Eosinophilic Esophagitis

Definition: Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus (the tube that carries food from the mouth to the stomach) that is often resistant to acid suppression medications. It can cause variable symptoms.

Symptoms: Older children and adults with EoE often complain of trouble swallowing. EoE can cause food impaction or the sensation of food sticking in the throat. People frequently describe pain or discomfort when swallowing certain solid foods. Commonly, the pain is presumed to be heartburn, burning in the chest or abdomen, but it does not improve after taking antacids (Tums, Rolaids, Zantac, Pepcid, etc.). In younger children, EoE is suspected when feeding problems or poor growth are discovered. Kids sometimes present to the pediatrician with recurrent nausea/vomiting or belly pain.

Causes: Eosinophils (e-o-SIN-o-fils) are white blood cells that play a role in allergic reactions. EoE results from high concentrations of these cells in the esophagus, most likely in response to an allergy-causing agent (allergen) or acid reflux or both. In many cases, people who have EoE are allergic to one or more foods. The most common food triggers for EoE include milk, eggs, wheat, soy, peanuts, corn, potato, rice, oat, barley and meat (beef, chicken, and pork). People with EoE may have other nonfood allergies. Inhaled allergens, such as pollen, may be the cause in some cases.

Diagnosis: Patients with suspected EoE benefit from shared management by both allergists and gastroenterologists (stomach doctors). EoE is considered when patients present with symptoms such as those described above. The diagnosis is made by a gastroenterologist with the use of a scope (upper endoscopy) to look at the lining of the esophagus for typical features. Tissue samples can be taken and analyzed to determine if eosinophils (allergy cells) are present.

Treatment: EoE is often treated using a combination of medications and diet changes. After the diagnosis of EoE is confirmed, your allergist can perform skin testing to determine your food sensitivities and provide recommendations for food avoidance diets that may improve symptoms. The use of prescription medications (swallowed steroids) may also be effective in treating the symptoms and underlying pathology of EoE. Additionally, acid suppression medications may provide symptomatic relief for some patients and continue to be used as complementary therapy. Finally, case reports suggest that allergy shots may improve EoE symptoms in some patients and new biologic therapies are currently under study.

Dr. Lotz discusses EoE in the video below.