A chronic immune system disease, eosinophilic esophagitis (EoE) affects the esophagus, the tube connecting the mouth to the stomach. The esophagus lining becomes inflamed, swollen, and damaged as a result of an allergic reaction to certain foods or substances. As a result, various symptoms and complications result from inflammation, swelling, and damage to the esophageal tissue.
There is no clear explanation for the exact cause of EoE, but it is believed to be caused by an abnormal immune response to certain allergens, such as food or pollen. The most common food allergens that may trigger EoE include dairy products, eggs, wheat, soy, peanuts, fish, and shellfish, but each person has a different sensitivity to certain foods. Acid reflux, airborne allergens, genetic factors, and cold or dry climates may also contribute to EoE.
Some people are more likely to develop EoE than others. The risk factors for EoE include:
Gender: Men are more likely to have EoE than women.
Age: EoE can affect people of any age, but it is more common in children and young adults.
Family history: Having a close relative with EoE increases the chance of developing the condition.
Allergic diseases: Having other allergic conditions, such as asthma, hay fever, eczema, or food allergies, increases the risk of EoE.
The symptoms of EoE may vary depending on the age and severity of the condition. Some of the common symptoms of EoE include:
Difficulty swallowing (dysphagia)
Food getting stuck in the esophagus (impaction)
Chest pain
Heartburn
Regurgitation of undigested food
Vomiting
Nausea
Abdominal pain
Reduced appetite
Poor weight gain or growth in children
Irritability in children
There are a number of factors that can affect the symptoms of EoE, such as the season, food intake, or medication used. Additionally, the symptoms may resemble those of gastroesophageal reflux disease (GERD), which occurs when stomach acid flows back into the esophagus from the stomach. Antacids and proton pump inhibitors (PPIs) are not effective for treating EoE.
The diagnosis of EoE is based on the combination of symptoms, medical history, physical examination, and laboratory tests. The main tests used to diagnose EoE are:
An upper endoscopy involves inserting a thin, flexible tube (endoscope) into the esophagus through the mouth with a light and a camera (endoscope). The endoscope allows the doctor to examine the inside of the esophagus for signs of inflammation, swelling, rings, furrows, strictures, or white spots that indicate the presence of eosinophils.
A biopsy involves taking a small sample of tissue from the esophagus during endoscopy. When more than 15 eosinophils per high-power field are found in at least one biopsy specimen, EoE is confirmed. The tissue samples are examined under a microscope for eosinophil numbers and distribution.
In blood tests, eosinophils and immunoglobulin E (IgE) levels are measured. IgE is an antibody involved in allergic reactions. High levels of these markers may indicate an allergic condition, such as EoE.
A skin prick test, patch test, or blood test that measures the IgE response to different foods or substances are allergy tests used to identify specific allergens that can trigger EoE.
An esophageal sponge test involves swallowing a capsule attached to a string. The capsule dissolves in the stomach and releases a sponge, which is pulled out with the string. The sponge collects samples of esophageal tissue, which is analyzed to determine the level of inflammation and the number of eosinophils present.
The treatment of EoE aims to reduce the inflammation and symptoms, prevent complications, and improve the quality of life. The treatment options for EoE include:
A diet-based approach to EoE is the most effective and preferred treatment. By eliminating the foods that trigger an allergic reaction and inflammation in the esophagus, dietary therapy can be tailored to an individual’s food allergies, preferences, and nutritional requirements. Dietary therapy comes in many forms, including:
The elimination diet involves avoiding common food allergens, such as dairy, eggs, wheat, soy, peanuts, fish, and shellfish. It can be modified according to the results of the allergy tests.
In severe cases of EoE or when other dietary therapies fail, an elemental diet involves replacing all foods with a liquid formula that contains amino acids, sugars, fats, vitamins, and minerals.
A diet empiric involves eliminating a certain number of foods based on the most common triggers of EoE, such as six, four, or two. The diet may be adjusted according to the response to treatment.
Medication: This involves using drugs that reduce the inflammation and the number of eosinophils in the esophagus. The medications used for EoE include:
The medications used to treat EoE include those that reduce inflammation and the number of eosinophils in the esophagus.e treatment for EoE, as they may also have anti-inflammatory effects on the esophagus. Examples of PPIs are omeprazole, pantoprazole, and esomeprazole.
In addition to reducing stomach acid production, proton pump inhibitors (PPIs) prevent acid reflux. As well as having anti-inflammatory effects on the esophagus, they are usually the first-line treatment for EoE. For example, omeprazole, pantoprazole, and esomeprazole are examples of PPIs and budesonide.
Steroids that are taken orally or injected into the bloodstream affect the entire body and the immune system. Systemic steroids are usually reserved for severe or refractory cases of EoE, as they carry more side effects and risks than topical steroids. Examples include prednisone and methylprednisolone.
An endoscope is used to dilate or stretch a narrowed or scarred esophagus. This procedure is called esophageal dilation, and it may alleviate dysphagia and impaction symptoms. However, it does not treat underlying inflammation or prevent the recurrence of EoE. It may also cause complications, such as bleeding, perforation, or infection.
The prevention of EoE mainly involves avoiding the exposure to the allergens that trigger the condition. This may include:
Following a strict dietary therapy and reading food labels carefully
Avoiding cross-contamination of foods and utensils
Carrying an epinephrine auto-injector in case of a severe allergic reaction (anaphylaxis)
Seeking medical advice before introducing new foods or changing the diet
Avoiding airborne allergens, such as pollen, dust mites, or animal dander
Using air filters, humidifiers, or dehumidifiers to improve the indoor air quality
Taking antihistamines or nasal sprays to control the symptoms of hay fever or allergic rhinitis
Getting regular check-ups and endoscopies to monitor the condition and the response to the treatment
There is a risk of lifelong complications associated with eosinophilic esophagitis, a chronic and potentially serious condition. If you have any questions or concerns about EoE, please consult your doctor or a specialist. It is possible to control symptoms, prevent complications, and improve quality of life if you receive proper diagnosis, treatment, and prevention.
