Eosinophilic Esophagitis

 

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Eosinophilic Esophagitis

October 15, 2014

 

What is Eosinophilic Esophagitis?

Eosinophilic Esophagitis (abbreviated EOE) is a chronic condition in which a person has significant inflammation of the esophagus (swallowing tube). This type of inflammation is different from others in that it is associated with mostly eosinophils in the esophagus.

 

What are Eosinophils?

Eosinophils are a type of white blood cell.  They can be involved in the immune response to “regular” bacterial infections, infection with parasites are the types of infections that cause the most vigorous reaction of eosinophils. Eosinophils are also elevated when a person has allergies.

 

What causes EOE?

The cause of EOE has not been completely worked out. However, it does appear to be a combination of genetics and environment. Persons who have a genetic susceptibility to EOE will develop the disease in response to allergic triggers.

 

What are these allergic triggers for EOE?

Though food allergies are associated with EOE, there is some evidence that even pollen allergies may play a role in EOE.

 

What kinds of symptoms do people with EOE have?

Symptoms of EOE typically vary with age. Whereas an infant or child may refuse certain types of food or have vomiting and feeding problems, adults may present with difficulty swallowing, heartburn or food “getting stuck” in the esophagus.

 

I have some of those symptoms, how can I be sure that I actually have EOE?

Having some of the above symptoms may represent EOE. However, one must proceed with caution. EOE is relatively rare compared with other more common illnesses that have the same symptoms such as reflux (commonly known as GERD), or other types of food sensitivities.

 

How can I find out if I really have EOE?

Your doctor can determine by thorough history and careful physical exam if your symptoms indicate that you have a high likelihood of having EOE. If this is the case, he or she may recommend that you have further testing to confirm the diagnosis.

 

What are these tests that are used to confirm the diagnosis of EOE?

Endoscopy with esophageal biopsy will determine if you have eosinophils in your esophagus. Once that diagnosis has been made, you will need to have allergy skin tests to determine your exact allergic sensitivities.

 

What kind of treatment is available for EOE?

Though EOE has likely existed for a very long time, the medical community has learned quite a bit more about it since 2005. Since our better understanding of the disease has only been for a relatively short amount of time, there are limited treatment options at this time. Medications are those which deliver appropriate anti-inflammatories to the lower esophagus. The other main treatment option involves avoidance of allergic triggers. There are some newer therapies involving monoclonal antibodies that have shown some promise in treating EOE but these are still in the investigational period.

 

What types of doctors treat EOE?

Of course, you should always talk to your primary care physician about any problems you are having first. If it seems that you are more likely to have EOE, your primary care physician may refer you to a gastroenterologist and an allergist for further evaluation and testing. Often the gastroenterologist and allergist will work as a team in treating the patient with EOE.

 What happens if EOE doesn’t get treated?

Without appropriate treatment, EOE can cause the esophagus to become further damaged and patients may also develop esophageal stricture (a narrowing of the esophagus that causes problems with swallowing). In children, the symptoms can also cause severe feeding problems that will lead to growth problems and failure to thrive.

 

Where can I get more information?

Though there is much information on the internet that is false and misleading, there are many sources that are trustworthy and helpful for patients with EOE. Check out the following websites:

 

http://www.mayoclinic.org/eosinophilic-esophagitis/

http://www.aaaai.org/patients/gallery/foodallergy.asp?item=1d

http://www.chop.edu/service/allergy/allergy-and-asthma-information/eosinophilic-esophagitis.html

 

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