What is eosinophilic esophagitis?
Eosinophilic esophagitis (EoE) is an inflammation of the
esophagus (the tube connecting the mouth to the stomach) caused by a specific
white blood cell – the eosinophil. Nearly three quarters of affected cases occur
in white males; and the number of people affected is about 1 in 10,000 (but
health officials think this number is underreported). This is a relatively newly
recognized disease that has been increasingly diagnosed in adults and children
over the past decade.
What are the symptoms of eosinophilic esophagitis?
Patients with eosinophilic esophagitis may experience symptoms
such as heartburn, regurgitation, chest pain and difficulty swallowing.
Adolescents and adults with eosinophilic esophagitis frequently complain of
intermittent swallowing problems; infants and young children may develop feeding
disorders leading to poor weight gain. In a small number of cases, eosinophilic
esophagitis leads to the development of an extremely narrowed esophagus and
occasionally food may get stuck in the esophagus and require emergency removal.
How is eosinophilic esophagitis diagnosed?
Currently, eosinophilic esophagitis is diagnosed by upper
endoscopy and biopsy. The endoscopy sometimes reveals rings, white plaques
(patches), or grooves in the esophagus. However, eosinophilic esophagitis may be
present even if the esophagus looks normal. That is why biopsy samples are
taken. Biopsy samples look for an overabundance of eosinophils in the esophageal
tissue. Sometimes multiple biopsies may need to be taken.
How is eosinophilic esophagitis treated?
There are two main treatment approaches to eosinophilic
esophagitis: steroid medications and dietary management.
Drug approaches. Steroids are the most commonly used
medication for both the control of the inflammation and the direct suppression
of the eosinophils. These medications can be taken orally (in pill form) or
topically. Steroids may need to be taken long term, though their long-term use
for eosinophilic esophagitis has not been well studied. What is known is that
for some patients, continued swallowed use of steroids can result in Candida
infections (yeast infections of the mouth and esophagus) as a side effect.
A drug class that is currently being investigated for future use is biologic agents.
These drugs would specifically target the white blood cell itself, the eosinophil.
Dietary management. There is also some thought that food
allergies may be a cause of eosinophilic esophagitis. However, which
foods might be the cause has yet to be determined. The more common foods
associated with foods allergies in general are milk, eggs, nuts, beef,
wheat, fish, shellfish, corn and soy. In the case of eosinophilic esophagitis, a
single food may be problematic in some people and many foods may be the cause in
others.