Understanding Eosinophilic Esophagitis

What is Eosinophilic Esophagitis?

Eosinophilic esophagitis is a chronic immune system disorder that causes irritation or inflammation of the esophagus, the tube that carries food from your mouth to your stomach. Normally, eosinophils, a type of white blood cell, are not found in the esophagus. But people with eosinophilic esophagitis are found to have a lot of these cells in the lining of their esophagus. It is thought that the eosinophils move into the esophagus as part of an allergic reaction to foods, allergens, or acid reflux. This causes damage to the esophagus and narrowing of the tube over time.

Doctors only learned about this condition in the last 20 years, but it is believed to be a major cause of gastrointestinal (GI) illness. Since it is relatively new, research is ongoing and new information is being found that is likely to change how it is diagnosed and treated.

The exact number of people who have eosinophilic esophagitis is currently unknown, but it appears to affect people of all ages, races, and sex equally. People who get eosinophilic esophagitis tend to have a family history of allergies or asthma, and it is thought to run in families.

What are the Symptoms of Eosinophilic Esophagitis?

The symptoms of eosinophilic esophagitis vary with age. Infants and toddlers may refuse to eat their food and tend to grow poorly. School aged children tend to have frequent episodes of abdominal pain, vomiting, difficulty swallowing, and weight loss. Adults are more likely to have difficulty swallowing solid foods, constant heartburn, food that come back up (regurgitation), and upper abdominal pain. In more severe cases, the esophagus can become so narrow that food gets stuck or becomes impacted in the esophagus. This is considered a medical emergency.

How is Eosinophilic Esophagitis Diagnosed?

If your doctor thinks you have eosinophilic esophagitis, you will be referred for an upper endoscopy. This involves inserting a long, narrow tube with a light and tiny camera attached to it, through your mouth and down into your esophagus. This allows your doctor to inspect the lining of your esophagus and take biopsies of any areas that look abnormal. The tissue that is taken during the biopsy is sent to the laboratory and checked for signs of eosinophilic esophagitis under a microscope.

After you are diagnosed, you are likely to be sent to an allergist for allergy testing. This helps to find out what things you are allergic to and will guide your treatment. But the process to identify the exact cause of your symptoms is often complex. This is because people with this type of allergy have a delayed allergic response to the specific food or allergen trigger. This means that the allergic reaction may occur several days after eating the food you are allergic to or being exposed to the allergen trigger, This makes allergy testing more difficult.

How is Eosinophilic Esophagitis Treated?

Eosinophilic esophagitis is a chronic condition that will require a combination of dietary changes and medication to treat. This means you will need to work closely with your doctor over a long period of time to find the right combination of treatments for you.

If you are diagnosed with specific food allergies, your doctor will have you stop eating those foods first. If the source of your allergy is unknown, your doctor may have you remove certain foods from your diet and see how you respond. Common causes of this condition are milk, eggs, soy, and wheat. These are likely to be the foods your doctor recommends you stop eating.

If you also need medication to treat your symptoms, you will likely be prescribed a topical corticosteroid that you take orally. It is important to know that topical corticosteroids are not approved by the FDA to treat eosinophilic esophagitis, but research has shown that this treatment can help improve your symptoms. You will likely be started on a high dose of the corticosteroid until your inflammation improves and then your dose will be decreased.

Proton pump inhibitors (PPI), which reduce the amount of acid your stomach produces, have also been shown to improve symptoms, especially if they are because of acid reflux. You will likely be prescribed one of these to take also.

Over time, you may get strictures or narrowing of the esophagus that need to be opened, or dilated. If you need to have your esophagus dilated, it will be done during an endoscopy.

What is the Prognosis of Eosinophilic Esophagitis?

Since eosinophilic esophagitis is a relatively new condition, the exact long-term prognosis is still unknown. It isn't likely to shorten your life expectancy or cause cancer of the esophagus, but it is important to know that there is no cure for it. Therefore, close monitoring of your symptoms and long-term treatment are needed.

Where Can You Get More Information About Eosinophilic Esophagitis?

American Academy of Allergy, Asthma, Immunology: http://www.aaaai.org/conditions-and-treatments/related-conditions/eosinophilic-esophagitis

American Partnership for Eosinophilic Disorders: http://apfed.org/about-ead/egids/eoe/

Eosinophilic Esophagitis Home: http://www.eosinophilicesophagitishome.org/