Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at NSU
What is Eosinophilic Esophagitis (EoE)?
Eosinophilic (ee-uh-sin-uh-fil-ik) esophagitis (EoE) is an inflammation of the esophagus. Esophagus is the tube that sends food from the mouth to the stomach. The inflammation in EoE is made of a lot of orange-colored cells calles eosinophils, giving the name of the condition, eosinophilic esophagitis.
How do I know if I have Eosinophilic Esophagitis (EoE)?
The most common symptom of EoE in older children and adults is difficulty swallowing solid foods, a feeling like a food is “stuck” in the esophagus. Sometimes, patients complain of pain. Vomiting is another common symptoms. This is due to inflammation of the esophagus.
In children, EoE symptoms can include poor growth, weight loss, a poor appetite or even refusing to eat.
What causes Eosinophilic Esophagitis (EoE)?
The leading cause of eosinophilic esophagitis is an allergy or a sensitivity to particular proteins found in foods, called allergens.
People of all ages can be affected by eosinophilic esophagitis. They have a large number of eosinophils - a type of white blood cell that is normally found in small numbers in the blood - in the wall of the esophagus (inflammation). A large number of eosinophils in the esophagus may result from a food allergy reaction, acid reflux, or airborne allergens, which can contribute to inflammation, or injury to the esophageal tissue.
Many people with EoE have a personal of family history of allergic disorders such as asthma, alergic rhinitis, atopic dermatitis or food allergy.
50% of patients with eosinophilic esophagitis have seasonal allergies or asthma. Many others also have food allergies or eczema. Some patients note a seasonal flare up of the condition, typically in the spring and in the summer.
How to diagnose Eosinophilic Esophagitis (EoE)?
You need to see 3 different specialists for optimal management of EoE:
- an allergist
- a gastroenterologist (GI)
- a nutritionist
An allergist will determine the role that allergies may play in EE. Your allergist will perform allergy testing to diagnose which specific allergens may be involved with your EoE. This is done with skin testing, blood testing, or both.
In order to diagnose EoE for sure, a gastroenterologist will perform an upper endoscopy (EGD) and a biopsy of the esophagus. This is usually done after medications to control acid reflux have failed to improve symptoms.
A nutritionist will help you choose an eliminations diet that will help your esophagus to heal.
What is the treatment for Eosinophilic Esophagitis (EoE)?
If the food allergy testing shows sensitizations, counseling is provided on foods to avoid. Food-related reactions may not be immediate, and in this case the skin test and blood tests may be negative. Some patients may find that the esophagus becomes inflamed by an offending food days or weeks after eating it. Dietary changes can improve the symptoms of eosinophilic esophagitis.
Medications may suppress eosinophil accumulation, relieve damage to the tissue in the esophagus, and alleviate symptoms.
Swallowed oral topical steroids are very effective. These are the same medications used for asthma (budesonide, Pulmicort) but instead of inhaling them, a patient with EoE will mix the liqued with thickening agent such as Splenda and swallow it twice a day.
Patients with eosinophilic esophagitis should work closely with an allergist, a gastroenterologist, and a nutritionist to find a treatment plan that works best for them.
Video: Learn about eosinophilic gastrointestinal disorders from Gus the esophaGUS! Video by the American Partnership for Eosinophilic Disorders (apfed.org):