Eosinophilic esophagitis involves swelling of the esophagus. This inflammation may cause difficulty swallowing, stunted growth in children, and abdominal pain.

Eosinophilic esophagitis is an allergic condition affecting the esophagus. The esophagus is the hollow tube that carries liquids and food from the throat to the stomach.

With eosinophilic esophagitis, the immune system releases excess white blood cells, called eosinophils. The eosinophils release substances that may lead to swelling of the esophageal tissues. The condition can affect people of any age and lead to various symptoms.

Eosinophilic esophagitis symptoms may vary depending on the age of the person. For instance, children and adults may have somewhat different symptoms. These symptoms may include difficulty swallowing, poor growth, food impaction, and a poor appetite.

The article below covers the symptoms of eosinophilic esophagitis, its causes, and treatment.

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Difficulty swallowing, or dysphagia, is one of the main symptoms of eosinophilic esophagitis for people of all ages.

As the esophagus becomes inflamed, it swells. The swelling may make swallowing difficult. In adults, 70% of people have difficulty swallowing solids. People with eosinophilic esophagitis may need to drink a lot of fluids while eating to help them swallow their food.

In some people with this condition, the esophagus becomes so narrow that food cannot pass properly. This can cause food impactation, which means the food becomes stuck in the esophagus. Sometimes, this may lead to life threatening complications.

Because it can be difficult to swallow, some children may not get the nutrition they require for proper growth. As such, a common symptom that can indicate eosinophilic esophagitis is poor growth in childhood.

In children, the most common symptoms often include:

  • abdominal pain
  • vomiting
  • food refusal
  • failure to thrive

Children may also have a decreased appetite. As such, these digestive symptoms and problems swallowing can lead to malnutrition and stunted growth.

Certain symptoms may occur commonly in children but not adults. For instance, abdominal pain occurs in children more often than in adults.

Typically, in addition to difficulty swallowing and poor growth in childhood, the most common symptoms of eosinophilic esophagitis include:

Some people with eosinophilic esophagitis develop symptoms, such as heartburn and acid reflux. These symptoms also occur frequently in GERD. Because of the overlap of symptoms and since GERD is common, doctors may initially diagnose a person with GERD.

After a clinical evaluation, the doctor can distinguish between the two conditions. Typically, people with GERD do not have a significant increase in eosinophils. For both conditions, a doctor may also prescribe proton pump inhibitors to help reduce symptoms.

Additionally, evidence notes that people can have both conditions and having one condition may increase the risk of developing the other.

Experts do not currently know the exact cause of eosinophilic esophagitis. However, it appears to occur due to an abnormal immune system response related to a food allergy or environmental trigger.

Currently, experts estimate the incidence at 1 out of every 2,000 people. Researchers believe that a combination of genetics and environmental factors may cause eosinophilic esophagitis.

Risk factors for eosinophilic esophagitis include:

  • Sex: Eosinophilic esophagitis affects three times as many males as females.
  • History of allergies or asthma: About 50% of people with eosinophilic esophagitis also have asthma. Having a food allergy also increases the risk of the condition.
  • Family history of eosinophilic esophagitis: Specific genes may contribute to the development of eosinophilic esophagitis.

Some people may experience a delay in diagnosis due to a lack of awareness about the condition or due to a misdiagnosis of GERD. Typically, doctors may diagnose eosinophilic esophagitis based on a review of symptoms, a physical exam, and an upper endoscopy.

An upper endoscopy involves inserting a small tube into the esophagus through the mouth to take a tissue sample. Doctors analyze the sample to check the eosinophil count. A count of 15 or more eosinophils under a microscope suggests eosinophilic esophagitis.

Treatment for eosinophilic esophagitis may include a combination of diet management and medications.

Dietary modifications, such as elimination diets, involve removing suspected foods that may trigger an allergic response. This often involves using the six food elimination diet (6FED), which includes eliminating foods that commonly cause allergies, such as:

  • eggs
  • animal milk
  • soy
  • nuts
  • wheat
  • fish and shellfish

Doctors often recommend removing foods one at a time to determine what food may trigger the response.

Different classifications of medications are available to treat eosinophilic esophagitis. Medications include:

  • Topical steroids: Topical steroids may decrease inflammation.
  • Acid suppressors: Acid suppressors, such as proton pump inhibitors, may reduce symptoms of heartburn and reflux.
  • Biologic therapies: Biologics, such as Dupixent, have approval from the Food and Drug Administration (FDA) for treating eosinophilic esophagitis. These medications help decrease inflammation.

If the esophagus becomes too narrow and food continues to become struck, doctors may suggest dilation. An esophageal dilation helps widen the esophagus to make food passage easier.

Eosinophilic esophagitis occurs due to the presence of excessive eosinophils, a type of white blood cell, in the esophagus. These cells release substances that lead to inflammation, which can make swallowing difficult.

Symptoms may vary slightly depending on a person’s age. In addition to dysphagia, symptoms can include food impaction, vomiting, heartburn, abdominal pain, and failure to thrive.

Treatment options include diet modifications to reduce the possible food triggers. Doctors may also prescribe medication to ease symptoms.