Eosinophilic Esophagitis (EoE) is an allergic/immune condition that causes inflammation or swelling of the esophagus. The esophagus is the tube that sends food from the throat to the stomach.
People with EoE have large numbers of eosinophils in their esophagus. Eosinophils are a type of white blood cell that causes inflammation. Normally there are no eosinophils inside the esophagus, but they can be found in other parts of the gastrointestinal tract. If this inflammation is not treated, the esophagus may end up with a stricture. A stricture is a narrowing of the esophagus that can lead to food getting stuck after it is swallowed.
Research suggests that the main cause of EoE is an allergy or a sensitivity to particular proteins found in foods and environmental allergens. Many people with EoE have a family history of allergic disorders such as asthma, rhinitis, atopic dermatitis/eczema, or food allergy.
EoE can occur at any age. It is most common in Caucasian (white) males, but can also occur in females and many races and ethnicities.
Symptoms & Diagnosis
Symptoms of EoE might be different depending on your age. In young children, vomiting, fussiness during meals, refusal to eat, and poor growth can occur. In older children and adults, pain in the abdomen, chest pain, heartburn, vomiting, difficulty swallowing and a feeling of food getting stuck are more common. Sometimes food can get stuck in the esophagus, which needs to be removed by a healthcare provider. Eosinophils cause inflammation of the esophagus, which creates these symptoms.
Currently, the only way to diagnose EoE is with an endoscopy and biopsy of the esophagus, which is often done by a gastroenterologist. An endoscopy is a medical procedure that lets your doctor see what is happening in your esophagus. During a biopsy, tissue samples will be taken and analyzed.
An endoscopy and biopsy is usually done after medications to control heartburn have not been able to improve symptoms.
It is also recommended to be evaluated by an allergist. An allergist can figure out the role that specific environmental and food allergies might play in EoE. This is done through skin prick, patch, and/or blood allergy testing.
Treatment & Management
There are two main ways to treat EoE. The first involves removing foods from your diet that are suspected triggers. Milk, eggs, soy, and wheat are common trigger foods, although others can be too. An allergist, sometimes with the help of a registered dietician, can help develop a plan to avoid these allergens.
A second treatment option for EoE is using medications to control the inflammation.
Dupilumab is the only medical therapy to date that has received approval for the treatment of EoE from the Food and Drug Administration (FDA). It was recently approved for patients 12 years of age and older who weigh at least 40 kilograms (about 88 pounds). Dupilumab is a monoclonal antibody (aka biologic) that is given as a weekly injection. It reduces the inflammation associated with the disease and improves the capacity of patients to swallow their food.
Other medications have been shown to reduce the number of eosinophils in the esophagus and improve symptoms. Proton pump inhibitors (PPIs), which reduce acid production in the stomach, have also been found to reduce esophageal inflammation in some patients with EoE. H2 anti-histamines (ie Famotidine, Nizatidine, and Cimetidine) are often used to treat inflammation in the esophagus. In addition, PPIs are often used as a first treatment for EoE. However, not all patients respond to PPIs, and other forms of therapy, such as swallowed topical corticosteroids, are considered. Careful monitoring by a doctor knowledgeable in the treatment of EoE is very important. After a treatment plan is developed, most people with EoE will need additional endoscopies with biopsies to see if their EoE is getting better or worse.