Eosinophilic Esophagitis

What is eosinophilic esophagitis?

Eosinophilic (pronounced “e-o-sin-o-FILL-ik”) esophagitis is inflammation in your esophagus, the tube that connects your mouth and stomach.

In this disease, white blood cells (eosinophils) collect in your esophagus and cause inflammation. Without treatment, this inflammation can lead to scar tissue and narrowing in your esophagus, so you have difficulty swallowing. For example, when you take a bite of food, that bite can’t easily move through your esophagus to your stomach. You may feel like something is stuck or moving slowly through your esophagus.

Eosinophilic esophagitis may cause heartburn, chest discomfort and regurgitation (spit up of food). Other less common symptoms are abdominal pain, nausea and vomiting.

It’s a chronic (long-term) disease. There’s no cure for it, but there are treatments that help address the inflammation and manage your symptoms. Most people with eosinophilic esophagitis will need treatment for the rest of their lives.

How common is eosinophilic esophagitis?

Eosinophilic esophagitis once was rare, but the number of cases is increasing. It affects about 34 in 100,000 people. Anyone — from babies to adults — can have it.

What are the symptoms of eosinophilic esophagitis?

Your symptoms may be different depending on when you develop the disease:

• A baby or toddler may vomit, refuse to eat or have issues with gaining weight (failure to thrive).
• Older children and adults may have difficulty swallowing (dysphagia), heartburn or chest discomfort.

Symptoms that are less common but that may affect people of any age include:

• Abdominal (belly) pain.
• Food impaction (food gets stuck in your esophagus). Food impaction may be a medical emergency and require a trip to the emergency room because it can tear a hole in your esophagus (esophageal rupture or perforation).
• Nausea and vomiting.
• Regurgitation (when you swallow food, but it comes back up into your mouth or there’s a spontaneous flow of liquid or food toward your mouth).

In some cases, people have symptoms that come and go. A healthcare practitioner may call this a flare-up. But you can also have symptoms all the time.

Eosinophilic esophagitis symptoms may feel like symptoms of more common esophageal disorders. People with this condition may have it for several years before they receive a correct diagnosis.

What causes eosinophilic esophagitis?

The disease happens when your immune system reacts to allergens in your esophagus, filling it with inflammatory cells, including eosinophils and cytokines. Allergens can be environmental or food triggers.

What foods trigger eosinophilic esophagitis?

The most common food triggers are:

• Dairy.
• Egg.
• Peanuts, tree nuts.
• Seafood/shellfish.
• Soy.
• Wheat.

What are the risk factors for eosinophilic esophagitis?

A risk factor is something that increases the chance you’ll have a disease. Many people with eosinophilic esophagitis also have:

• Asthma.
• Allergic rhinitis.
• Atopic dermatitis.
• Eczema.
• Food allergies.

Another risk factor is having a family history of eosinophilic esophagitis.

What are the complications of eosinophilic esophagitis?

Damage to your esophagus from eosinophilic esophagitis may cause the following complications:

• Esophageal perforation (rupture).
• Esophageal strictures.

How do healthcare providers diagnose eosinophilic esophagitis?

A healthcare provider will do a physical examination and ask about your symptoms. Questions may include:

• Your eating habits: People with this condition often try to manage their symptoms by chewing their food into mush so they can swallow it, avoiding foods they can’t easily swallow or drinking lots of fluids so they can swallow food.
• Your medical history: Often, people with eosinophilic esophagitis have asthma, food allergies, seasonal allergies, eczema or atopic dermatitis.
• Your family’s medical history: Risk of eosinophilic esophagitis is higher if a biological family member also has it. You’re more likely to have the condition if a sibling or parent has it, but overall rates are still low. It’s unclear if it has to do with genetics or if it’s due to environmental factors.

If a provider thinks you may have eosinophilic esophagitis, they’ll refer you to a gastroenterologist, who can do the following procedures:

• Esophagogastroduodenoscopy (EGD): During an EGD test, your gastroenterologist uses an endoscope to look at the inside of your esophagus. Endoscopes are long flexible tubes with small lighted cameras at one end.
• Biopsy: During your EGD, your gastroenterologist may take tiny samples of your esophagus tissue. A pathologist will examine the samples under a microscope to see if there are unusually large numbers of eosinophils in the tissue.

