, and eliminating specific foods—diary, egg, wheat, soy, peanut, tree nuts, and fish—from your diet can help reduce the redness and swelling in your esophagus.

You can help manage EoE by learning what substances cause your allergic reaction and avoiding them. It is important to know that reactions related to EoE might take days or weeks to develop. Keep this in mind when beginning a food elimination plan. It might take some time after avoiding a particular food to determine whether that strategy worked.

Sometimes the esophagus needs to be dilated (stretched) if it has narrowed.

Complications

The long-term complications of EoE are not clearly understood. If left untreated, symptoms will continue and damage to the esophagus causing narrowing may happen. 

Call 911

Call 911 if you have:

• Food stuck in your throat

• Difficulty breathing or talking

• Chest pain

When to call the healthcare provider

Call your healthcare provider if you have EoE and notice any of these symptoms:

• Increasing weight loss

• Increase in vomiting

• Stomach pain

Living with EoE

EoE is often a life-long condition. Management includes avoiding the foods or allergens that cause the allergic reaction, or medications. It is important to work with your allergen and gastroenterologist to develop a management plan that works best for you. It can take patience to identify and then remove allergens from your diet. However, your quality of life will improve as your management plan progresses. 

Online Medical Reviewers:

• Freeborn, Donna, PhD, CNM, FNP
• Kirsi Järvinen-Seppo, MD, PhD
• Lehrer, Jenifer, MD