What is eosinophilic esophagitis?
Eosinophilic esophagitis is an inflammation (swelling) of the esophagus (the tube connecting the mouth to the stomach), caused by a specific white blood cell (the eosinophil). The number of people affected is about 1 in 10,000 (though health officials think this number is underreported). Nearly three-quarters of cases occur in white males. This is a relatively newly 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?
Patients 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 may need emergency removal.
Diagnosis and Tests
How is eosinophilic esophagitis diagnosed?
Currently, eosinophilic esophagitis is diagnosed by upper endoscopy and biopsy. The endoscopy sometimes reveals rings, white plaques (patches), or grooves in the esophagus. However, the patient may have eosinophilic esophagitis even if the esophagus looks normal. That is why biopsy samples are taken. Biopsy samples look for an extremely 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: steroid medications and dietary management.
Drug approaches: Steroids are the most commonly used medication for both the control of the inflammation and the direct suppression of the eosinophils. These medications can be taken orally (in pill form) or topically (swallowed, liquefied medications). Steroids may need to be taken for a long time, though their long-term use for eosinophilic esophagitis has not been well studied. What is known is that for some patients, continued use of steroids by swallowing can cause Candida infections (yeast infections of the mouth and esophagus) as a side effect.
Dietary management: There is also some thought that food allergies may be a cause of eosinophilic esophagitis. However, which foods might be the cause is still not known. 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.
With this in mind, 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. Therefore, another type of elimination diet – the "common foods" elimination diet (as outlined in the paragraph above) – is often tried.
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 are not causing the problems.
Other non-drug approaches: Another treatment that has been tried for some patients 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 is known to date, eosinophilic esophagitis does not cause cancer of the esophagus and is not thought to limit life expectancy in any way.