Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease characterized by inflammation of the esophagus. This condition is driven by an accumulation of eosinophils, a type of white blood cell, in the esophageal lining. Over time, this inflammation can lead to damage, making swallowing difficult and potentially painful. While EoE is a relatively new diagnosis in the medical community, its recognition and treatment options have grown significantly in recent years.

What is Eosinophilic Esophagitis?

EoE is considered a type of allergic disease that affects the esophagus, often triggered by certain foods or environmental allergens. It is not caused by acid reflux, although it may present with similar symptoms. The condition can affect both children and adults and tends to run in families, suggesting a genetic component. If left untreated, EoE can result in fibrosis and narrowing of the esophagus.

Common Symptoms of EoE

Symptoms can vary based on age and the severity of the inflammation. In children, feeding difficulties and failure to thrive may be noted, while adults often report swallowing difficulties.

• Dysphagia (trouble swallowing)


• Food impaction (food getting stuck in the esophagus)


• Chest pain that is not related to the heart


• Upper abdominal pain


• Persistent heartburn not relieved by antacids


• Vomiting or regurgitation


• Poor appetite or growth delays in children

Causes and Triggers

EoE is believed to result from a combination of genetic and environmental factors, particularly allergic reactions to food or airborne allergens. Common dietary triggers include:

• Milk


• Eggs


• Wheat


• Soy


• Peanuts and tree nuts


• Seafood and shellfish

Seasonal allergies and environmental allergens like pollen and dust mites can also contribute to EoE symptoms in some individuals.

Diagnosis of EoE

Diagnosing eosinophilic esophagitis involves a combination of clinical evaluation, endoscopy, and biopsy. Because its symptoms resemble those of other gastrointestinal conditions, proper testing is essential.

1. Endoscopy and Biopsy

During an upper endoscopy, a flexible tube with a camera is inserted through the mouth into the esophagus. The physician looks for signs of inflammation,rings, or narrowing. Multiple tissue samples (biopsies) are taken and examined for eosinophils. A diagnosis is typically confirmed when more than 15 eosinophils per high-power field are found in the tissue.

2. Allergy Testing

Identifying potential triggers is crucial for effective management. Allergy testing may include skin prick tests, patch tests, and blood tests to detect specific IgE antibodies related to food or environmental allergens.

Treatment Options

Treatment for EoE aims to reduce inflammation, relieve symptoms, and prevent long-term complications. Approaches typically include dietary management, medications, and in some cases, esophageal dilation.

1. Dietary Management

• Elemental Diet: A strict formula-based diet used mainly in children. It is highly effective but difficult to maintain long-term.


• Elimination Diet: Removal of common allergens such as dairy, wheat, eggs, soy, nuts, and seafood. Foods are reintroduced one at a time under supervision.


• Targeted Diet: Based on allergy test results, specific foods are avoided while maintaining a more balanced diet.

2. Medications

• Proton Pump Inhibitors (PPIs): While primarily used for acid reflux, PPIs may also reduce eosinophil counts in some EoE patients.


• Topical Corticosteroids: Swallowed corticosteroids such as fluticasone or budesonide are commonly used to reduce inflammation in the esophagus.


• Biologics: Newer biologic drugs targeting specific immune pathways are being studied and may offer future treatment alternatives.

3. Esophageal Dilation

In cases where the esophagus has narrowed severely due to inflammation and scarring, esophageal dilation may be performed to widen the esophagus and improve swallowing.

Long-Term Management

EoE is a chronic condition that often requires long-term care. Regular follow-ups with a gastroenterologist and allergist are recommended. Repeat endoscopies may be necessary to monitor inflammation and response to treatment.

Conclusion

Eosinophilic esophagitis is a challenging but manageable condition. With the right combination of dietary changes, medications, and medical monitoring, individuals living with EoE can achieve symptom relief and improve their quality of life. As awareness grows and treatments evolve, the future looks promising for those affected by this condition.