Eosinophilic Esophagitis

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Overview

People with certain food or environmental allergies, asthma or eczema may be at a higher risk of developing eosinophilic esophagitis, an allergic condition that causes inflammation in the esophagus. This chronic condition is becoming more common, especially among young men, and requires ongoing treatment to manage symptoms.

• What is eosinophilic esophagitis?

  Eosinophilic esophagitis, or EoE, is an allergic condition that affects the esophagus, the “food tube” connecting the mouth to the stomach. People with EoE have high levels of eosinophils in the esophageal tissue. Eosinophils, a type of white blood cell, can cause inflammation in the esophagus. In addition, this inflammation can cause chest pain, heartburn, difficulty swallowing, or cause food to become stuck in the esophagus (impaction)

• What is the outlook for people with eosinophilic esophagitis?

  Most people with EoE function well with proper treatment, although there is no cure for the condition. Treatment focuses on managing symptoms and helping people maintain their quality of life.

• What are the signs and symptoms of eosinophilic esophagitis?

  Signs of symptoms, which include those of reflux, can vary depending on age:

  In infants and toddlers:

  • Difficulty feeding
  • Poor growth and weight gain

  In children:

  • Abdominal pain
  • Difficulty swallowing, especially solid foods
  • Poor appetite

  In adults:

  • Difficulty swallowing, especially solid foods
  • Food getting stuck in the esophagus
  • Heartburn
  • Upper abdominal and chest pain
• When should I see a doctor about eosinophilic esophagitis?

  Chest pain, especially when it occurs with shortness of breath or jaw or arm pain, can be a symptom of a heart attack. Seek immediate medical attention if you are experiencing these symptoms.

  See your doctor if you:

  • Experience frequent or severe symptoms of EoE
  • Take over-the-counter medications for heartburn more than twice per week
• What causes eosinophilic esophagitis?

  Although medical experts are not certain of the exact causes of EoE, they believe that the condition is related to an allergic reaction to environmental or food triggers. Certain people may have a genetic condition that can increase the risk of developing EoE.

  Other conditions such as gastroesophageal reflux disease (GERD), parasitic diseases or inflammatory bowel disease may also cause high levels of eosinophils in the esophagus. If you have symptoms of EoE, see a doctor for an accurate diagnosis. A doctor can rule out other conditions and decide on the best treatment plan for you.

• What are the risk factors for eosinophilic esophagitis?

  Factors that increase your risk of developing eosinophilic esophagitis include:

  • Gender: EoE affects 3 times as many men as women.
  • Allergies and asthma: People with food or environmental allergies, asthma, eczema or a chronic respiratory disease are at a higher risk of developing EoE.
  • Family history of EoE: Research has shown that the condition is related to specific genes. If others in your family have EoE, you may be at a higher risk.
  • Season: Levels of pollen and other allergens are higher in the spring, summer and fall, which means people may be more likely to be diagnosed during those seasons.
• Who should be evaluated for eosinophilic esophagitis?

  Previously considered a rare disease, EoE has recently been recognized as one of the most common causes of difficulty swallowing and food impaction in young adults. If you experience any of the symptoms or have some of the risk factors for EoE, see your doctor for a checkup.

• How is eosinophilic esophagitis diagnosed?

  Doctors typically begin your evaluation by asking you about your symptoms and personal and family medical history. They may also conduct a physical exam to evaluate your symptoms.

  To confirm a diagnosis of EoE and rule out other conditions with similar symptoms, your doctor will recommend other tests, such as:

  • Upper endoscopy: Also known as an esophagogastroduodenoscopy (EGD) [LINK http://patients.gi.org/topics/upper-gi-endoscopy-egd/], this test involves an endoscope (long, narrow tube with a lighted camera on its tip). The doctor passes the endoscope through your mouth and into your esophagus to examine the lining for inflammation and other issues.
  • Biopsy: During the EGD, your doctor will also perform a biopsy. Doctors insert instruments through the endoscope and take small tissue samples of the esophageal lining to inspect under a microscope. Doctors will check for high levels of eosinophils, signs of inflammation and other changes that indicate EoE.
• What are the treatments for eosinophilic esophagitis?

  EoE is a chronic disease with no cure. But treatment can manage your symptoms, reduce eosinophil levels in the tissue and prevent further damage to the esophagus. The main types of treatment are dietary changes and medications:

  • Elimination diet: You stop eating and drinking certain foods, such as milk, soy, eggs, wheat, nuts and seafood, for several weeks. Then you add them back in one at a time to identify the food that is triggering the allergic reaction. An elimination diet helps reduce symptoms and inflammation.
  • Elemental diet: You stop consuming any protein and drink an amino acid formula instead. Similar to the elimination diet, you reintroduce foods one at a time to identify the food trigger.
  • Acid-blocking medications: Medications such as proton pump inhibitors (PPIs) can help rule out gastroesophageal reflux disease and can sometimes reduce inflammation and reflux symptoms.
  • Topical Corticosteroids: These medicines control inflammation. You ingest them either from an inhaler or as a liquid.
  • Esophageal dilation: Some people have a narrowing (stricture) of the esophagus, so medications and dietary changes may not improve their symptoms. Doctors can perform a minimally invasive procedure called esophageal dilation. This procedure stretches esophageal strictures, making it easier to swallow and relieving other symptoms.

  Newer medications that target specific parts of the body's immune system are under investigation, but are not currently a part of routine patient care.

  Speak with your doctor about what treatment options may be best for you.

• Am I at risk of developing other conditions?

  In some people, EoE can lead to complications such as:

  • Esophageal strictures: Narrowed areas of the esophagus, often caused by scarring, can make it difficult to swallow.
  • Food impaction: If the esophagus is too narrow, food can become stuck and cause pain and other symptoms.
  • Damage to the esophagus: Forceful vomiting or prolonged food impaction can cause a tear or hole in the esophagus, which requires immediate medical attention.

Author(s) and Publication Date(s)

Nirmala Gonsalves, MD, Northwestern University, The Feinberg School of Medicine, Chicago, IL – Published July 2010. Updated July 2019.

Matthew Chin, MD, John Muir Health, Walnut Creek, CA – Updated March 2021.

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