Eosinophilic esophagitis (EoE) is recognized as a chronic inflammatory condition affecting the esophagus, the muscular tube responsible for transporting food and liquids from your mouth to your stomach. In individuals with EoE, there’s an abnormal accumulation of eosinophils, a type of white blood cell, within the esophageal lining. This eosinophilic infiltration leads to inflammation and damage, potentially resulting in a range of uncomfortable symptoms, notably pain, dysphagia (difficulty swallowing), and the sensation of food impaction in the throat.
While EoE is considered a relatively rare condition, its diagnosis rates are increasing, likely due to greater awareness and improved diagnostic methods in recent years. It’s important to note that some individuals initially diagnosed with gastroesophageal reflux disease (GERD) might, upon further investigation, actually be experiencing EoE.
Unpacking the Causes of Eosinophilic Esophagitis
The precise etiology of eosinophilic esophagitis remains an area of ongoing research. Current understanding points towards EoE being an immune-mediated or allergic reaction. This reaction is often triggered by specific foods or environmental allergens such as dust mites, pet dander, pollen, and mold. Furthermore, genetic predisposition is believed to play a significant role, making some individuals more susceptible to developing EoE.
Identifying Who is at Risk for EoE
Eosinophilic esophagitis can affect individuals across all age groups and demographics. However, certain factors increase the likelihood of developing this condition:
- Gender: EoE is observed more frequently in males than females.
- Atopic Conditions: Individuals with pre-existing allergic diseases have a higher risk. These conditions include allergic rhinitis (hay fever), eczema (atopic dermatitis), asthma, and food allergies.
- Family History: A family history of EoE significantly elevates an individual’s risk, suggesting a genetic component.
Recognizing the Symptoms of Eosinophilic Esophagitis
The clinical presentation of EoE can vary with age. Common symptoms across different age groups include:
Symptoms in Infants and Toddlers:
- Feeding Difficulties: Reluctance to feed, fussiness during feeding, or food refusal can be indicative of EoE.
- Vomiting: Frequent vomiting, especially after meals.
- Failure to Thrive: Poor weight gain and stunted growth due to feeding issues and nutrient malabsorption.
- Reflux-like Symptoms Unresponsive to Medication: Symptoms resembling infant reflux that do not improve with standard reflux medications.
Symptoms in Older Children:
- Vomiting: Recurrent vomiting.
- Abdominal Pain: Unexplained abdominal discomfort.
- Dysphagia (Difficulty Swallowing): Trouble swallowing, particularly solid foods.
- Persistent Reflux Symptoms: Reflux that doesn’t respond to typical reflux treatments.
- Poor Appetite: Reduced desire to eat.
Symptoms in Adults:
- Dysphagia (Difficulty Swallowing): A prominent symptom, especially when swallowing solid foods.
- Food Impaction: The uncomfortable sensation of food getting stuck in the esophagus.
- Refractory Reflux: Heartburn or reflux symptoms that persist despite medication.
- Heartburn: Burning sensation in the chest.
- Chest Pain: Non-cardiac chest pain.
How Eosinophilic Esophagitis is Diagnosed
Diagnosing EoE involves a comprehensive approach, typically including:
- Detailed Medical History and Symptom Review: Your doctor will inquire about your symptoms, their duration, and your medical history. This is crucial as EoE symptoms can overlap with other conditions.
- Upper Gastrointestinal (GI) Endoscopy: This procedure involves inserting a thin, flexible tube with a light and camera (endoscope) into your esophagus. This allows the doctor to visually examine the esophageal lining for signs suggestive of EoE, such as white plaques, esophageal rings, narrowing (strictures), and inflammation. However, it’s important to note that these visual findings are not always present in EoE and can be seen in other esophageal disorders.
- Esophageal Biopsy: During the endoscopy, small tissue samples (biopsies) are taken from the esophagus. These samples are then examined under a microscope to count the number of eosinophils. A high eosinophil count in the esophageal tissue is the definitive diagnostic criterion for EoE.
- Additional Testing: Blood tests may be conducted to rule out other conditions. Allergy testing (blood or skin prick tests) may be recommended in some cases to identify potential food or environmental triggers, although allergy testing alone cannot diagnose EoE.
Treatment Strategies for Eosinophilic Esophagitis
Currently, there is no cure for EoE, but effective treatments are available to manage symptoms, reduce esophageal inflammation, and prevent long-term complications. Treatment approaches primarily involve medications and dietary modifications:
Medications:
- Topical Corticosteroids: These medications, such as fluticasone or budesonide, are swallowed and act locally in the esophagus to reduce eosinophilic inflammation. They are often delivered via metered-dose inhalers or as viscous liquids. In cases of severe dysphagia or weight loss, oral corticosteroids (systemic steroids) may be prescribed for short-term symptom relief.
- Proton Pump Inhibitors (PPIs): These medications reduce stomach acid production and can help alleviate reflux symptoms that may coexist with EoE and contribute to esophageal inflammation.
- Monoclonal Antibodies: Dupilumab is a biologic medication approved for EoE in adults and children aged 12 years and older. It targets specific inflammatory pathways, effectively reducing eosinophil levels and improving swallowing function.
Dietary Modifications:
- Elimination Diets: These diets aim to identify and remove food triggers contributing to EoE. Different types of elimination diets exist:
- Allergy Test-Directed Elimination Diet: This approach involves allergy testing (skin prick or blood tests) to identify specific food allergens. These identified foods are then eliminated from the diet.
- Empirical Elimination Diets (e.g., 6-Food Elimination Diet): This involves removing the most common allergenic foods (dairy, egg, wheat, soy, peanuts/tree nuts, and fish/shellfish) from the diet. Foods are then reintroduced one at a time under medical supervision to identify triggers. Repeat endoscopies and biopsies may be necessary to assess the impact of food reintroduction.
- Elemental Diet: This is a highly restrictive diet where all protein is eliminated, and nutrition is obtained through an amino acid-based formula. While effective in reducing inflammation, it is often challenging to adhere to long-term and may require feeding tube administration for some individuals. Food reintroduction is carefully managed to identify tolerated foods.
The optimal treatment strategy for EoE is individualized and depends on factors such as age, symptom severity, and patient preferences. Some individuals may require a combination of medication and dietary therapy. Research continues to advance our understanding of EoE and refine treatment approaches.
In cases where esophageal narrowing (stricture) develops despite medical and dietary management, esophageal dilation may be necessary. This procedure gently stretches the esophagus to improve swallowing.
If you experience symptoms suggestive of eosinophilic esophagitis, it is essential to consult with a healthcare professional for proper diagnosis and management.
