Eosinophilic esophagitis (EoE) is a chronic immune-mediated condition affecting the esophagus, the muscular tube connecting the mouth to the stomach. This disease involves inflammation and damage to esophageal tissue. This article explores the nature of EoE, its potential complications, and how it is managed.
What is Eosinophilic Esophagitis
Eosinophilic esophagitis develops when eosinophils, a type of white blood cell, accumulate in the esophagus lining. While eosinophils are normal elsewhere in the digestive tract, their presence in the esophagus is unusual and indicates an allergic reaction. This buildup triggers inflammation and injures the esophageal tissue.
The immune system’s reaction to allergens, often certain foods or environmental triggers, leads to this inflammatory response. Common symptoms include difficulty swallowing, food getting stuck, and heartburn unresponsive to typical antacid medications. Other symptoms can involve chest pain, abdominal discomfort, nausea, and vomiting.
Understanding the Severity of EOE
Eosinophilic esophagitis is not considered a directly fatal or immediately life-threatening condition. It is a chronic disease requiring ongoing management. While it does not typically lead to death, its impact on a person’s quality of life can be significant.
If left unaddressed, persistent inflammation can lead to progressive damage within the esophagus. This damage can result in various complications that necessitate medical intervention. Therefore, EoE is a serious condition that requires attention and proper care to prevent severe outcomes.
Serious Health Risks
Untreated or poorly managed EoE can lead to several serious health complications due to continuous inflammation and tissue remodeling. One common risk is esophageal strictures, narrowings that make swallowing difficult. These result from scar tissue and excessive fibrous tissue.
Food impaction, where food gets firmly stuck, is a frequent and serious complication often requiring emergency medical attention. This can be alarming and painful, sometimes mimicking heart attack symptoms. If impacted food cannot pass or be removed, it can lead to esophageal perforation, a tear or hole in the lining.
Perforation can also occur during diagnostic or therapeutic procedures, such as endoscopy or dilation, especially when esophageal tissue is fragile due to severe inflammation.
Living Well with EOE
Managing eosinophilic esophagitis involves a comprehensive approach aimed at reducing inflammation, preventing complications, and improving swallowing function. Dietary modifications are a common and effective strategy, often involving elimination diets where common food allergens like dairy, wheat, eggs, soy, nuts, and seafood are removed. An elemental diet, which uses a special amino acid-based formula, may be used in more severe cases.
Medications also play a central role. Proton pump inhibitors (PPIs) are often a first-line treatment to reduce stomach acid, which can help alleviate symptoms and inflammation. Topical corticosteroids, such as swallowed fluticasone or budesonide, are commonly prescribed to directly reduce inflammation in the esophageal lining. In some cases, biologic medications like dupilumab, which target specific inflammatory pathways, may be used.
For individuals who develop esophageal narrowings, endoscopic dilation is a procedure that can help widen the esophagus and improve swallowing. This involves gently stretching the narrowed areas using specialized balloons or tubes. While dilation provides symptomatic relief, it does not address the underlying inflammation, so it is often combined with dietary changes or medication. Regular monitoring through follow-up endoscopies and biopsies is important to assess treatment effectiveness and adjust management plans as needed, ensuring long-term esophageal health and improved quality of life.