Eosinophilic Esophagitis (EoE) is a chronic immune system disease. It is caused by an accumulation of eosinophils, a type of white blood cell, in the esophagus—the muscular tube connecting the mouth to the stomach. This buildup leads to inflammation and injury to the esophageal tissue. As an allergic condition, EoE can make eating uncomfortable and difficult. First identified in the 1990s, it is now diagnosed with increasing frequency.
Symptoms and Triggers
The signs of Eosinophilic Esophagitis present differently depending on a person’s age. In infants and toddlers, symptoms often revolve around feeding. These youngest patients may refuse to eat, experience vomiting, and show signs of poor weight gain or failure to thrive. As children get older, the symptoms may shift toward recurring abdominal pain, trouble swallowing, and continued issues with vomiting.
For teenagers and adults, the most common and defining symptom is difficulty swallowing, a condition known as dysphagia, particularly with solid foods. This can become severe enough to cause food to get stuck in the esophagus, a medical emergency called food impaction. Many adults also experience chest pain or heartburn that does not get better with standard antacid medications.
The inflammation in EoE is driven by triggers, which are most often specific foods. The most common culprits are dairy, wheat, egg, and soy, with nuts and fish or shellfish also being frequent triggers. While food is the primary trigger, environmental allergens can also contribute to the inflammation in some individuals. The condition can sometimes worsen for patients during seasons with high pollen counts.
The Diagnostic Journey
Confirming a diagnosis of Eosinophilic Esophagitis requires the expertise of a gastroenterologist and a specific series of steps. The primary diagnostic tool is an upper endoscopy, or EGD. During this procedure, a thin tube with a camera is passed through the mouth to allow the doctor to visually inspect the esophagus.
The physician looks for visual signs of inflammation, such as white spots, linear furrows, or concentric rings along the esophageal wall. While these visual cues are strong indicators, they are not sufficient for a diagnosis. The most important part of the procedure is collecting small tissue samples, known as biopsies, from different parts of the esophagus.
These tissue samples are sent to a pathologist for microscopic examination to count the number of eosinophils present. A diagnosis of EoE is confirmed only when a high concentration of these white blood cells is found. This final step distinguishes EoE from other conditions that might cause similar symptoms, such as gastroesophageal reflux disease (GERD).
Treatment Approaches
Managing EoE involves a multidisciplinary approach aimed at reducing inflammation in the esophagus. Treatment strategies are centered on diet, medication, or a combination of both. Dietary therapy involves eliminating the foods that trigger the allergic reaction. The most frequent method is the six-food elimination diet, where common allergens like dairy, wheat, egg, soy, nuts, and fish are removed and then gradually reintroduced to identify the problem food.
For more severe cases, an elemental diet may be used. This involves consuming a special amino acid-based formula in place of all food. Medications are also a primary treatment option.
Proton Pump Inhibitors (PPIs), which reduce stomach acid, can help decrease inflammation and symptoms for some patients. Topical steroids, such as fluticasone or budesonide, are often prescribed. These medications are swallowed to directly target the inflammation within the esophagus.
If chronic inflammation has led to significant narrowing of the esophagus, a procedure called dilation may be necessary. This mechanical stretching of the esophagus is performed during an endoscopy. By widening the narrowed sections, or strictures, dilation can provide relief from the difficulty of swallowing.
Associated Allergic Conditions
Eosinophilic Esophagitis is often part of a broader pattern of allergic hypersensitivity. Many people diagnosed with EoE also have a personal or family history of other atopic conditions. These include asthma, eczema (atopic dermatitis), environmental allergies like hay fever, and other food allergies. This cluster of related conditions is sometimes referred to as the atopic march.
The connection highlights that EoE is not just an isolated digestive problem but is linked to a systemic predisposition of the immune system to overreact. An individual with EoE is more likely to be atopic, meaning they have a genetic tendency to develop allergic diseases. This understanding helps place EoE in the larger context of a person’s overall health, recognizing it as one manifestation of a general allergic tendency.