The esophagus is the tube that carries food and liquids from your mouth to your stomach. Eosinophilic esophagitis (EE or EOE) occurs when high levels of eosinophils, a type of blood cell, build up in the esophagus, causing inflammation. This condition can affect people of all ages and have varying symptoms. Treatment methods include certain diets and medication.
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What Is Eosinophilic Esophagitis?
Eosinophilic esophagitis (EE or EoE) is an immune system disease that occurs when white blood cells, called eosinophils, are found in the inner lining of the esophagus. The esophagus is the muscular tube that connects the mouth to the stomach.
This buildup of eosinophils causes inflammation and scarring of the esophagus. For people with EoE, managing the condition and identifying the specific allergens that trigger it are crucial for living with the disease.
Without proper care, EoE can damage the esophagus, stomach, and intestines.
What are other esophageal conditions?
Gastroesophageal reflux disease (GERD)
GERD, also known as reflux, occurs when some acidic contents from the stomach flow back up into the esophagus. This can cause heartburn, sour burps, chest pain, sore throat, and a cough. Treatment includes diet changes, lifestyle changes, and medication options.
Esophageal cancer
Esophageal cancer can begin in the mucosa, the inner layer of tissue lining the esophagus, or in the gland cells (adenocarcinoma). Esophageal cancer is rare, and treatment may include chemotherapy, radiation, surgery, and other oncology treatment methods.
Heartburn
Heartburn occurs when you feel a burning sensation in your chest or throat. This is usually the result of stomach acid flowing into your esophagus. Certain foods, beverages, and medications may trigger heartburn. It can be treated with over-the-counter medicine, prescription medications, and surgery.
How common is eosinophilic esophagitis?
Eosinophilic esophagitis is rare — affecting only about 34 people in every 100,000. With more awareness of the condition, its prevalence has increased recently.
What causes eosinophilic esophagitis?
EoE is caused by an allergy to a food or environmental factor. The immune system responds to the allergen with white blood cells that cause inflammation.
Eosinophilic esophagitis risk factors
You are more likely to develop eosinophilic esophagitis if you:
Complications of eosinophilic esophagitis
If you have EoE, you may also suffer from:
- Esophageal damage, including perforations or tears in the tissue of the esophagus.
- Narrowing of the esophagus walls, which makes it harder to swallow.
- Scarring of the esophagus.
What Are the Signs and Symptoms of Eosinophilic Esophagitis?
Common symptoms of EoE in infants and children include:
- Abdominal pain.
- Difficulty eating or feeding (infants).
- Difficulty swallowing.
- Food stuck in the throat after swallowing, also known as impaction.
- Poor growth or failure to thrive.
- Vomiting.
Symptoms of EoE in adults looks like:
- Centrally located chest pain that does not respond to antacids.
- Difficulty swallowing.
- Impaction.
- Regurgitating food.
When should I see a doctor about my eosinophilic esophagitis symptoms?
If you or your child are experiencing any of the above symptoms, schedule a call with your primary care doctor. A formal diagnosis is critical to treating the condition before it becomes worse.
How Do You Diagnose Eosinophilic Esophagitis?
First, your doctor will ask you questions about your current symptoms and health history. They may perform a physical exam to understand your symptoms better. You can expect them to run one or more diagnostic tests to rule out other esophageal conditions, such as GERD.
Tests to diagnose eosinophilic esophagitis
- A biopsy may also be ordered – Your doctor will take a small sample of tissue to examine under a microscope.
- Blood tests – Your doctor may order a series of blood tests to confirm an EoE diagnosis. These tests can determine allergens as well as eosinophil counts.
- Endoscopy – Doctors will insert a long tube with a light and camera on the end into your esophagus. They will inspect for inflammation, white spots, and strictures that may show signs of EoE or another esophageal condition. For some people with EoE, their esophagus looks healthy.
- Esophageal sponge – In this test, a capsule with a string attached is swallowed in your doctor’s office. Once the capsule dissolves, it releases a sponge that your doctor will pull out of your stomach with the string. This test can show the level of esophageal inflammation.
How Do You Treat Eosinophilic Esophagitis?
For most people, EoE is a chronic relapsing disease, which means they will need to manage the condition continually. There are many successful treatment options today that can help people live normal, healthy lives while managing their EoE.
Medications to treat eosinophilic esophagitis
Dietary changes to treat eosinophilic esophagitis
Your doctor may suggest an elimination diet to help identify the food or environmental allergen causing the condition. Common foods usually avoided during elimination diets include dairy, wheat, soy, and eggs. Depending on your medical history and symptoms, other foods may be eliminated as well.
Over time and one by one, foods are reintroduced to your diet. Endoscopies may be paired with the reintroduced foods, allowing your care team to monitor your esophageal health and determine the presence of a food allergy.
For children with multiple food allergies or sensitivities, an elemental diet may be necessary. While on this strict diet, the child will only be able to drink an amino acid formula. For some children, a feeding tube is needed. This method is reserved for severe cases in children.
Medication to treat eosinophilic esophagitis
Proton pump inhibitors (PPIs)
PPIs are medications that control the production of stomach acid and reduce EoE symptoms. Typically, the first medication prescribed for EoE, PPIs are moderately helpful in managing the condition. Many people require more treatment methods.
Other medications
- Your doctor may prescribe Dupixent (dupilumab), a weekly injected medication that reduces inflammation and improves swallowing.
- Corticosteroids are another type of medication designed to help control inflammation. To avoid steroid side effects, this medication is typically taken in small doses and decreased over time once symptoms are controlled.
