Eosinophilic Esophagitis – What is it, Symptoms and Treatments

Eosinophilic Esophagitis – What it is, Symptoms and Drug Treatments. Also, Eosinophilic Esophagitis (eo-sin-o-FILL-ik uh-sof-uh-JIE-tis), a type of white blood cell (eosinophil) builds up in the lining of the tube that connects your mouth to your stomach (esophagus) . This buildup, which is a reaction to food, allergens, or acid reflux, can inflame or injure esophageal tissue. Damaged esophageal tissue can lead to difficulty swallowing or cause food to catch when you swallow. Eosinophilic Esophagitis is a chronic disease of the immune system .

It was only identified in the last two decades, but is now considered a major cause of digestive (gastrointestinal) system disease. Research is ongoing and will likely lead to revisions in its diagnosis and treatment.

Causes of Eosinophilic Esophagitis:  Previously, doctors thought that the symptoms of Eosinophilic Esophagitis were caused by gastroesophageal reflux disease (GERD), but now they recognize it as a distinct condition with very different causes. Eosinophilic Esophagitis is an allergic reaction where the lining of the esophagus reacts to allergens such as food or pollen.

Eosinophils are a normal type of white blood cells present in your digestive tract, but in Eosinophilic Esophagitis they multiply in your esophagus. Eosinophils produce a protein that causes inflammation, which can lead to scarring, narrowing, and the formation of excessive fibrous tissue in the lining of the esophagus. As a result, you may have difficulty swallowing (dysphagia) or have food getting stuck when you swallow (impactment), as well as other symptoms.

People with Eosinophilic Esophagitis may also have food allergies, environmental allergies, asthma, atopic dermatitis, or chronic respiratory disease. Doctors also think that some people are genetically more likely than other people to develop Eosinophilic Esophagitis .

There has been a significant increase in the number of people diagnosed with Eosinophilic Esophagitis in the last decade. At first, the researchers thought this was due to increased awareness among clinicians and greater availability of upper endoscopy. However, studies now suggest that the condition is becoming more and more common, alongside the rise in asthma and allergy.

Symptoms of Eosinophilic Esophagitis: Signs and symptoms of  Eosinophilic Esophagitis  include:

Adults: In adults the main signs and symptoms of Eosinophilic Esophagitis are:

• Difficulty swallowing (dysphagia)
• food impact
• Chest pain that is usually centrally located and unresponsive to antacids
• persistent heartburn
• upper abdominal pain
• regurgitation

Children: In children the main signs and symptoms of Eosinophilic Esophagitis are:

• feeding difficulty
• vomit
• Abdominal pain
• Difficulty swallowing (dysphagia)
• food impact
• Failure to thrive (poor growth, malnutrition, and weight loss)

When to See a Doctor:  Seek immediate medical attention if you have chest pain, especially if you have other signs and symptoms, such as shortness of breath or pain in your arm or jaw. These can be signs and symptoms of a heart attack. Make an appointment with your doctor if you have severe or frequent symptoms of Eosinophilic Esophagitis . If you take over-the-counter heartburn medications more than twice a week, see your doctor.

Eosinophilic Esophagitis Risk Factors:  Conditions that can increase your risk of Eosinophilic Esophagitis  include:

• Climate. Living in a cold or dry climate.
• Season. It may be more likely to be diagnosed between spring and fall, probably because levels of pollen and other allergens are higher and people are more likely to be outdoors.
• Sex. More common in males than females.
• Family history. If family members have Eosinophilic Esophagitis , you are more likely to be diagnosed.
• Allergies and asthma. If you have food or other allergies, or asthma, you are more likely to be diagnosed.
• Advanced age. Originally thought to be a childhood illness, but it is now known to be common in adults as well. However, the symptoms differ slightly.

Complications of Eosinophilic Esophagitis:  In some people, Eosinophilic Esophagitis can lead to the following:

• Scarring and narrowing of the esophagus. This makes it difficult to eat and more likely you will have food getting stuck.
• Damage to the esophagus. Due to inflammation of the esophagus , endoscopy can cause perforation or tears in the tissue of the esophageal lining. Sometimes the tearing occurs spontaneously.

