Eosinophilic Esophagitis

Topic Overview

What is eosinophilic esophagitis?

Esophagitis (say "ee-sof-uh-JY-tus") is irritation or inflammation the esophagus. This is the tube that carries food from your throat to your stomach. In eosinophilic (say "ee-uh-sin-uh-FILL-ick") esophagitis, the irritation is caused by white blood cells called eosinophils in the esophagus.

This condition is called "EoE" for short.

Eosinophils aren't normally in the esophagus. They are part of the immune system. The body sends them out in response to an allergic reaction. This has led experts to think that allergies—especially food allergies—may cause EoE. People who have EoE often have other types of allergies too, like hay fever, eczema, or asthma.

EoE can occur in both children and adults. It's more common in males than in females. It may run in families.

What are the symptoms?

In adults, the symptoms include:

  • Trouble swallowing. This is the most common symptom. It may hurt to swallow. Or it may feel like food gets stuck in your throat.
  • Pain in the chest or upper belly.
  • Heartburn.

In children, common symptoms include:

  • Refusing to eat.
  • Not gaining weight as expected.
  • Nausea or vomiting.
  • Belly pain.

How is EoE diagnosed?

To diagnose EoE, a doctor will ask about your symptoms and do an endoscopy. For this test, the doctor puts a thin, flexible tube down your throat to look at your esophagus. During the test, the doctor will take small tissue samples, or biopsies, from your esophagus, stomach, and small intestine. The tissue samples are sent to a lab and looked at under a microscope.

You may be asked to take medicine for acid reflux for 2 months before your endoscopy. This will help the doctor find out if gastroesophageal reflux disease (GERD) is causing your symptoms.

EoE is usually diagnosed and treated by a specialist called a gastroenterologist.

If you are diagnosed with EoE, you may want to see an allergist. This type of doctor can do tests to find what foods you're allergic to.

How is it treated?

Changing your diet is usually the first step in treating EoE. If you have been tested and know your food allergens, you can simply avoid those foods. If not, your doctor may suggest one of these diets:

  • Cutting out foods that are known to cause EoE. That would mean avoiding milk, eggs, wheat, soy, nuts, and seafood.
  • Replacing all solid foods with a special liquid protein diet.

After some time, you would add back one group of allergy-causing foods at a time. This is a way to identify which foods you are allergic to. Then you can avoid them in the future.

If you try one of these diets, it's best to work with a dietitian to be sure that you are getting the nutrients you need to be healthy.

Medicines are also used to treat EoE. The most common ones are:

  • Proton pump inhibitors, such as lansoprazole (Prevacid) and omeprazole (Prilosec). These medicines reduce acid reflux, so they may help relieve irritation in your esophagus.
  • Corticosteroids, which can reduce inflammation in the esophagus. Some people need to take a corticosteroid long-term to keep their symptoms under control.

Sometimes, EoE causes narrowing of the esophagus that makes it hard to swallow food. If medicine or diet changes don't relieve the problem, it can be treated with a procedure called dilation. This may be done during endoscopy. During dilation, the doctor guides a balloon or plastic dilator down your throat and into your esophagus. When the device is expanded, it widens any narrow areas of your esophagus. Your doctor can discuss the risks and benefits of this treatment.

References

Other Works Consulted

  • Dellon ES, et al. (2013). ACG Clinical guideline: evidenced-based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). American Journal of Gastroenterology, 108(5): 679–692.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Peter J. Kahrilas, MD - Gastroenterology
Current as of November 6, 2013

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