Taking the Sting Out of Eosinophilic Esophagitis
Eosinophilic esophagitis (EoE) occurs when too many eosinophils, a type of white blood cell, gather in the esophagus and cause inflammation, swelling, and scarring.
Allergic reactions to foods are the main cause of EoE in most patients. For those afflicted with this chronic immune system disease, life can be severely impacted.
Symptoms
The symptoms of EoE are similar to those of other GI disorders. Symptoms vary, according to the age of those affected. This can make it difficult to diagnose EoE.
- Infants and toddlers may reject food, or they may not grow as expected.
- In older children, there can be decreased appetite, abdominal pain, difficulty swallowing, and vomiting.
- Teenagers and adults may experience similar symptoms. More often, they have trouble swallowing foods that are dry, dense, or compacted. Food can get stuck in the esophagus, a painful condition called impaction.
Risk Factors
Allergies are the biggest risk factor for EoE.
- About 50% of people with EoE have asthma or seasonal allergies. And those who have other allergies — such as hay fever and eczema — may find that their symptoms’ strength varies by season.
- Patients with food or environmental allergies or with atopic dermatitis have a greater chance of developing EoE.
- Males experience more EoE than females.
- A family history of allergies may increase one’s risk of developing the disorder.
- Living in a cold or dry climate also is linked to EoE.
When to see a doctor
Make an appointment with your doctor if you have EoE symptoms such as:
- Trouble swallowing food.
- Food gets stuck in your throat.
- Abdominal pain.
- Vomiting after eating.
- Regular use of over-the-counter heartburn medicines – more than twice weekly.
Seek immediate medical help if you have chest pain, especially with shortness of breath or jaw/arm pain. These may be symptoms of a heart attack.
Diagnosis
The common diagnostic procedures are:
Endoscopy
A gastroenterologist performs an outpatient procedure called an upper endoscopy. A thin, flexible tube with a built-in camera, called an endoscope, is passed through the mouth and down the throat. The camera allows for detailed inspection of the esophagus, checking for inflammation and other signs of EoE.
Biopsies
During the endoscopy, the doctor does a biopsy, taking several very small tissue samples. The samples are studied under a microscope to look for eosinophils.
Allergy testing
Health care providers will review a patient’s medical history to look for allergies and signs of allergies. Doctors may use skin prick tests for airborne allergens and skin and/or blood allergy tests to food(s) associated with an immediate allergic reaction. Recent data has not shown any benefit for food allergy panels, so at this time food allergy panel are not recommended.
Treatment
An EoE treatment approach can involve several lines of action:
- Proton pump inhibitors. PPIs reduce stomach acid production, and in some patients it helps reduce EoE problems.
- Swallowed corticosteroids. When topical steroids are swallowed, they coat the lining of the esophagus, reducing inflammation.
- Food elimination diet. An elimination diet helps identify triggers that cause EoE symptoms. One such diet therapy, the six food elimination diet (SFED), excludes milk, wheat, soy, egg, nuts, and fish/shellfish. Another approach is a step up avoidance diet. In adults starting with avoiding wheat/gluten containing foods and milk. In children starting with avoiding milk and egg. And if not effective (eosinophils are still excessively present), then adding additional foods to avoid can be considered.
- Treat underlying factors. Though food allergies are the number one cause of EoE, other things can also trigger EoE issues. Treating seasonal or environmental allergies can sometimes help.
- Biologics such as Dupixent. Dupixent was the first medical treatment approved by the FDA for EoE. It’s an injectable monoclonal antibody that reduces inflammation in the esophagus.
- Possible dilation. If the EoE has progressed to the point of narrowing the esophagus, stretching may be necessary. This is sometimes done during an upper endoscopy. It usually includes sedatives to relax the patient, and anesthetic sprays to numb the throat. A balloon is lowered into the esophagus and blown up to widen it.
- Recheck for response. Rechecking by repeat endoscopy and biopsy after at least 6 weeks of adhearing to whichever treatment has been started is the only way to know if EoE is controlled. If not controlled then additional or change in treatment may be considered.
Call for Help Today
If you suspect that you may have eosinophilic esophagitis, contact the medical professionals at Florida Medical Clinic. They’ll confirm a diagnosis and help you treat your condition.
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