Eosinophilic esophagitis

What is Eosinophilic esophagitis?

Eosinophilic esophagitis is an inflammation of the esophagus (the tube that connects the mouth to the stomach), caused by a specific type of white blood cell known as the eosinophil.

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 GI illness. Research is ongoing and will likely lead to revisions in the diagnosis and treatment approach as more information about the condition is discovered.

What causes Eosinophilic esophagitis?

Eosinophils are a normal type of white blood cell found in your digestive tract. In eosinophilic esophagitis, you have an allergic reaction to an outside substance. This could be something you’re consuming in your diet or something you’re exposed to in your environment (like a pollen or dust).

How common is it?

It is a rare condition. Nonetheless, there has been a rise in the number of patients diagnosed with eosinophilic esophagitis in the past decade. Initially this was thought to be due to an increase in awareness among doctors and greater availability to diagnostic tests like upper endoscopy. However, studies now suggest the disease is becoming more common, in parallel to the rise in asthma and other allergy diagnoses.

Who is at risk?

It is more common in Caucasian males but can occur in both men and women of any age.

What are the symptoms?

  1. Difficulty swallowing
  2. Food getting stuck in the esophagus
  3. Chest pain that is often centrally located and does not respond to antacids
  4. Persistent heartburn
  5. Upper abdominal pain
  6. Reflux symptoms that are unresponsive to treatment
  7. Backflow of undigested food or regurgitation

 

How is it diagnosed?

 

Eosinophilic esophagitis is diagnosed by upper endoscopy and biopsy. Greater than 25 eosinophils will be seen per high-powered field under the microscope.

What are the complications of Eosinophilic esophagitis?

Based on what is known today, eosinophilic esophagitis does not cause or lead to esophageal cancer. Current information suggests if it is left untreated it may lead to esophageal narrowing and stricture over time.

How is it treated?

There are two main treatment approaches: inhaled steroid medications and dietary management.

Food allergies are thought to contribute to the disease. The most common foods associated with the conditions are dairy and gluten, although eggs, nuts, beef, fish, shellfish, corn or soy could be triggers. For some patients a single food may be the cause, while for others many foods may contribute to the development of the disease.

Unfortunately typical allergy tests, such as skin prick tests and blood tests, are not usually effective for identifying the causative agent or problematic foods. Elimination diets are often recommended. Nutrition consultation may be helpful.

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