Eosinophilic Esophagitis

Eosinophilic esophagitis is a medical condition that affects the esophagus, which is a long, hollow tube that carries food from the mouth to the stomach. It occurs when immune cells called eosinophils infiltrate the tissue lining the esophagus. This infiltration of the wall of the esophagus with eosinophils leads to stiffening of the walls and narrowing of the lumen such that it becomes difficult to swallow solid foods, throat and chest pain.

 

To diagnose eosinophilic esophagitis, doctors will take tissue samples from different parts of the esophagus and examine them under a microscope. They will look for a high number of eosinophils and other changes in the tissue. Eosinophilic esophagitis is thought to be caused by an allergic reaction to food. It is more common in people who have a history of non-food allergies and asthma, or who have a parent or sibling with the condition. Long-term acid reflux disease (GERD) may also increase the risk of eosinophilic esophagitis.

Treatment

Daily acid blocking medication (also known as proton pump inhibitors or PPIs) alone initially to rule out acid reflux as the cause of eosinophilic esophagitis.  If use of PPIs does not resolve the inflammation, it is then used in combination with either swallowed steroid medications (fluticasone propionate or budesonide) or targeted elimination diet usually followed for 6 weeks with reintroduction of eliminated foods, one at a time to help identify the food trigger.  Additionally, gentle stretching open of the esophagus (dilatation) at endoscopy may be pursued when medications and/or diet fail to relieve difficulty swallowing or dysphagia.

Six Food Elimination Diet

The six food elimination diet is a way to help figure out if certain foods are causing your eosinophilic esophagitis symptoms. To do this diet, you’ll need to avoid the top 6 most common food allergens for 6 weeks: 

  • Milk or dairy products.
  • Eggs.
  • Wheat/gluten containing products.
  • Soy.
  • Peanuts and tree nuts.
  • Seafood – fish/shellfish etc.

After 6 weeks, your doctor will check your symptoms and may do a test called an EGD (esophagogastroduodenoscopy) with biopsy to see if the esophagus has any inflammation or narrowing. Then, you’ll bring each of the avoided foods back into your diet one at a time for 2 weeks each, and your doctor will check in with you after each food is added back in. This can help identify which foods may be causing your EoE symptoms.

FAQs

The exact cause of Eosinophilic esophagitis is not fully understood. It is believed to be an immune-mediated condition triggered by an allergic or hypersensitivity reaction to certain foods or allergens.

Symptoms of Eosinophilic esophagitis can include difficulty swallowing, chest pain, heartburn, food impaction, and vomiting.

Eosinophilic esophagitis is typically diagnosed by performing an upper endoscopy and obtaining a biopsy of the esophagus. The biopsy will be examined for the presence of eosinophils.

Treatment for Eosinophilic esophagitis typically involves use of acid reducing medication, eliminating the allergens that trigger the inflammation through diet modification and/or using medication such as swallowed corticosteroids, and/or swallowed topical immunomodulators.

The long-term prognosis for eosinophilic esophagitis is generally good with appropriate management. With a proper treatment plan and ongoing monitoring, most people with EoE are able to manage their symptoms and avoid complications.

In some cases, eosinophilic esophagitis can lead to complications such as esophageal strictures (narrowing of the esophagus) or food impaction (food getting stuck in the esophagus), and even spontaneous tear or perforation of the esophagus.

Since the exact cause of eosinophilic esophagitis is not fully understood, it is difficult to say for certain how to prevent it. However, avoiding known triggers and allergens, and maintaining a healthy diet, may help to reduce the risk of developing the condition.

While there is no cure for eosinophilic esophagitis, it can be managed with treatment and ongoing monitoring. With appropriate management, most people with EoE are able to control their symptoms and avoid complications.

Yes, eosinophilic esophagitis can occur in children as well as adults. Children with EoE may experience symptoms such as difficulty swallowing, vomiting, and food impaction.

In some cases, eosinophilic esophagitis can lead to long-term complications such as esophageal strictures, food impaction, and difficulty swallowing. Regular monitoring with endoscopy is important to detect any complications early.

No, eosinophilic esophagitis is not contagious.

No, eosinophilic esophagitis is not a rare condition. It is estimated to affect about 1-2% of the population.