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Eosinophilic Esophagitis

Eosinophilic Esophagitis

What is eosinophilic esophagitis?

The esophagus, the muscular tube that connects the throat and the stomach, is lined with a special type of tissue that lubricates food as it passes through. Eosinophils, a type of white blood cell, are not normally present in the esophagus, but people who are allergic to specific foods can develop a reaction that causes eosinophils builds up in the lining of the esophagus. As these cells accumulate they cause inflammation of the esophageal lining, dysfunction, and narrowing of the tube. Food has difficulty passing through the narrowed area, and becomes impacted, or stuck. Eosinophilic esophagitis (EoE) often presents in people between the ages of 20 and 40, but it can also appear in children and older adults. Allergists and gastroenterologists are reporting an increase in the number of people with EoE.

What are the symptoms of eosinophilic esophagitis?

People with eosinophilic esophagitis have intermittent episodes of food getting stuck in the esophagus for a few minutes to a few hours. This may cause chest or upper abdominal pain, persistent heartburn, and a backflow of undigested food (regurgitation). People with EoE may have made one or more trips to the emergency room to have food removed. Many patients have histories of significant allergy symptoms.

How is eosinophilic esophagitis diagnosed?

To diagnose eosinophilic esophagitis physicians perform an upper endoscopy.  This may reveal a normal-appearing esophagus or abnormalities including furrowing, rings, and inflammation.  The diagnosis is often missed because the esophagus can appear normal; therefore a biopsy is essential to make, and not miss, the diagnosis. During the upper endoscopy the doctor will remove a tiny sample of tissue from the lower, middle, and upper areas of the esophagus. They will examine these samples for the presence of eosinophils. If they find large numbers of eosinophils in all these samples (more than 15-20), then the diagnosis of EoE is confirmed.

How is eosinophilic esophagitis treated?

Eosinophilic esophagitis is thought to arise from an immune or allergic reaction, so patients work with an allergist to determine which foods cause the reaction; these foods will be restricted from the diet. People with EoE may also be treated with oral or liquid steroids to decrease inflammation or with an immunomodulating medication. Many patients respond to these approaches within 6 to 8 weeks, their symptoms resolve, and they have no problem eating solid foods. Very often though, patients’ symptoms return when treatment stops, so some people require chronic, ongoing treatment. 

What is the outlook for people with eosinophilic esophagitis?

With severe and chronic or recurrent inflammation, some patients develop scarring and strictures and will periodically need to have those areas stretched or dilated. Physicians treat these patients by dilating the esophagus to restore it to its normal size. Patients with EoE may need to stay on their medication long-term as symptoms often return when medications are stopped.  EoE is a relatively new disorder, and our understanding and treatment is evolving.