Eosinophilic Esophagitis (EoE) is a chronic inflammatory condition affecting the esophagus, the muscular tube connecting your mouth to your stomach. EoE commonly causes dysphagia, or difficulty swallowing. Understanding the connection between EoE and dysphagia is a first step in managing this condition.
Understanding Eosinophilic Esophagitis
Eosinophilic Esophagitis is an immune system disease where a type of white blood cell, called an eosinophil, accumulates in the lining of the esophagus. Their presence in large numbers in the esophagus is abnormal, indicating an allergic reaction. This buildup triggers inflammation, which can injure the esophageal tissue.
The inflammation can lead to scarring, narrowing, and the formation of excessive fibrous tissue within the esophageal lining. This damage can impair the esophagus’s ability to contract properly, making it difficult for food and liquids to pass through.
The probable causes of EoE include allergic reactions to certain foods or environmental allergens like pollen, dust mites, and animal dander. Genetic factors can also play a role, as EoE sometimes runs in families, particularly those with a history of other allergic conditions such as asthma, eczema, or allergic rhinitis.
Recognizing Dysphagia and Other Symptoms
Dysphagia is a primary symptom of EoE and can manifest as a sensation of food sticking in the throat or chest. This feeling can range from mild discomfort to severe distress and may occur intermittently or with every swallow. People with dysphagia often adapt their eating habits, such as chewing food excessively, taking smaller bites, or drinking large amounts of fluid during meals to help food pass.
Other common symptoms of EoE include chest pain, which is often centrally located and may not respond to antacids, and heartburn-like sensations. Individuals might also experience abdominal pain, nausea, vomiting, or the regurgitation of undigested food. In severe instances, swallowed food can become completely stuck in the esophagus, a condition known as food impaction, which is considered a medical emergency requiring immediate attention. Symptoms can vary by age, with infants and toddlers often showing feeding difficulties, vomiting, or poor growth, while older children and adults more frequently experience swallowing issues and food impaction.
Diagnosing EOE
The diagnostic process for EoE involves evaluating symptoms and conducting medical tests. A healthcare provider will take a detailed medical history, inquiring about eating habits and any history of allergic conditions in the patient or their family. The definitive diagnosis relies on an upper endoscopy with biopsies.
During an upper endoscopy, a thin, flexible tube equipped with a light and camera is inserted through the mouth to visualize the esophagus. The doctor will look for visible signs of inflammation, such as irritated rings, vertical furrows, white spots, or narrowing of the esophageal lining. Even if the esophagus appears normal, biopsies are collected from multiple areas of the esophagus.
These tissue samples are then examined under a microscope for the presence of eosinophils; a count of 15 or more eosinophils per high-power field is indicative of EoE. It is also important to rule out other conditions that can cause eosinophils in the esophagus, such as gastroesophageal reflux disease (GERD), often by conducting a trial of proton pump inhibitors (PPIs).
Treatment Options for EOE
Treatment for EoE aims to reduce eosinophil-driven inflammation and alleviate symptoms. One common approach involves dietary elimination, where specific foods suspected of triggering allergic reactions are removed from the diet. The 6-food elimination diet is a widely used method, which involves strictly avoiding dairy, wheat, soy, eggs, peanuts/tree nuts, and seafood for a period of 4 to 6 weeks. If symptoms improve, foods are then reintroduced one by one to identify the specific triggers, with reactions often being delayed by hours or even days.
Medications are another primary treatment. Proton pump inhibitors (PPIs) are often prescribed first, as they can reduce acid in the stomach and, in some EoE patients, can also decrease eosinophilic inflammation in the esophagus. Swallowed topical steroids, such as fluticasone (delivered via a metered-dose inhaler and swallowed) or budesonide (often given as an oral viscous slurry), are also commonly used. These topical steroids work directly on the esophageal lining to reduce inflammation and are safer than systemic steroids due to fewer side effects.
For patients who develop esophageal strictures or narrowing due to chronic inflammation, endoscopic dilation may be performed. This procedure involves gently stretching the narrowed areas of the esophagus using a balloon or mechanical dilator to improve swallowing. Dilation provides immediate symptomatic relief of dysphagia but does not address the underlying inflammation, so it is often used in conjunction with dietary or medicinal therapies to prevent recurrence. While minor post-procedural chest pain is common, the risk of serious complications like esophageal perforation is low.
Living with EOE
Managing EoE in daily life involves dietary adjustments, careful eating habits, and ongoing medical follow-up. Taking small bites, chewing food thoroughly, and drinking plenty of fluids during meals can help facilitate swallowing and reduce the likelihood of food getting stuck. Some individuals find it helpful to avoid certain food textures, such as tough meats or doughy breads, that are more difficult to swallow.
Stress management techniques, such as deep breathing or meditation, can also be beneficial, as increased stress may worsen symptoms. Maintaining open communication with healthcare providers, family, and friends is helpful for managing dietary restrictions and navigating social situations involving food. Regular medical follow-up appointments are important to monitor the condition, assess treatment effectiveness, and adjust therapies as needed to maintain symptom control and prevent complications.