14321 Eosinophilic Esophagitis

Overview

Eosinophilic esophagitis, often called EoE, is a long-term inflammation of the esophagus, the tube that carries food from your mouth to your stomach. In people with EoE, a type of white blood cell called an eosinophil builds up in the esophagus. These cells cause swelling and irritation, which can make it hard to swallow and may cause food to stick or get stuck.

EoE is not very common, but doctors are recognizing it more often. It may affect about 1 in 1,000 to 2,000 people in the general population.

EoE can affect anyone of any age, but it is most often found in people who have other allergic conditions like asthma, eczema, hay fever, or food allergies. It is more common in males, and it often appears in childhood, the teen years, or young adulthood.

Symptoms

Common symptoms

• Trouble swallowing, especially dry foods
• A feeling that food is stuck in the throat or chest
• Heartburn or chest pain that does not go away
• Food coming back up or vomiting
• Pain in the upper belly
• Loss of appetite or eating very slowly

Symptoms in children

• Feeding problems, such as refusing food or turning away from the bottle
• Vomiting or spitting up more often than usual
• Slow eating or chewing an unusually long time
• Poor weight gain or growth
• Stomach aches or being fussy around mealtimes

Symptoms in older adults

• Difficulty swallowing and food getting stuck are common symptoms
• Chest pain or heartburn that may be mistaken for acid reflux
• Pain when swallowing
• Unintended weight loss from avoiding food because swallowing is difficult

Causes

Main causes

• The exact cause of EoE is not fully known. It seems to happen when the immune system overreacts to something you eat or breathe in, such as foods, pollen, or dust mites.
• This overreaction causes eosinophils to travel to the esophagus and release substances that cause inflammation.
• Genes also play a part, since EoE can run in families.

Risk factors

• Having asthma, eczema, hay fever, or food allergies
• Being male
• Having a parent, child, or sibling with EoE
• Living in a colder climate, where certain airborne allergens are more common

When to see a doctor

See a doctor urgently if:

• You keep having trouble swallowing, and it is getting more frequent.
• You have had food stuck in your throat more than once.
• You are losing weight because you avoid eating.
• Your child is not growing well or is refusing to eat.

Book a routine appointment if:

• You have ongoing heartburn, chest discomfort, or belly pain that keeps coming back.
• You notice that certain foods consistently get stuck or cause discomfort.
• You want an evaluation for swallowing symptoms that have lasted a few weeks.

Diagnosis

To diagnose EoE, a doctor needs to look at the lining of the esophagus and take a small sample of tissue. A gastroenterologist usually does this through a test called an upper endoscopy. If the tissue sample shows a high number of eosinophils, the doctor may diagnose EoE.

Tests that may be done

• Upper endoscopy with biopsies, the most important test
• Blood tests to look for signs of allergy or other causes
• Sometimes allergy testing or a trial diet, with guidance from an allergist or dietitian
• Sometimes a barium swallow X-ray to look for narrowing of the food pipe

What to expect at your appointment

Before an endoscopy, you will be asked to stop eating for a few hours. You will receive medicine to make you drowsy and relaxed. The test usually takes about 15 to 30 minutes. Most people go home the same day. After the results come back, your doctor will explain what they found and talk with you about a treatment plan.

Treatment

Treatment for EoE focuses on three things: reducing inflammation in the esophagus, making swallowing easier, and preventing long-term damage. Your doctor may suggest a combination of medicine, dietary changes, and careful follow-up. No single treatment works for everyone.

Self-care at home

• Chew each bite of food very well before swallowing
• Take small bites and sips of fluid between bites
• Avoid eating while rushing or talking a lot
• Sit upright during and after meals
• Keep a diary of foods, drinks, and symptoms to share with your care team

Medical treatments

Doctors often prescribe medicines that reduce stomach acid or calm inflammation in the food pipe. Some are swallowed as a liquid so they coat the esophagus. In some cases, an elimination diet removes common trigger foods like milk, wheat, eggs, soy, or seafood, with the support of a dietitian. Your healthcare provider will decide the safest plan for you. Do not start, stop, or change any medicine without talking to your doctor.

When is surgery considered?

Surgery is not a routine treatment for EoE. If the esophagus becomes narrow and food keeps getting stuck, a doctor may perform a procedure called dilation. This is done during an endoscopy to help widen the food pipe. It can make swallowing easier, but it does not treat the inflammation itself.

Living with this condition

Living with EoE means learning what triggers your symptoms and what makes you feel better. Many people need to take medicine regularly and be mindful at mealtimes. It can help to work with a dietitian to find a safe, enjoyable diet, rather than cutting out many foods on your own.

Lifestyle tips

• Plan meals so you have enough time to eat slowly
• Keep water nearby and take small sips while eating
• Try to eat at regular times and avoid big meals late at night
• Manage stress, since it can make symptoms feel worse
• Stay in regular contact with your healthcare team and attend follow-up visits

Diet and exercise

There is no single EoE diet that works for everyone. Some people find that removing certain foods improves symptoms, but a strict elimination diet should only be done with a doctor and dietitian so you still get all the nutrients you need. Exercise is generally safe and healthy. If you have trouble swallowing, eating a little earlier before exercise and choosing softer or moist foods may help.

Mental health and emotional wellbeing

Living with a swallowing problem can feel frustrating, isolating, or embarrassing. It can be stressful to worry about eating in front of others. These feelings are normal. It may help to talk to a counselor, join a peer group, or be open with people you trust. If you are in crisis or have thoughts of hurting yourself, please reach out to a mental health crisis support line in your area or go to the nearest emergency department right away.

Prevention

Because doctors do not yet know exactly what causes EoE, there is no proven way to prevent it. Once you know what triggers your symptoms, avoiding those triggers may reduce flare-ups and protect your esophagus from damage.

Vaccines

There is no vaccine for eosinophilic esophagitis.

Screening programmes

There is no routine screening test for EoE in people without symptoms. If you have symptoms, your healthcare provider will decide which tests are appropriate.

Complications

If left untreated

• Inflammation can lead to narrowing of the esophagus, called strictures
• Food can become trapped in the esophagus and block swallowing
• Long-term inflammation can cause scarring or a food pipe that does not move food well
• Trouble eating can lead to poor nutrition or weight loss

Long-term outlook

With a clear diagnosis and a consistent treatment plan, most people with EoE can manage their symptoms and prevent serious damage. It may take time to find the right combination of treatment, but many people lead full, active lives. Your healthcare team is there to help you adjust your plan as your needs change.

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