Eosinophilic esophagitis is a chronic inflammatory condition of the esophagus, or food pipe. The esophagus is the tube that connects the mouth to the stomach.
Eosinophilic esophagitis causes chronic inflammation in the esophagus, which can make it difficult for a person to eat, drink, or even swallow saliva. A person may also experience related symptoms, such as heartburn, nausea, and malnutrition.
Both adults and children can get eosinophilic esophagitis. In children, the condition can lead to developmental issues, such as stunted growth.
In this article, we provide information on the symptoms and causes of eosinophilic esophagitis. We also outline the dietary and medical treatment options available.
Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus.
In people with EoE, white blood cells called eosinophils build up within the inner lining of the esophagus. These eosinophils release substances that cause inflammation. Chronic inflammation of the esophagus may lead to symptoms such as difficulty eating or swallowing.
EoE is a rare condition, affecting about 1 in 2,000 people. However, the American College of Allergy, Asthma & Immunology state that the condition is becoming more common, though this may be partly because increased awareness has led to more diagnoses.
EoE can develop in children or adults and in people of all ethnicities. People who develop EoE typically have preexisting allergies, such as:
Experts have suggested that these allergies may trigger EoE in some cases.
The symptoms of EoE may differ from person to person. However, some of the more common symptoms include:
- difficulty swallowing
- food blockages in the esophagus
- chest and stomach pain
- nausea and vomiting
- appetite loss
- weight loss
- difficulty sleeping due to uncomfortable or painful EoE symptoms
Children who develop EoE may become irritable and refuse to eat or drink. As a result, they may experience developmental problems, such as stunted growth.
Eosinophils are a type of white blood cell that is not usually present in the esophagus. In EoE, eosinophils accumulate in this part of the body, causing inflammation of the esophageal tissues.
Scientists have noticed that many people who develop EoE have some type of allergy. As such, the consensus is that a person’s immune response to an allergen may cause the accumulation of eosinophils in the esophagus.
According to the American Academy of Allergy, Asthma & Immunology, abnormal immune responses to foods are the leading cause of EoE. However, experts do not yet fully understand the mechanism by which foods trigger EoE.
Other potential allergens that could contribute to EoE include:
- dust mites
- mold spores
According to the American Partnership for Eosinophilic Disorders, specific genes may also play a role in the development of EoE.
To diagnose EoE, a doctor will ask about a person’s symptoms and whether they have any allergies.
If the doctor suspects EoE, an upper endoscopy (UE) will be necessary to confirm the diagnosis. A UE involves passing a long, flexible tube called an endoscope down the esophagus. A small camera on the end of the endoscope allows the doctor to look for inflammation.
During the procedure, the doctor may take a small sample of the esophageal tissue for further examination. The presence of eosinophils within the sample would indicate EoE.
Additional diagnostic tests
A person who receives a diagnosis of EoE may require further medical tests to identify any allergens underlying the condition.
In most cases, a doctor will recommend an elimination diet, which involves removing food triggers from the diet and monitoring the effect on EoE symptoms.
Occasionally, they may use a blood test to detect a type of immune cell called immunoglobulin E (IgE), which a person’s immune system releases in response to certain allergens. High levels of IgE indicate that the body is overreacting to an allergen.
A skin prick test is also an option. This test involves using a fine needle to insert a small amount of a suspected allergen beneath the skin. Redness or swelling at the site of the skin prick test suggests an allergic reaction to the substance.
However, blood tests and skin prick tests may not be useful, as they commonly produce false-positive results. Also, as experts believe that EoE may not be IgE-mediated, these tests may have little to no value.
There is currently no cure for EoE. However, a combination of dietary changes and medical treatments may help manage inflammation and alleviate symptoms.
Elimination diets can help a person identify their trigger foods so that they can avoid them in the future. There are different types of elimination diet, which vary in terms of convenience and effectiveness.
A doctor may recommend one of the following three elimination diets:
Empiric elimination diets
Empiric elimination diets involve removing all foods that commonly affect EoE. Such foods include:
Food test-directed elimination diets
Food test-directed elimination diets involve eliminating any food that a person has previously shown sensitivity to during a skin prick test.
After eliminating these foods from the diet, a person monitors their symptoms to check for any improvement.
Elemental diets involve using a special formula to supplement or replace the diet. The formula contains a combination of amino acids, which provide nutrition without triggering EoE.
Elemental diets are the most extreme treatment option, and doctors usually only recommend them for children. However, they may be necessary if other approaches are not working.
The Food and Drug Administration (FDA) have not yet approved any medications for the treatment of EoE. However, the following treatments may help manage inflammation or alleviate symptoms:
- Proton pump inhibitors: These medications limit the production of stomach acid. In some cases, this may help reduce inflammation of the esophagus.
- Topical steroids: Steroids are medications that help control inflammation inside the body. Fluticasone (Flonase) and budesonide (Pulmicort) are steroids that a person can inhale from an asthma inhaler or swallow in a viscous solution. The steroid comes into contact with the inner lining of the esophagus, thereby targeting the inflammation directly.
- Dilation: Severe esophageal inflammation results in the narrowing of the esophagus. This narrowing makes it difficult for food to pass down into the stomach. Dilation is a procedure that involves inflating a balloon or tube inside the esophagus to open it up.
Most people with eosinophilic esophagitis will require ongoing treatment. However, the disorder is unlikely to cause further chronic illness or affect life expectancy.
Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus. People who have the condition may experience difficulty eating and drinking, which can lead to complications, such as weight loss and malnutrition.
The exact cause of EoE remains unclear. However, most people who develop the condition have preexisting allergies. Experts generally agree that these allergies may contribute to EoE.
There is no cure for EoE. However, a combination of dietary changes and medical treatments can help reduce inflammation and alleviate symptoms.