Eosinophilic Esophagitis (EoE)
Eosinophilic esophagitis (EoE) is a condition that affects the esophagus (the food pipe between the mouth and stomach). Eosinophils are a type of white blood cells that are typically released during allergic reactions. Eosinophilic esophagitis (EoE) is a condition in which the allergy cells are within the lining of the esophagus causing inflammation and narrowing of the esophagus. There is ongoing research to determine why this occurs, but it appears that swallowed food or airborne allergens (ex. Ragweed, pollen) stimulate this allergic reaction.
Some patients may have no symptoms at all. Some patients have symptoms similar to reflux disease such as heartburn. EoE commonly present as difficulty swallowing foods or chest pain during or after eating. This can cause a sensation of the food becoming stuck in the esophagus or even blocking the esophagus causing inability to even swallow one’s own saliva.
To establish the diagnosis of EoE, biopsies of the esophagus are required. This is done during upper endoscopy, passing a flexible scope thru the mouth and into the upper digestive tract in a sedated patient. During the endoscopy, esophageal tissue can be sampled (biopsied) to look microscopically for eosinophils and other abnormalities.
Consultation with an allergy specialist may be recommended to test for food or environmental allergies. If an allergy is present, avoidance of the food or desensitization to the environmental allergen can be effective in controlling symptoms.
The most common food that cause EoE are cow milk protein, soy, wheat, egg, peanut, and seafood. A trial of avoidance of some or all of these foods can help to identify the specific problem. In children, there is a 95% response to food elimination.
Some patients require medications to treat EoE. Proton pump inhibitors (PPIs) are often prescribed. Examples of PPI’s are omeprazole (Prilosec), Nexium, Prevacid and others. These medications significantly reduce the production of stomach acid and are often used in patients with acid reflux. Reflux often occurs in EoE, and the use of these medications is often helpful.
Corticosteroids are also used. These medications decrease the amount of inflammation in the esophagus. Rather than taking steroid pills, for EoE steroids are usually given by swallowing a dose of steroid from a steroid inhaler that would usually be inhaled to treat asthma. This places the steroid directly on the esophagus. Examples include fluticasone (Flonase) and budesonide (Pulmicort).
Endoscopy may be used to treat the swallowing difficulty associated with EoE. Many individuals with EoE develop strictures/narrowing that appear like rings of tissue in the esophagus (see photo) that can mildly or more severely constrict the diameter of the esophagus. Dilation to stretch the rings during a sedated endoscopic procedure can improve swallowing.
Endoscopic photo and microscopic appearance of EoE