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Eosinophilic Esophagitis – Beyond Heartburn
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Eosinophilic Esophagitis – Beyond Heartburn

A growing number of children and adults have Eosinophilic Esophagitis.  Commonly abbreviated as EoE, Eosinophilic Esophagitis is a chronic inflammatory process affecting the esophagus (the tube connecting the mouth to the stomach).  This inflammation is caused by a type of white blood cell, known as an eosinophil, that reacts in an allergic fashion to the lining of the esophagus.  These cells remain in the esophagus causing damage, despite acid blocking medications that are traditionally used to treat heartburn like symptoms.   This injury and inflammation within the esophagus can cause many symptoms.

WHAT ARE THE SYMPTOMS?

Symptoms of Eosinophilic Esophagitis may differ between individuals as well as various ages from infancy through adulthood.  Infants and children often may be irritable, refuse their food / have poor appetites, or have growth concerns. School age children may have intermittent stomach pain, swallowing difficulties, or vomiting.  Adolescents and adults most commonly have trouble swallowing, chest discomfort, pain with swallowing, or food getting stuck within the esophagus (commonly with consuming meats or breads) known as food impaction.

WHO DOES IT AFFECT?

Eosinophilic Esophagitis affects the entire age spectrum and is becoming increasingly recognized.  There does seem to be a higher incidence in the male population and can impact every ethnic background.  It is important to note — patients with EoE often have other allergic processes like hay fever, asthma, eczema, or food intolerances.  

HOW DO WE DIAGNOSE EOSINOPHILIC ESOPHAGITIS?

The most important first step in recognizing the symptoms of EoE is taking a careful history of the patient.

You should always consider GERD. Additionally, it presents in a similar fashion as EoE.   If despite treatment with acid reducing medications and symptoms persist, a Gastroenterologist will take a small camera and look into the esophagus to examine the lining visually while also obtaining tiny pieces of tissue to have reviewed under a microscope.  This procedure (abbreviated as an EGD) is painless but requires sedation.   The amount of inflammation and number of eosinophils present are then document by a Pathologist to help establish the diagnosis.  The normal number of eosinophils in the esophagus is zero, but more than 15 eosinophils in a high powered microscopic area is an important diagnostic criteria.

HOW DO WE TREAT EOSINOPHILIC ESOPHAGITIS?

There are several treatment options available and the decision on which is best is individualized in discussion with your Gastroenterologist.  

Additionally, most therapies center around a modification in one’s diet with elimination of one or more foods followed by a repeat look at the tissue with an EGD.    Determining which foods to avoid in an effort to treat EoE is often challenging.  Unfortunately, allergy testing alone is often unable to identify a potential causative food product.  People often avoid common allergy-causing foods. Additionally these include milk, egg, wheat, soy, peanut/tree nuts, and fish/shellfish.   

You can use medication instead of a dietary modification or as a complementary treatment.   Beyond acid suppressing medications, most commonly a steroid product prescribed that is swallowed with the intent to coat the inflamed esophagus tissue.  There are different forms of corticosteroids available.

In some situations, the inflammation within the esophagus causes the diameter of this tube to become narrowed.  These cases often require the tissue to stretch open known as an EGD with dilation.

Regardless of the therapy pursued, the goal of treatment is to heal the tissue. Additionally, it can alleviate any symptoms of concern.  

WHAT IS THE PROGNOSIS?  

People still study the natural history of Eosinophilic Esophagitis.  It is a chronic disease that requires long term follow-up.  

If you have symptoms that raise the concern for potential EoE – please contact your primary care provider or a Gastroenterologist with Digestive Health Associates of Texas.   It’s our honor to help!

Michael A. Russo, MD
Board Certified Pediatric
Physician Liaison for the Eosinophilic Family Coalition – DFW Chapter

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