Eosinophilic oesophagitis (EoE) is a chronic inflammatory condition affecting the oesophagus, the muscular tube connecting the mouth to the stomach. It is considered an allergic condition where specific white blood cells accumulate in the oesophageal lining. This condition is becoming increasingly recognized and diagnosed, with estimates suggesting a prevalence of approximately 1 in 700 people in the United States. EoE requires ongoing management due to its chronic nature, and increased awareness is helping to address this digestive illness.
Understanding Eosinophilic Oesophagitis
Eosinophils are a type of white blood cell that plays a role in the body’s immune system, particularly in fighting certain infections and regulating immune responses. In a healthy individual, these cells are typically absent from the oesophageal tissue. In eosinophilic oesophagitis, eosinophils abnormally accumulate in large numbers within the oesophagus.
This excessive buildup of eosinophils triggers inflammation and can cause damage to the oesophageal tissue. The inflammation may lead to various structural changes, such as the development of rings, furrows, or narrowing (strictures) in the oesophagus. While eosinophils are normally present in other parts of the digestive tract, their presence in the oesophagus is a key indicator of the condition.
Recognizing the Signs and Symptoms
The symptoms of eosinophilic oesophagitis vary significantly depending on a person’s age. In infants and toddlers, common indicators include feeding difficulties, refusal to eat, poor weight gain, and vomiting. These young children may also experience reflux-like symptoms that do not improve with typical medications.
Older children often present with recurring abdominal pain, vomiting, and difficulty swallowing. Adolescents and adults frequently report dysphagia, the sensation of food getting stuck in the throat, and may experience food impaction. Food impaction is a medical emergency where food becomes firmly lodged in the oesophagus. Other symptoms in older individuals can include chest pain, which may be mistaken for heartburn, and regurgitation.
Understanding the Causes
Eosinophilic oesophagitis is an allergic inflammatory condition. The immune system reacts to certain substances, leading to the accumulation of eosinophils in the oesophagus. Food allergens are a common trigger, with milk, soy, egg, wheat, nuts, and seafood implicated.
Environmental allergens also contribute to EoE for some individuals. Pollen, dust mites, animal dander, and molds are examples of airborne allergens that can play a role. Many people with EoE also have other allergic conditions like asthma, allergic rhinitis, or eczema, suggesting a broader allergic predisposition. Genetic factors and dysregulation of the immune system also contribute to susceptibility to EoE, indicating a complex interplay of factors in its development.
Confirming the Diagnosis
Diagnosing eosinophilic oesophagitis involves a comprehensive evaluation, as its symptoms can overlap with other conditions like gastroesophageal reflux disease (GERD). A thorough medical history and assessment of symptoms are initial steps. The definitive diagnosis of EoE relies on an upper endoscopy with biopsies.
During an endoscopy, a flexible tube with a camera is passed into the oesophagus, allowing doctors to visually inspect the lining. They may observe characteristic signs such as rings, furrows, white exudates, or narrowing of the oesophagus. However, the oesophagus can appear normal in some cases of EoE, making biopsies essential for confirmation. Small tissue samples are taken from different parts of the oesophagus and examined under a microscope for the presence and count of eosinophils. A count of at least 15 eosinophils per high-power microscopic field is strongly suggestive of EoE.
Treatment and Management Strategies
Managing eosinophilic oesophagitis involves a combination of strategies tailored to the individual, focusing on reducing inflammation and alleviating symptoms. Medical therapies are a common approach. Proton pump inhibitors (PPIs), typically used to reduce stomach acid, can help decrease oesophageal inflammation and are often a first-line treatment.
Swallowed topical corticosteroids are another important medication class. These steroids coat the oesophagus, directly reducing eosinophils and promoting healing. Dupilumab is a biologic medication that has also been approved for EoE, working to reduce inflammation and improve swallowing.
Dietary management is a significant component of EoE treatment, given its allergic nature. Elimination diets, such as the 6-food elimination diet (which removes common allergens like milk, soy, egg, wheat, nuts, and seafood), are used to identify and remove trigger foods. An elemental diet, consisting of a hypoallergenic amino acid-based formula, may also be prescribed. These dietary changes are often guided by an allergist or dietitian.
Esophageal dilation is a mechanical intervention used when severe inflammation has caused the oesophagus to narrow. This procedure involves gently stretching the constricted areas of the oesophagus using an endoscope and specialized tools. Dilation helps to improve the passage of food and relieve symptoms of dysphagia and food impaction. EoE is a chronic condition that requires ongoing monitoring and management.