Overview
Eosinophilic esophagitis (EoE) is a chronic immune system disease in which eosinophils, a specific type of white blood cell, accumulate in the lining of the esophagus, the tube connecting the mouth to the stomach. This buildup occurs as a reaction to foods, allergens, or acid reflux and can cause inflammation or injury to the esophageal tissue. EoE can lead to difficulty swallowing or food getting stuck when swallowing. The disease has been identified only since the early '90s but is now considered a significant cause of digestive system illnesses. Research is ongoing, and there may be revisions in the diagnosis and treatment of EoE in the future.
Understanding the disease
Symptoms
The symptoms of eosinophilic esophagitis include difficulty swallowing, also called dysphagia, and food getting stuck in the esophagus after swallowing, also known as impaction. These symptoms are more common in adults than in children. Other symptoms may include allergies and asthma, as people with food or environmental allergies, asthma, atopic dermatitis, or a chronic respiratory disease are more likely to be diagnosed with eosinophilic esophagitis.
Risk Factors
The risk factors for developing eosinophilic esophagitis are:
- Allergies and asthma: Having food or environmental allergies, asthma, atopic dermatitis, or a chronic respiratory disease increases the likelihood of being diagnosed with eosinophilic esophagitis.
- Family history: There seems to be a genetic component to the condition, as it sometimes runs in families, which increases the chance of being diagnosed.
- Climate and season: People living in cold or dry climates are more likely to be diagnosed, with a higher rate of diagnosis between spring and fall, possibly due to increased exposure to allergens during these seasons.
- Sex: Eosinophilic esophagitis is more common in males than in females.
- Age: Originally thought to be a childhood disease, eosinophilic esophagitis is now known to be common in adults as well, with symptoms differing between children and adults.
Development
Eosinophilic esophagitis develops when there is an excessive buildup of eosinophils, a specific type of white blood cell, in the lining of the esophagus. This buildup is usually in response to an allergen, such as food or pollen, or acid reflux. The eosinophils multiply in the esophagus and produce a protein that causes inflammation, which can lead to damage and scarring of the esophagus. This damage can result in difficulty swallowing (dysphagia) or food getting stuck in the esophagus (impaction). The disease has been identified since the early '90s and is considered a major cause of digestive system illness. Risk factors include climate, season, sex, family history, allergies and asthma.
Assessment and Diagnosis
Triage
Seek immediate medical attention if you experience chest pain, especially if you also have shortness of breath or jaw or arm pain. These may be symptoms of a heart attack. Make an appointment with your health care provider if you experience severe or frequent eosinophilic esophagitis symptoms, or if you take nonprescription medicines for heartburn more than twice a week. If you have difficulty swallowing, food getting stuck in the esophagus, or are losing weight, consider seeing a doctor. Additionally, get emergency care if you have pain in your chest that lasts more than a few minutes, suspect you have food stuck in your esophagus, have a history of heart disease and experience chest pain, have pain in your mouth or throat when you eat, have shortness of breath or chest pain that happens shortly after eating, vomit large amounts, or have vomit that is yellow or green, looks like coffee grounds, or contains blood.
Diagnosis
To diagnose eosinophilic esophagitis, your healthcare provider will consider your symptoms and test results. Tests for eosinophilic esophagitis include upper endoscopy, biopsy, and blood tests. During an upper endoscopy, a long, narrow tube with a camera is inserted through your mouth to inspect your esophagus for inflammation, swelling, narrowing, and white spots. A biopsy involves taking a tissue sample from your esophagus, which is then examined under a microscope for eosinophils. Blood tests may also be performed to look for higher than usual eosinophil counts or total immunoglobulin E levels, suggesting an allergy.
Management and Treatment
Complications
Potential complications of eosinophilic esophagitis include scarring and narrowing of the esophagus, which can make it difficult to swallow and more likely for food to get stuck. Inflammation can also lead to damage to the esophagus, including perforation or tears in the tissue that lines the esophagus. Additionally, eosinophilic esophagitis can result in dysphagia (difficulty swallowing) and impaction (food becoming stuck during swallowing). Other symptoms may include chest pain or stomach pain.
Home Remedies
It is important to consult a healthcare provider for proper diagnosis and treatment of eosinophilic esophagitis.
Treatment
Treatments for eosinophilic esophagitis (EoE) typically involve identifying and eliminating the allergenic foods, acid reflux triggers, or both that are causing the eosinophil buildup in the esophagus. Treatments may vary depending on individual cases and may include:
- Elimination diet: A dietitian or healthcare provider will help identify the specific allergenic foods that need to be eliminated from your diet. Eating only non-triggering foods can significantly improve symptoms.
- Proton pump inhibitors (PPIs): If acid reflux is a contributing factor, PPIs can help reduce acid production in the stomach. PPIs may be prescribed to alleviate symptoms.
- Topical corticosteroids: These medications can be administered directly into the esophagus to reduce eosinophil inflammation.
- Esophageal dilation: In severe cases, a healthcare provider may perform a dilation procedure to widen the narrowed esophagus.
- Surgery: In rare cases where other treatments are ineffective, surgery may be considered to remove the esophagus and create a new connection between the mouth and the stomach. It is essential to work closely with a healthcare provider to determine the most appropriate treatment plan for eosinophilic esophagitis.
Preparing for medical consultation
To prepare for an appointment for eosinophilic esophagitis, you can:
- Write down a list of questions: Prepare a list of questions to ask your healthcare provider during the appointment. Include questions about your symptoms, diagnosis, treatment options, and any concerns or questions you may have.
- Gather your medical history: Collect any relevant medical records, test results, or medication lists to share with your healthcare provider.
- Note your symptoms: Make a note of the severity, frequency, and any triggers of your symptoms, such as specific foods or eating patterns.
- Prepare for diagnostic tests: Follow any special instructions provided by your healthcare provider for any diagnostic tests, such as fasting before an endoscopy or blood tests.
- Be prepared to discuss your medical history: Be ready to discuss any other medical conditions you have, as well as any medications or supplements you are currently taking.
- Bring someone with you: Consider bringing a family member or friend to the appointment for support and to help recall information discussed during the appointment. Remember to arrive early to your appointment to allow time for any necessary paperwork or check-ins. Being well-prepared can help you make the most of your time with your healthcare provider and ensure you receive the information and care you need.