Eosinophilic esophagitis: what you need to know
Eosinophilic esophagitis (EOE) is an allergic/immune condition that affects the esophagus – the tube that takes food from your mouth to your stomach. It is a form of eosinophil-driven disease (EDD), along with severe asthma, atopic dermatitis, nasal polyps, and Samter´s Triad. When the stomach is primarily affected, this is called “eosinophilic gastritis”.
While it is not a life-threatening disease, it is a chronic condition that is not outgrown and should be properly treated.
If you have EOE, large numbers of a particular kind of white blood cell – called eosinophils – are found in the lining of your esophagus. A healthy person without EOE usually has no increased eosinophils in their esophagus.
Eosinophils are a normal part of the body’s immune system, but when they accumulate in the esophagus they release substances that inflame the tube lining. Over time this inflammation and damage can cause pain, difficulty swallowing, or increase the risk of food getting stuck in your throat.
Perhaps because it is an allergic disease, EOE is sometimes called ‘oesophageal asthma’. While it’s possible to have both EOE and asthma together, they are separate diseases affecting different parts of the body – EOE affects the esophagus and asthma affects the lungs.
Is eosinophilic esophagitis common?
EOE is quite rare – about five people out of every 10,000 may have the condition. However, the numbers of people being diagnosed with the condition are increasing rapidly worldwide. This is partly due to it being a recently recognized condition, but there may well be other reasons for the rise.
EOE is quite common in children and young adults but it can affect people of any age. It’s most prevalent in people in their 30s.
Who is at risk for eosinophilic esophagitis?
You’re more at risk of developing EOE if you already have another allergy-type disease, such as asthma, eczema, hay fever, or a food allergy. You’re also more likely to develop it if you have a relative with the condition. Three times as many men have EOE as women.
What causes eosinophilic esophagitis?
We don’t know exactly what causes EOE but it is thought to be an immune response to specific food allergens – often but not always milk, wheat, nuts, soy, fish, and eggs. It is also possibly triggered by something we breathe in and there may be a genetic component too.
What are the symptoms?
The symptoms of EOE vary from person to person, while also depending on their age.
Babies and toddlers
- Problems feeding, e.g. refusing to eat or ‘fussy eating’
- Vomiting and/or regurgitation
- Poor growth and weight gain (‘failure to thrive’)
- Gastroesophageal reflux (GER), which is when the stomach contents come back up into the esophagus. With EOE, the GER symptoms do not usually go away with medicines.
- Abdominal and/or chest pain
- Difficulty swallowing (‘dysphagia’), especially with solid foods
- GER that does not usually get better with medicines
- Poor appetite.
- Difficulty swallowing, especially with solid foods
- Food stuck in the esophagus
- GER that does not usually get better with medicines
- Chest pain.
At all ages, the symptoms can lead to disturbed sleep.
Dysphagia can feel like the food you’ve swallowed is moving towards your stomach too slowly or sticking halfway in your chest. This might happen every time you swallow or just occasionally. Some people get a mild sensation of ‘stuckness’, but for others, it can range from uncomfortable to severe and distressing. There may or may not be pain with the sensation.
Occasionally the food becomes completely stuck in the esophagitis – this is called ‘food bolus obstruction’ and is a medical emergency.
If you think you may have EOE, you should discuss the symptoms with your family doctor.
How is eosinophilic esophagitis diagnosed?
Before making a diagnosis, your doctor will ask you about your symptoms, medical history, and whether you or your family members have any allergies. Your doctor may refer you to a specialist for further investigations.
They’ll also want to rule out other possible conditions that might be causing your symptoms, such as:
- Gastro-esophageal disease (GERD)
- Esophageal Crohn’s disease
- Infection (fungal/viral)
- An auto-immune disorder
- Other rare causes of eosinophilia.
GERD is the most common alternative diagnosis. Many people initially diagnosed with GERD have subsequently been found to have EOE instead.
However, the only way to confirm a diagnosis of EOE is to investigate by endoscopy. This is when a flexible tube with a tiny camera at one end is passed via your mouth and throat into your esophagus to view the inner lining of the esophagus wall. At the same time, your doctor will take small tissue samples (biopsies) of the lining. Biopsy samples are examined under a high-power microscope to count the number of eosinophils present. More than 15 eosinophils per microscope view will confirm the diagnosis.
How is eosinophilic esophagitis treated?
There are two main types of treatment: drug therapy and diet management. The drug options are:
- Corticosteroids – to reduce inflammation. These are usually topical liquid preparations that you swallow.
- A proton pump inhibitor – to alleviate GER symptoms and reduce inflammation.
Dietary treatments include cutting foods that may be triggering your symptoms from your diet. They include:
- Elimination diet – you stop eating and drinking certain foods that commonly cause allergies, such as dairy, wheat, egg, soy, fish and shellfish, peanuts, and tree nuts. After several weeks, if your symptoms go away, you can then re-introduce the foods one at a time
- Elemental diet – you cut out all proteins and instead drink an amino acid formula. If your symptoms go away you re-introduce different protein foods and drinks one at a time
- Allergy test-directed diet – you first have an allergy test to find out what foods and drinks you are allergic to. You can then cut them from your diet to see if your esophagitis symptoms improve.
Dietary management can be an effective alternative to drug therapy, but it doesn’t suit everyone – as they mean sticking to strict food intake rules for long periods while you withdraw and re-introduce foods to your diet.
Most people with EOE respond well to either drug treatment or dietary therapy. However, if these treatment options do not help sufficiently and your esophagus is narrowed, you may be offered a procedure called endoscopic esophageal dilation. This stretches the esophagus to widen it, so it becomes easier to swallow.
If you think you have EOE, you should seek medical help.
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