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Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is a condition that affects the esophagus, the tube that carries food from the mouth to the stomach. In EoE, the esophagus contains allergy cells not normally found in the body’s foodpipe,  or eosinophils. Eosinophils collect in the gut lining, affecting gut function. Before diagnosing EoE other causes of eosinophilia in the esophagus need to be excluded. Reflux or acid in the esophagus can cause some eosinophils to be present. Other diseases can be excluded with a biopsy.

Food allergy has been implicated as major cause of EoE, but other allergies, unknown triggers and heredity play a role. Many individuals with EoE have other allergic disorders such as eczema, allergic rhinitis (nasal and environmental allergies), asthma and/or an IgE-mediated food allergy that may cause hives, wheezing and rapid onset of stomach pain.

EoE sometimes runs in families and can develop in both children and adults.

Eosinophilic Esophagitis (EoE) Symptoms

Eosinophilic esophagitis may cause abdominal pain as the esophagus may have trouble squeezing food to the stomach due to the eosinophil cells. Food may get stuck or go down slowly. Additional EoE symptoms may include:

  • chest pain
  • trouble swallowing
  • heartburn
  • poor appetite
  • need to eat slowly
  • vomiting
  • poor growth
  • food impaction or lodging in the esophagus

EoE symptoms can be different, depending on a person’s age.

 Adults and teens often have:

  • trouble swallowing—the most common symptom. People usually have difficulty swallowing solid foods. Some have pain with swallowing or feel as if food is lodged in their throat or chest.
  • chest or upper belly pain
  • burning in the chest (heartburn) that doesn’t get better after taking medicine to treat heartburn

Children often have:

  • feeding problems, such as refusing to eat solid foods, that lead to poor growth
  • nausea or vomiting
  • belly pain

Eosinophilic Esophagitis Diagnosis

Diagnosing EoE begins with a detailed patient history and a solid understanding of your symptoms, allowing the physician to include or exclude various common disorders such as reflux esophagitis, inflammation of the esophagus or infection that may mimic EoE symptoms. A physical examination helps to rule out other causes of upper chest and/or abdominal pain. Reflux or acid in the esophagus may cause some of these symptoms. 

Your physician may order an upper endoscopy, the test most often used to check for this condition. The upper endoscopy will allow your gastroenterologist to look at the lining of your esophagus and take biopsies or small samples of it. An examination of the cells under a microscope will show if there are sufficient numbers of eosinophils present. Depending on the number and location of eosinophil cells, a diagnosis of EoE may be made. 

Eosinophilic Esophagitis Treatment

Eosinophilic Esophagitis treatment usually involves diet changes (elimination diet), medications (topical steroids) and/or procedures to dilate or widen the esophagus, if needed.

Diet modification is often recommended in treating EoE. Your doctor might have you avoid foods that could be causing your symptoms. Three main strategies for doing so include:

  • Avoiding the foods that most commonly cause EoE. A six-food elimination diet may be tried.  With this diet, patients are advised to avoid milk, wheat, soy, egg, nuts and seafood. To make sure that you are receiving enough calories and nutrition, it is helpful to meet with a nutritionist prior to starting this diet.
  • Eliminating the foods you are allergic to. Working in collaboration with NorthShore’s allergists, your gastroenterologist may suggest scratch testing and patch testing to help determine the foods likely to be triggering an allergic reaction that may be, in turn, causing the EoE. Unfortunately, currently available testing is often not very accurate at pinpointing the foods involved. Even with allergy testing, a six-food elimination diet is often recommended by your physician. Milk is usually avoided because it is a very common trigger for EoE.
  • Going on a special liquid diet, using elemental (allergen-free) formula and avoiding all solid foods.

Unless you have had a history of an IgE-mediated allergic reaction, (such as rash, hives, wheezing, coughing or suddenly occurring abdominal pain) to the typical trigger foods, an epinephrine autoinjector (e.g., EpiPen®) is not needed for patients with EoE. Many patients, though, can have both types of allergic reactions and should consult with their doctors about the best course of Eosinophilic Esophagitis treatment.

Medication such as topical steroids may be used to help reduce inflammation. These medications can help treat the EoE symptoms but not the cause.

In some people, EoE leads to a condition called an esophageal stricture—narrowing of the esophagus caused by scar tissue. The main treatment for an esophageal stricture is Esophageal Dilation, an endoscopic procedure to widen the esophagus. The degree of stricture and the extent of the blockage may limit food intake and lead to weight loss. In severe pediatric cases, if other treatments fail and the child is not growing, it may be necessary to insert a feeding tube and feed the child with elemental (allergen-free) formula.

The long-term course of the illness is not well understood at the present time. There is no cure. We do not know if this will be outgrown or not in children and teens. At the current time, repeat upper endoscopies and biopsies are the only way to follow if Eosinophilic Esophagitis treatment is effective.

For More Information

For more information or to make an appointment with a gastroenterologist, please call 847.657.1900.