Eosinophilic Esophagitis

What is eosinophilic esophagitis?

Eosinophilic esophagitis (EoE) is a disease that occurs in the esophagus (food pipe). In EoE, the esophagus becomes inflamed by white blood cells, also known as eosinophils. The inflammation can then lead to dysmotility of the esophagus and narrowing of the esophagus. This condition can happen at any age and in both men and women but is commonly seen in white males.

Causes

EoE is thought to be caused by certain foods and/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

A large proportion of patient’s with EoE will have atopic dermatitis (eczema), asthma, or food/environmental allergies. Patients who have a family history of EoE are also at increased risk of developing EoE.

Diagnosis

Your healthcare provider will take your medical history and obtain a physical exam. In order to evaluate for EoE, the following tests may be utilized:

• Upper Endoscopy. This test checks the inside of part of the digestive tract. It uses a small, flexible tube called an endoscope. The tube has a light and a camera lens at the end. Tissue samples or biopsies from inside the digestive tract may also be taken for testing. In particular, the procedure will be used to look for visible signs of inflammation and biopsies will be evaluated for increased number of eosinophils to confirm the diagnosis. This procedure is done under anesthesia.
• Allergy Testing. A referral to an allergist may be helpful for testing to determine potential triggers or causes of the inflammation.

Treatment

For treatment, you will need to work closely with an allergist and a gastroenterologist. Treatment will usually involve eliminating the “food culprit” or “food culprits”. Other treatments include topical steroids that patient’s will swallow to help reduce the inflammation in the esophagus. The foods that tend to be implicated in EoE are dairy, egg, wheat, soy, peanut, tree nuts, and fish. However, other foods may be causing the inflammation as well. Working closely with the allergist will help determine which foods are causing the inflammation.

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

Repeat upper endoscopies are frequently needed to help determine if the esophagus has healed based on the treatment plan.

Complications

The long-term complications of EoE are not clearly understood. If left untreated, symptoms will continue and cause damage to the esophagus leading to potential narrowing of the esophagus and inflammation.

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
• Difficulty swallowing

Living with EoE

EoE is often a life-long condition. Management includes avoiding the foods or allergens that cause the inflammation, or medications. It is important to work with your allergist 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.