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Eosinophilic esophagitis (EoE) is a chronic disease of the esophagus, the muscular tube that carries food and drink from the mouth to the stomach. In EoE, white blood cells called eosinophils build up in the esophagus, causing inflammation and damage — and with it pain, trouble swallowing, and food getting stuck in the throat.
EoE is rare, but because it has only recently been recognized, it is being diagnosed more often. Some people who believe they have reflux (GERD) actually have EoE.
Causes and risk
The exact cause is not known. Researchers think EoE is an immune or allergic reaction to foods or to things in the environment, such as dust mites, animal dander, pollen and molds. Certain genes may play a part.
Anyone can get EoE, but it is more common in people who:
- are male
- have other allergic diseases — hay fever, eczema, asthma or food allergies
- have relatives with EoE
Symptoms change with age
| Age | Common symptoms |
|---|---|
| Infants and toddlers | feeding problems, vomiting, poor weight gain and growth, reflux that medicine doesn’t fix |
| Older children | vomiting, abdominal pain, trouble swallowing (especially solid food), reflux that medicine doesn’t fix, poor appetite |
| Adults | trouble swallowing (especially solid food), food stuck in the esophagus, reflux that medicine doesn’t fix, heartburn, chest pain |
Diagnosis
Because other conditions cause the same symptoms, diagnosis starts with a thorough medical history. Then:
- Upper endoscopy. A long, flexible tube with a light and camera is passed down the esophagus. Signs of EoE can include white spots, rings, narrowing and inflammation — but not everyone with EoE has them, and they can point to other disorders.
- Biopsy. During the endoscopy, small tissue samples are taken and checked for a high number of eosinophils. A biopsy is the only way to diagnose EoE.
- Other tests as needed — blood tests to rule out other conditions and, if EoE is found, tests for specific allergies.
Treatment
There is no cure, but treatment can control symptoms and prevent further damage. The two main approaches are medicine and diet, and some people use both.
Medicines
- Steroids to calm inflammation — usually swallowed topical steroids from an inhaler or as a liquid; steroid pills are sometimes used for serious swallowing problems or weight loss
- Acid suppressors such as proton pump inhibitors (PPIs), which may ease reflux and reduce inflammation
- Monoclonal antibodies, which can reduce inflammation and may help swallowing; used in adults and in children over age 12
Diets
- Elimination diet: certain foods and drinks are cut out for several weeks, then added back one at a time, with repeat endoscopies to check whether each is tolerated. Some elimination diets are guided by allergy tests; others remove the foods that most often cause allergies — dairy, egg, wheat, soy, peanuts, tree nuts and fish or shellfish.
- Elemental diet: all protein is replaced with an amino acid formula, drunk or — for those who dislike the taste — given through a feeding tube. If symptoms and inflammation clear completely, foods may be reintroduced one by one.
The choice depends on factors including age, and research on how best to treat EoE continues. If treatment is not enough and the esophagus has narrowed, dilation — a procedure to stretch it — can make swallowing easier.
Sources
Based on "Eosinophilic Esophagitis," MedlinePlus, U.S. National Library of Medicine; a work of the United States government in the public domain.
Лицензия: CC0 1.0 (общественное достояние) · По материалам medlineplus.gov
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