Eosinophilic esophagitis (EoE) is a chronic immune/antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominated inflammation.
What is Eosinophilic Esophagitis?
Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus. It is characterized by the presence of high numbers of eosinophils in multiple biopsy samples from the esophagus of patients who present with symptoms of esophageal dysfunction. EoE causes inflammation and scarring in the esophagus, which restricts the passage of food.
Symptoms of Eosinophilic Esophagitis
The most common symptoms of EoE include dysphagia (difficulty swallowing), food impaction (feeling of something getting stuck in the throat or chest), heartburn, chest pain, abdominal pain, vomiting and feeding difficulties in children and infants. Several foods or food groups often worsen EoE symptoms and alter the inflammatory response in the esophagus. The common triggers are dairy products, eggs, nuts, soy, wheat and meats.
Causes of Eosinophilic Esophagitis
The exact cause of Eosinophilic Esophagitis is unknown, but it is considered a chronic immune/antigen-mediated disease. Genetics appears to play a role as people with a family history are at higher risk. Environmental factors like certain foods, allergens and acid reflux disease likely contribute to EoE development in genetically predisposed individuals. EoE results from an inappropriate immune response involving eosinophils to otherwise harmless antigens in the esophagus.
Diagnosis of Eosinophilic Esophagitis
EoE is diagnosed based on symptoms, medical history, endoscopy and biopsy of the esophagus. During endoscopy, the esophagus may appear normal or have visible features of inflammation and scarring. Targeted biopsies are taken and assessed under a microscope. EoE is defined by >15 eosinophils in one high power field of the esophagus. Other conditions need to be excluded through testing before confirming an EoE diagnosis.
Treatment of Eosinophilic Esophagitis
The main goals of EoE treatment are to reduce symptoms, promote healing of the esophagus and prevent long-term complications. Therapy focuses on eliminating food triggers, using medications to reduce esophageal inflammation and dilating the esophagus if strictures have formed.
Elimination diets: Identifying and avoiding the specific foods triggering symptoms through an elimination diet is often the first-line treatment. A 2-6 food elimination diet guided by an allergist is effective in many cases.
Medications: Topical corticosteroids like fluticasone or swallowed budesonide are commonly used to reduce esophageal inflammation. Other options include acid-suppressing medications and rare cases may need immune-modifying drugs.
Dilation: As EoE causes scarring and strictures, endoscopic dilation can help widening of the esophagus to improve swallowing in patients with food impactions despite medical treatment. Serial dilations may be needed.
Prognosis and complications of Eosinophilic Esophagitis
With proper long-term management, EoE prognosis is typically good in terms of symptom control and prevention of esophageal complications. Left untreated, it can lead to scarring, strictures and narrowing of the esophagus making swallowing difficult or painful over time. This raises risk of food getting lodged or in severe cases requiring feeding tubes. Risk of esophageal tearing or perforation during swallowing also increases in advanced stages when scarring is severe.
Eosinophilic Esophagitis in Children
EoE commonly presents in early childhood with feeding difficulties, poor appetite and failure to thrive. Treatment principles are similar to adults focusing on dietary changes, topical steroids and dilation if needed. Close monitoring is important as rapid growth phase in children can worsen esophageal damage if EoE remains active. Prompt diagnosis and treatment improves long-term outcomes preventing growth issues and food aversion behaviors.
Raising Awareness of Eosinophilic Esophagitis
As an emerging disease, awareness of EoE is growing among both medical providers and the general public. Early recognition and management prevents complications and improves quality of life for patients. National foundation like American Partnership for Eosinophilic Disorders (APFED) play a vital role in educating communities, advocating for research and connecting those affected by this chronic condition. With multidisciplinary care and appropriate lifelong therapy, people with EoE can stay symptom-free enabling normal daily activities and nutrition.
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