What are treatments for eosinophilic esophagitis?

Treatment focuses on managing the inflammation in your esophagus. You may receive medication or work with your gastroenterologist to eliminate food groups that trigger inflammation. You and your gastroenterologist will decide what approach works best for you.

Medication

Medications to reduce inflammation may include:

• Biologic agent (monoclonal antibody dupilumab (Dupixent®).
• Corticosteroids that coat the inside of your esophagus.
• Proton pump inhibitors.

Food group elimination

In food group elimination, you temporarily stop eating any food from the six common food triggers: dairy, egg, peanuts and tree nuts, seafood and shellfish, soy and wheat. Most people have one to three food triggers. Dairy and wheat are the most common triggers.

Your provider will do follow-up biopsies to see if inflammation in your esophagus is under control. If it is:

• You’ll start re-introducing food into your daily meals. That may mean adding one, two or four new food groups at a time.
• Every four weeks, you’ll add another food group.
• You’ll have a follow-up endoscopy with a biopsy after adding a new food group to your meals so your provider can look for signs if the added food groups trigger inflammation.

Your provider may recommend an elemental diet for short-term use.

What is the treatment for food impaction?

You may have food impaction — food that’s stuck in your esophagus — because your esophagus is too narrow for food to pass through. When that happens, your gastroenterologist may use an endoscope to remove the food. And if they feel that it’s safe to do, they can dilate (stretch) your esophagus (endoscopic dilation).

What happens after therapy?

Everyone is different, and each treatment option may not work for everyone. Your gastroenterologist will order upper endoscopies with biopsy to confirm treatment is reducing inflammation. For example, if proton pump inhibitors aren’t effective, your gastroenterologist will recommend other treatment options.

What can I expect if I have eosinophilic esophagitis?

Eosinophilic esophagitis is a chronic and serious illness, but it’s not life-threatening. You’ll probably need treatment for the rest of your life, like taking medication or avoiding specific food triggers.

Does having eosinophilic esophagitis increase my risk of esophageal cancer?

No, it doesn’t appear to increase the risk you’ll have this kind of cancer.

How do I take care of myself?

Living with eosinophilic esophagitis can be challenging. If you’re like most people, your symptoms will go away after treatment for inflammation and reducing scar tissue.

But you may feel anxious or nervous about swallowing food, especially if you experience food impaction (food stuck in your esophagus). You may feel reluctant about taking bigger bites of food when you eat or eating foods, like bread, that you struggled to swallow before your treatment. Some people develop phagophobia (fear of swallowing).

Here are some suggestions that may help you to take care of yourself:

• Connect with others: Eosinophilic esophagitis isn’t common. You may feel like you’re one of the only people you know who has it. That can be a lonely feeling. Ask your gastroenterologist to recommend support groups.
• Work with a nutritionist: A nutritionist can help with a food plan. They can recommend strategies, like planning for family meals or meals out.
• Consider mental health support: A psychologist trained in gastroenterology can help you get over a fear of swallowing. If you have anxiety or depression, that can sometimes make the fear of swallowing worse. A mental health specialist like a psychologist or psychiatrist can help.

When should I see my gastroenterologist?

You should follow up at least once a year with your gastroenterologist. You should contact them right away if your symptoms come back or you have new issues with swallowing or food impaction.

What’s the difference between eosinophilic esophagitis and eosinophilic gastritis?

Both conditions are types of eosinophilic gastrointestinal disease (EGID). All EGIDs involve high numbers of eosinophils in different parts of your digestive system. Eosinophilic gastritis affects your belly while eosinophilic esophagitis affects your esophagus. Other types are:

• Eosinophilic colitis (EC) involves your large intestine (colon).
• Eosinophilic duodenitis affects the first part of your small intestine.
• Eosinophilic enteritis (EoN) affects your small bowel.
• Eosinophilic gastritis, which affects your stomach.
• Eosinophilic gastroenteritis (EGE) primarily affects your stomach and intestines.