What is eosinophilic esophagitis?
Eosinophilic esophagitis is an inflammatory condition (swelling) of the esophagus (the tube connecting the mouth to the stomach). With this condition you have an over-abundance of a specific type of white blood cell (the eosinophil).
The number of people affected by eosinophilic esophagitis is about 1 in 10,000. Nearly three-quarters of cases occur in white males. This is a recently recognized disease that has been increasingly diagnosed in adults and children over the past decade.
Symptoms and Causes
What are the symptoms of eosinophilic esophagitis?
People with eosinophilic esophagitis may have symptoms such as heartburn, regurgitation, chest pain and trouble swallowing. Adolescents and adults with eosinophilic esophagitis will complain of having swallowing problems from time to time. Infants and young children may develop feeding disorders, leading to poor weight gain.
In a small number of cases, eosinophilic esophagitis leads to the development of an extremely narrowed esophagus. As a result, food may get stuck in the esophagus and need emergency removal.
Diagnosis and Tests
How is eosinophilic esophagitis diagnosed?
Eosinophilic esophagitis is diagnosed by upper endoscopy and biopsy. The endoscopy sometimes reveals rings, white plaques (patches) or grooves in the esophagus.
However, a person can have eosinophilic esophagitis even if the esophagus looks normal. That's why biopsy samples (tissue samples) are taken. Biopsy samples look for an unusually large number of eosinophils in the esophageal tissue. Sometimes several biopsies may need to be taken.
Management and Treatment
How is eosinophilic esophagitis treated?
There are two main treatment approaches to eosinophilic esophagitis: medications and dietary management.
Medication approaches: Antacid medications, called proton pump inhibitors, and steroids are the most commonly used medication for both the control of the inflammation and direct suppression of the eosinophils. Proton-pump inhibitors can be taken orally (in pill form) while steroid medications are taken topically (swallowed, liquid medications). These medications need to be taken for a long time to keep the inflammation from coming back. For some people, continued use of steroids can cause Candida infections (yeast infections of the mouth and esophagus) as a side effect.
Dietary management: Some healthcare professionals think food allergies may be a cause of eosinophilic esophagitis. However, the foods which might be the cause are still unknown. The more common foods associated with food allergies in general are milk, eggs, nuts, beef, wheat, fish, shellfish, corn and soy. In the case of eosinophilic esophagitis, a single food may cause problems in some people, and many foods may be the cause in others.
Several dietary approaches can be tried. Under a "targeted" approach, foods are eliminated from the diet one at a time, based on allergy testing. Unfortunately, typical allergy tests, such as skin prick tests or blood tests, are not usually effective in finding the problem foods that are responsible for eosinophilic esophagitis. So another type of elimination diet – cutting the common foods mentioned above – is the usual approach.
With any of these food trial diets, foods are slowly brought back into the diet to try to discover which ones are causing the allergic reaction. The patient will have to have more biopsy and endoscopic examinations to determine which foods aren’t causing the problems.
Other non-drug approaches: Another treatment that has been tried for some people is esophageal dilatation. This is a procedure in which the doctor dilates (stretches) the esophagus, either during an endoscopy or in a separate procedure. This is tried specifically in patients who get food stuck in their esophagus.
Outlook / Prognosis
What is the outlook for patients with eosinophilic esophagitis?
Based on what’s known to date, eosinophilic esophagitis doesn’t cause cancer of the esophagus, and isn’t thought to limit life expectancy in any way.
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