What Is Eosinophilic Esophagitis?

Eosinophilic Esophagitis (EoE) is a chronic allergic inflammatory condition of the esophagus, the tube that connects your mouth to your stomach. In this condition, a specific type of white blood cell called eosinophils builds up in the lining of the esophagus, causing inflammation and damage to the tissue.

EoE is considered an allergic disorder, often triggered by food allergens or environmental factors. The immune system responds inappropriately to these triggers, causing eosinophils to accumulate where they normally shouldn't be present in such high numbers. This immune response leads to inflammation, which can cause narrowing of the esophagus and the characteristic symptoms that patients experience.

The condition has been increasingly recognized over the past two decades, with rising diagnosis rates worldwide. It affects people of all ages but is more commonly diagnosed in males than females. While not life-threatening, EoE can significantly impact quality of life if left untreated.

Common Symptoms of Eosinophilic Esophagitis

The symptoms of Eosinophilic Esophagitis can vary between adults and children, but several key indicators are common across age groups:

Dysphagia (Difficulty Swallowing) - This is the most common symptom in adults with EoE. Patients often describe food getting stuck in their throat or chest, requiring extra effort to swallow. Some may need to drink liquids to help push food down.

Food Impaction - This occurs when food becomes completely stuck in the esophagus and cannot pass into the stomach. It can be a medical emergency requiring immediate attention if the person cannot swallow liquids or saliva.

Chest Pain - Many EoE patients experience pain in the center of the chest that is not related to heart issues. This pain may worsen during or after eating.

Heartburn and Acid Reflux - These symptoms are common in EoE and may not respond well to standard acid-suppressing medications, which can be a clue that EoE rather than typical acid reflux is present.

Regurgitation - The involuntary return of food into the mouth after swallowing is experienced by many patients with EoE.

How EoE Symptoms Differ in Children

Children with Eosinophilic Esophagitis often present with different symptoms than adults, which can make diagnosis challenging:

Feeding Difficulties - Younger children may refuse meals, eat very slowly, or demonstrate fussy eating behaviors. Parents might notice their child avoiding certain food textures.

Failure to Thrive - Due to decreased food intake, some children with EoE may show poor weight gain or growth problems.

Abdominal Pain - Children may complain of stomach aches, especially after eating, but might not be able to describe the sensation of food getting stuck.

Vomiting - Recurrent vomiting or regurgitation is more common in pediatric EoE cases than in adults.

Behavioral Changes Around Mealtime - Children may develop anxiety around eating or adopt unusual eating habits, such as excessive chewing, eating very slowly, or cutting food into tiny pieces.

Adolescents tend to show a symptom pattern that transitions between childhood and adult presentations, often reporting both abdominal pain and difficulty swallowing.

Diagnosing Eosinophilic Esophagitis

If you or your child experiences persistent symptoms that might indicate EoE, seeking medical attention is important. The diagnosis typically involves several steps:

Medical History and Physical Examination - Your healthcare provider will ask about your symptoms, dietary habits, allergies, and family history. While the physical exam may appear normal in many cases, it helps rule out other conditions.

Endoscopy with Biopsy - This is the gold standard for diagnosing EoE. During an endoscopy, a gastroenterologist examines the esophagus visually and takes small tissue samples (biopsies) to analyze under a microscope. A diagnosis of EoE is confirmed when the biopsy shows elevated numbers of eosinophils in the esophageal tissue.

Allergy Testing - Since EoE is often triggered by food allergies, allergy testing may be recommended. This can include skin prick tests, blood tests for specific IgE antibodies, or patch testing. The American College of Allergy, Asthma & Immunology provides resources for finding appropriate allergy testing.

It's worth noting that many patients with EoE have tried acid-reducing medications before diagnosis without complete resolution of symptoms, which can be an important diagnostic clue for healthcare providers.

Treatment Options and Management

While there is no cure for Eosinophilic Esophagitis, several effective treatment approaches can manage symptoms and reduce inflammation:

Dietary Modifications - Eliminating trigger foods is often the first-line treatment. This may involve:

  • Elimination diets that remove common allergens like dairy, wheat, eggs, soy, nuts, and seafood
  • Elemental diets using specialized formulas that contain basic nutrients without potential allergens
  • Targeted elimination based on allergy test results

Working with a registered dietitian experienced in EoE, like those affiliated with the American Academy of Allergy, Asthma & Immunology, is crucial for maintaining proper nutrition during dietary treatment.

Medications - Several medication options can help manage EoE:

  • Proton pump inhibitors (PPIs) to reduce stomach acid
  • Topical steroids, such as fluticasone or budesonide, which are swallowed to coat the esophagus and reduce inflammation
  • Biologics like Dupixent (dupilumab), recently approved for EoE in certain patients

Esophageal Dilation - For patients with significant narrowing (strictures) of the esophagus, a procedure called dilation may be performed during endoscopy to stretch the esophagus and improve swallowing.

The American Partnership for Eosinophilic Disorders provides comprehensive resources for patients managing this condition, including support groups and educational materials.

Conclusion

Eosinophilic Esophagitis is a chronic condition that requires ongoing management, but with proper diagnosis and treatment, most patients can achieve significant symptom relief and improved quality of life. The key to successful management is recognizing symptoms early, obtaining an accurate diagnosis through endoscopy and biopsy, and working closely with healthcare providers to develop an individualized treatment plan.

If you or your child experiences persistent difficulty swallowing, food getting stuck, chest pain, or recurrent heartburn that doesn't respond to typical treatments, consider discussing the possibility of EoE with your healthcare provider. With increasing awareness and advancing treatment options, the outlook for people with EoE continues to improve.

Remember that symptoms can change over time, and regular follow-up with gastroenterology specialists is important for monitoring the condition and adjusting treatment as needed. Patient advocacy organizations like the CURED Foundation can provide additional support and resources for those living with this challenging but manageable condition.

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This content was written by AI and reviewed by a human for quality and compliance.