What is eosinophilic esophagitis?
In eosinophilic esophagitis, a type of white blood cell (eosinophil) builds up in the lining of the tube that connects your mouth to your stomach (esophagus). This buildup, which is a reaction to foods, allergens or acid reflux, can inflame or injure the esophageal tissue. Damaged esophageal tissue can lead to difficulty swallowing or cause food to get caught when you swallow.
Eosinophilic esophagitis is a chronic immune system disease. It has been identified only in the past two decades, but is now considered a major cause of digestive system (gastrointestinal) illness. Research is ongoing and will likely lead to revisions in its diagnosis and treatment.
How common is eosinophilic esophagitis?
The frequency of eosinophilic esophagitis has been estimated to be approximately 1 in 1,000 children. This condition has been reported in multiple continents including Europe, Australia, and America. Please discuss with your doctor for further information.
What are the symptoms of eosinophilic esophagitis?
The common symptoms of eosinophilic esophagitis are:
- Difficulty swallowing (dysphagia)
- Food impaction
- Chest pain that is often centrally located and does not respond to antacids
- Persistent heartburn
- Upper abdominal pain
- No response to gastroesophageal reflux disease (GERD) medication
- Backflow of undigested food (regurgitation)
- Difficulty feeding
- Abdominal pain
- Difficulty swallowing (dysphagia)
- Food impaction
- No response to GERD medication
- Failure to thrive (poor growth, malnutrition and weight loss)
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes eosinophilic esophagitis?
Previously, doctors thought eosinophilic esophagitis symptoms were caused by gastroesophageal reflux disease (GERD), but they now recognize it as a distinct condition with very different causes. Eosinophilic esophagitis is an allergic reaction in which the lining of your esophagus reacts to allergens, such as food or pollen.
Eosinophils are a normal type of white blood cells present in your digestive tract, but in eosinophilic esophagitis they multiply in your esophagus. The eosinophils produce a protein that causes inflammation, which can lead to scarring, narrowing and formation of excessive fibrous tissue in the lining of your esophagus. As a result, you may have difficulty swallowing (dysphagia) or have food become stuck when you swallow (impaction), as well as other symptoms.
People with eosinophilic esophagitis may also have food allergies, environmental allergies, asthma, atopic dermatitis or chronic respiratory disease. Doctors also think some people are genetically more likely than others to develop eosinophilic esophagitis.
There has been a significant increase in numbers of people diagnosed with eosinophilic esophagitis in the past decade. At first researchers thought this was due to the increase in awareness among doctors and greater availability of upper endoscopy. However, studies now suggest that the disease is becoming increasingly common, parallel to the increase in asthma and allergy.
What increases my risk for eosinophilic esophagitis?
There are many risk factors for eosinophilic esophagitis, such as:
- Climate. Living in a cold or dry climate.
- Season. May be more likely diagnosed between the spring and fall, probably because levels of pollen and other allergens are higher and people are more prone to be outdoors.
- Sex. More common in males than in females.
- Family history. If family members have eosinophilic esophagitis, you have a greater chance of being diagnosed.
- Allergies and asthma. If you have food or other allergies, or asthma, you are more likely to be diagnosed.
- Age. Originally thought to be a childhood disease, but now is known to be common in adults as well. However, the symptoms differ somewhat.
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is eosinophilic esophagitis diagnosed?
The diagnosis of eosinophilic esophagitis is often delayed because of a lack of awareness of this condition. A small tube is inserted through the mouth into the esophagus (upper endoscopy) and small tissue samples are removed (biopsy) in order to count eosinophils, and look for tissue injury and thickening of tissue. If a diagnosis of eosinophilic esophagitis is made, allergy testing is usually then performed to determine if particular foods or environmental agents trigger esophageal symptoms or are contributing to other allergic problems.
Elevated expression of eotaxin-3 is part of a whole panel of dysregulated genes expressed by the esophagus of eosinophilic esophagitis patients, termed the “eosinophilic esophagitis transcriptome” which can now be used to diagnosis and test for eosinophilic esophagitis through a test called EoGenius.
How is eosinophilic esophagitis treated?
Eosinophilic esophagitis is considered a chronic relapsing disease, meaning that most people will require ongoing treatment to control their symptoms. Treatment will involve one or more of the following:
Depending on your response to tests for food allergies, your doctor may recommend that you stop eating certain foods, such as dairy or wheat products, to relieve your symptoms and reduce inflammation. A more limited diet is sometimes required. Your doctor may refer you to an allergist for specific recommendations.
Your doctor will likely first prescribe an acid blocker such as a PPI. This treatment is the easiest to use, but most people’s symptoms don’t improve. If you do not respond to the PPI, your doctor will then likely prescribe a topical steroid, such as fluticasone or budesonide, which is taken orally to treat eosinophilic esophagitis.
This type of steroid is not absorbed into the bloodstream, so you are unlikely to have the typical side effects often associated with steroids. If a topical steroid is not effective or you need more immediate symptom relief, you may be prescribed prednisone.
Steroids may decrease the buildup of eosinophils in the esophagus, reduce the inflammation associated with an allergic reaction, and allow your esophagus to heal. Some people may need to take steroids on an ongoing basis.
If you experience severe narrowing (strictures) of your esophagus, your doctor may recommend dilation to help make swallowing easier. Dilation may be used if steroids are not helpful.
Because people with eosinophilic esophagitis can have bleeding or tearing of their esophagus, doctors have been concerned about the safety of dilation, especially of perforation during the procedure. Studies have found that dilation is safe and may provide symptom relief for some people — though it may initially be painful. However, it does not improve the underlying inflammation.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage eosinophilic esophagitis?
The following lifestyles and home remedies might help you cope with eosinophilic esophagitis:
- Maintain a healthy weight. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus. If your weight is at a healthy level, work to maintain it. If you are overweight or obese, work to slowly lose weight — no more than 1 or 2 pounds (0.5 to 1 kilogram) a week. Ask your doctor for help in devising a weight-loss strategy that will work for you.
- Avoid foods and drinks that trigger heartburn. Common triggers, such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine, may make heartburn worse. Avoid foods you know will trigger your heartburn.
- Elevate the head of your bed. If you regularly experience heartburn at night or while trying to sleep, put gravity to work for you. Place wood or cement blocks under the feet of your bed so that the head end is raised by 6 to 9 inches. If it’s not possible to elevate your bed, insert a wedge between your mattress and box spring to elevate your body from the waist up.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Eosinophilic esophagitis. http://www.mayoclinic.org/diseases-conditions/eosinophilic-esophagitis/basics/definition/con-20035681. Accessed August 25, 2017.
Eosinophilic Esophagitis. https://rarediseases.org/rare-diseases/eosinophilic-esophagitis/. Accessed August 25, 2017.
Review Date: August 24, 2017 | Last Modified: August 28, 2017