Eosinophilic Esophagitis Tests and Diagnosis:  Your doctor will consider your symptoms and test results to diagnose Eosinophilic Esophagitis . This will include determining if you have:

• Gastroesophageal reflux disease (GERD), in which eosinophils are usually not present.

Proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE), in which eosinophils are present but symptoms improve with proton pump inhibitor (PPI) medication. Tests to diagnose Eosinophilic Esophagitis include:

• Upper endoscopy . Your doctor will use a long, narrow tube (endoscope) containing a small, lightweight camera and insert it through your mouth into your esophagus. He or she will inspect the lining of the esophagus for inflammation and swelling, horizontal rings, vertical grooves, narrowing (stenosis), and white patches. Some people with Eosinophilic Esophagitis will have an esophagus that looks normal.
• Biopsy. Your doctor will perform a biopsy of the esophagus, likely taking two to four cell samples from two sites.
  If doctors suspect Eosinophilic Esophagitis , you may be given some additional tests to confirm the diagnosis and start looking for the sources of your allergic reaction (allergens).
• Bloodtests. You may get a blood test to look for higher than normal eosinophil counts or total immunoglobulin E (IgE) levels, suggesting an allergy.
• Medication trials. You may be given anti-reflux medication, specifically proton pump inhibitors (PPIs), to see if your symptoms improve. After 8 weeks, you will have a repeat endoscopy to see how healing has progressed.
• Dietary treatment trials. Your doctor may have you on a food elimination diet. This will include taking esophageal biopsies to learn how the disease responds to these dietary changes.
• Food birth test. In this test, food is placed in a small container, which is then taped to the back, touching your skin. The doctor looks for inflammation at this location.

Eosinophilic Esophagitis Treatments: Eosinophilic  Esophagitis is considered a chronic recurrent disease, which means that most people will require ongoing treatment to control their symptoms. Treatment will involve one or more of the following:

Diet Therapy:  Depending on your response to food allergy tests, your doctor may recommend that you stop eating certain foods, such as dairy or wheat, to relieve your symptoms and reduce inflammation. A more limited diet is sometimes necessary. Your doctor may refer you to an allergist for specific recommendations.

Medication:  Your doctor will likely first prescribe an acid blocker, such as a PPI. This treatment is the easiest to use, but people’s symptoms do not improve. If you do not respond to PPI, your doctor will likely prescribe a topical steroid such as fluticasone or budesonide, which is taken by mouth to treat Eosinophilic Esophagitis .

This type of steroid is not absorbed into the bloodstream, so you will likely not experience the typical side effects often associated with steroids. If a topical steroid is not effective or you need immediate symptom relief, you may be prescribed prednisone. Steroids can decrease the buildup of eosinophils in your esophagus , reduce inflammation associated with an allergic reaction, and allow your esophagus to heal. Some people may need to take steroids on an ongoing basis.

Dilation:  If you have severe narrowing (restrictions) of the esophagus , your doctor may recommend dilation to make swallowing easier. Dilution can be used if steroids are not helpful. Because people with Eosinophilic Esophagitis may have bleeding or tearing of the esophagus, doctors are concerned about the safety of dilation, especially with perforation during the procedure. Studies have found that dilation is safe and can provide symptom relief for some people — although it can initially be painful. However, it does not improve the underlying inflammation.

Alternative Medicine: Alternative  medicine therapies have not been proven to treat Eosinophilic Esophagitis . Still, some complementary and alternative therapies can provide some relief from heartburn or reflux symptoms when combined with your doctor’s care. Talk to your doctor about what alternative treatments might be safe for you. Options can include:

• Herbal Remedies. Herbal remedies sometimes used for heartburn or reflux symptoms include licorice, slippery elm, chamomile , marshmallow, and others. Herbal remedies can have serious side effects and can interfere with medications. Ask your doctor about a safe dosage before starting any herbal remedy.
• Relaxation therapies. Techniques to calm stress and anxiety can reduce the signs and symptoms of heartburn or reflux. Ask your doctor about relaxation techniques, such as progressive muscle relaxation or guided imagery.
• Acupuncture. Acupuncture involves inserting fine needles into specific points on your body. Limited evidence suggests it may help people with regurgitation and heartburn, but important studies have not proven it to be of benefit. Ask your doctor if acupuncture is safe for you.