Eosinophilic Esophagitis

Eosinophilic (ee-o-sin-o-fil-ik) esophagitis (EoE) is an allergic condition where a person has inflammation in the esophagus.   The esophagus is the tube that carries food from your mouth to your stomach. 

The cells in your blood that cause EoE are called eosinophils.  One of the jobs of these cells is to protect us from parasites but the other function, the one we are most familiar with, is causing allergies.  Eosinophils can cause allergies in the nose (runny nose) or allergies to foods (like peanuts or milk) but can also be a part of skin conditions like eczema and the breathing disease asthma.

In the condition of EoE, eosinophils build up in the esophagus and can become inflamed and swollen when exposed to foods that we may be allergic to. 

Thankfully, allergy and gastrointestinal medical providers are very good at diagnosing and treating this condition.

Symptoms:

Difficulty Swallowing

Food getting stuck in your swallowing or the feeling that food is getting stuck

Long term heart burn, especially if it does not get better with regular medicine

Stomach or abdominal pain

Backflow of undigested food back into your mouth after swallowing

Causes of EoE:

Because eosinophils are the cells that can make us allergic to things like food and pollen, when these cells collect in the esophagus they can cause an allergic reaction to food or pollen that we swallow. 

When we swallow a food we are allergic to, even if that allergy is not severe normally, the eosinophils that have built up can become active and cause swelling (inflammation).  This may make it hard to swallow or maybe feel like food is getting stuck before it can reach our stomach. 

Over time this swelling can cause permanent damage to the esophagus and may require oral medications or even surgery.

Who is likely to have EoE?

               People with allergies – if you have seasonal allergies (like a runny nose in the summer) or if you have a skin condition like eczema or if you have asthma you are at a higher risk for EoE

               Family history – even if you don’t have allergies, if there are a few people in your family who do have allergies, your risk for EoE is higher

               Age/Gender – while EoE is more common in men, any one at any age can have EoE

Diagnosis of EoE:

The only way to know for sure if you have EoE is to have a procedure called an endoscopy.  In this procedure a doctor looks down your throat into the esophagus and takes a tiny sample of tissue.  This tissue is examined under a microscope and the diagnosis of EoE is possible. 

Treatment of EoE:

Once you have a diagnosis of EoE, or EoE is strongly suspected by your allergy medical provider, there are things you can do to help the symptoms and control EoE.  Always follow your medical provider’s instructions. 

               Diet Changes – taking out certain foods can help.  Foods that are commonly removed include dairy, egg, wheat, peanut and soy.  In people with EoE, eliminating these foods can reduce or even stop the inflammation in the esophagus, greatly relieving symptoms. 

               Medications – while there are no FDA approved medications for EoE, certain medications may be prescribed to help reduce or eliminate symptoms.  These include steroid medications that reduce inflammation.  EoE patients will often swallow small amounts of steroid medications daily, either in pill form or in an easy to use spray.  Other medications often used include acid reduction medications that are used for acid reflux.

Allergy Specialists

Patients suspected of having EoE are often referred to an allergy specialist.  These specialists can do allergy tests to identify if there are allergies in the air (like pollen or allergies to a pet) or if there are food allergies (like peanut or milk) and even test for contact allergies (like a metal or soaps/makeup) and help to figure out what might be causing the EoE.    Finding out what a patient is allergic to is an important step in treating EoE.   Allergy specialists will work closely with gastrointestinal providers to make sure patients get the care they need.