Eosinophilic Esophagitis: Symptoms, Causes, Treatment

What are the symptoms of eosinophilic esophagitis?

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disorder characterized by eosinophilic inflammation in the esophagus. Symptoms of EoE can vary depending on the age of the individual. In children, symptoms may include:

1. Difficulty feeding: Infants may have difficulty feeding or may refuse to eat.
2. Poor weight gain or growth: This can be a result of feeding difficulties.
3. Vomiting: Children may experience frequent vomiting.
4. Abdominal pain: Some children may have abdominal pain.
5. Reflux-like symptoms: These can include heartburn, regurgitation, and chest pain.
6. Difficulty swallowing: Also known as dysphagia, this can lead to a sensation of food sticking in the throat.
7. Food impaction: Solid food may get stuck in the esophagus, requiring medical intervention to remove.

In adults, symptoms of EoE may include:

1. Dysphagia: Difficulty swallowing, especially with solid foods.
2. Food impaction: Solid food may become stuck in the esophagus.
3. Heartburn: This can be persistent and not always relieved by antacids.
4. Chest pain: Some individuals may experience chest pain, which can be mistaken for heart-related chest pain (angina).
5. Upper abdominal pain: Some individuals may experience pain in the upper abdomen.
6. Regurgitation: The sensation of food coming back up into the throat.

Because the symptoms of EoE can mimic those of gastroesophageal reflux disease (GERD), it’s important to consult with a healthcare professional for an accurate diagnosis and appropriate management if you are experiencing symptoms suggestive of EoE.

What are the causes of eosinophilic esophagitis?

The exact cause of eosinophilic esophagitis (EoE) is not fully understood, but it is believed to be related to an immune response to certain foods or allergens. EoE is considered to be an allergic or immune-mediated disorder, and several factors may contribute to its development:

1. Allergies: EoE is often associated with other allergic conditions, such as asthma, allergic rhinitis, and atopic dermatitis. Allergens in foods or the environment may trigger an immune response in the esophagus.
2. Food antigens: Certain foods may trigger an allergic response in the esophagus, leading to inflammation and the accumulation of eosinophils. Common food triggers include dairy products, wheat, soy, eggs, and nuts, but the specific triggers can vary among individuals.
3. Genetics: There appears to be a genetic predisposition to EoE, as it tends to run in families. Specific genetic factors that contribute to EoE are still being studied.
4. Environmental factors: Environmental factors, such as exposure to certain allergens or pollutants, may play a role in triggering EoE in susceptible individuals.
5. Immune dysregulation: EoE is characterized by an abnormal immune response in the esophagus, leading to the accumulation of eosinophils and inflammation. This immune dysregulation is thought to be central to the development of EoE.

It’s important to note that while certain factors are associated with EoE, the exact cause can vary among individuals, and additional research is needed to fully understand the underlying mechanisms of the condition.

How is the diagnosis of eosinophilic esophagitis made?

The diagnosis of eosinophilic esophagitis (EoE) involves a combination of clinical evaluation, imaging studies, endoscopy, and biopsy. Here’s how the diagnosis is typically made:

1. Medical history: Your healthcare provider will ask about your symptoms, including any swallowing difficulties, reflux symptoms, or history of allergies.
2. Physical examination: A physical examination may be performed to check for signs of EoE and other conditions.
3. Endoscopy: A procedure called an upper endoscopy is usually performed to visualize the esophagus and take tissue samples (biopsies) for analysis. During the procedure, your healthcare provider may look for characteristic features of EoE, such as rings, furrows, or white plaques in the esophageal lining.
4. Biopsy: Tissue samples taken during the endoscopy are examined under a microscope to look for an increased number of eosinophils in the esophageal lining. A diagnosis of EoE is typically made if there are 15 or more eosinophils per high-power field (HPF) in the biopsy samples.
5. Other tests: Additional tests may be done to rule out other conditions that can cause similar symptoms, such as gastroesophageal reflux disease (GERD) or infections.
6. Dietary evaluation: Your healthcare provider may recommend dietary changes or an elimination diet to identify and eliminate food triggers that may be causing or exacerbating EoE.
7. Monitoring: If EoE is diagnosed, regular monitoring may be recommended to assess the response to treatment and monitor for complications.

Because the symptoms of EoE can overlap with other conditions, it’s important to consult with a healthcare professional experienced in diagnosing and treating EoE for an accurate diagnosis and appropriate management plan.

What is the treatment for eosinophilic esophagitis?

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition characterized by the accumulation of eosinophils in the esophageal mucosa, leading to symptoms such as difficulty swallowing, chest pain, and food impaction. The treatment for EoE typically involves a combination of dietary changes, medications, and lifestyle modifications. Here are some common treatments for EoE:

1. Dietary elimination diet: Eliminating common allergens such as dairy, soy, wheat, nuts, and fish from the diet can help reduce symptoms.
2. Elemental diet: An elemental diet consists of a formula that is easy to digest and lacks common allergens. This can be used as a short-term treatment or as a long-term management strategy.
3. Biologics: Medications such as omalizumab (Xolair) can help reduce eosinophil levels in the esophagus and alleviate symptoms.
4. Corticosteroids: Topical corticosteroids can be applied directly to the esophagus to reduce inflammation and alleviate symptoms.
5. Montelukast (Singulair): This medication is often prescribed to reduce inflammation and relieve symptoms.
6. Fluticasone (Flonase): This nasal spray can be used to reduce inflammation in the esophagus.
7. Gastroesophageal reflux disease (GERD) treatment: Managing GERD symptoms through antacids, proton pump inhibitors, or histamine-2 (H2) blockers can help alleviate EoE symptoms.
8. Swallowing therapy: Speech therapy or swallowing therapy can help improve swallowing function and reduce symptoms.
9. Endoscopic dilatation: In some cases, endoscopic dilatation may be necessary to dilate the esophagus and relieve food impaction.

Lifestyle modifications that can help manage EoE symptoms include:

1. Avoiding trigger foods: Identifying and avoiding trigger foods that exacerbate symptoms can help manage EoE.
2. Keeping a food diary: Keeping a food diary can help identify which foods trigger symptoms.
3. Eating small, frequent meals: Eating smaller meals more frequently can help reduce discomfort and alleviate symptoms.
4. Avoiding lying down after eating: Lying down after eating can exacerbate symptoms; avoiding this can help alleviate discomfort.
5. Staying hydrated: Drinking plenty of water can help maintain a healthy digestive system.

It’s essential to work with a healthcare provider to develop a personalized treatment plan for EoE. The goal of treatment is to reduce inflammation, alleviate symptoms, and improve quality of life.