Eosinophilic oesophagitis

Overview

Eosinophilic oesophagitis (say: ee-oh-sin-oh-FILL-ik uh-sof-uh-JIE-tis) is a long-term condition where a type of white blood cell called eosinophils builds up in the oesophagus (the tube that carries food from your mouth to your stomach). This buildup causes swelling, which can make it hard to swallow and cause food to get stuck.

Eosinophilic oesophagitis is considered rare, but it is being diagnosed more often as doctors learn more about it. It affects about 1 in 1,000 to 1 in 2,000 people.

It can affect people of any age, but it is most often diagnosed in adults between 20 and 40 years old. It is more common in men than in women.

Symptoms

Common symptoms

• Trouble swallowing (dysphagia)
• Food getting stuck in the throat (food impaction)
• Heartburn that does not go away
• Chest pain (often in the centre of the chest)
• Regurgitation (food coming back up)

Symptoms in children

• Vomiting or spitting up often
• Fussiness or refusal to eat
• Slow weight gain or poor growth
• Abdominal pain
• Difficulty feeding in infants

Symptoms in older adults

• Similar symptoms to younger adults, but food getting stuck may happen more often
• Narrowing of the food pipe (stricture) that makes swallowing harder
• Less common: chest pain or heartburn

Causes

Main causes

• An allergic reaction to certain foods or things in the environment (like pollen)
• The immune system sends too many eosinophils to the oesophagus, causing inflammation
• Common food triggers include milk, eggs, wheat, soy, peanuts, and shellfish

Risk factors

• Having other allergic conditions such as asthma, eczema, or hay fever
• A family history of eosinophilic oesophagitis or other allergies
• Being male or having a personal history of food allergies

When to see a doctor

See a doctor urgently if:

• You have food stuck in your throat and cannot get it out, especially if you cannot swallow saliva
• You have severe chest pain or trouble breathing after eating

Book a routine appointment if:

• You have trouble swallowing that lasts for more than a few days
• You get heartburn often and medicines from the pharmacy do not help
• Your child is not growing well or is vomiting often

Diagnosis

A doctor, usually a gastroenterologist (a specialist in the digestive system), will take a detailed history and perform an endoscopy. During an endoscopy, a thin, flexible tube with a camera is passed through your mouth into your oesophagus to look for swelling, rings, or narrowing. Small tissue samples (biopsies) are taken to check for eosinophils.

Tests that may be done

• Upper endoscopy with biopsy (the main test)
• Sometimes allergy tests (skin prick tests or blood tests) to identify triggers
• Rarely, a barium swallow (X-ray after drinking a chalky liquid) if there is narrowing

What to expect at your appointment

The endoscopy is done under sedation, so you will not feel pain. It usually takes 15 to 30 minutes. You may have a mild sore throat afterwards. Your doctor will discuss the results with you and plan treatment based on what they find.

Treatment

Treatment aims to reduce inflammation, relieve symptoms, and prevent food from getting stuck. It often involves changes to your diet and sometimes medication. Treatment is usually long-term because the condition can come back.

Self-care at home

• Keep a food diary to identify foods that cause symptoms
• Eat soft foods, cut food into small pieces, and chew thoroughly
• Drink plenty of water while eating to help food go down
• Avoid lying down right after meals

Medical treatments

Doctors may prescribe swallowed steroid preparations (such as a liquid or spray) to reduce inflammation, or recommend acid-reducing medicines called proton pump inhibitors (PPIs). In some cases, they may use medications that calm the immune system. Treatment is personalised to your symptoms and triggers.

When is surgery considered?

Surgery is not typically used. However, if the oesophagus becomes very narrow (stricture), a doctor may perform a procedure called dilation during an endoscopy to gently stretch it open.

Living with this condition

Most people with eosinophilic oesophagitis can manage their condition well by avoiding their trigger foods and following their treatment plan. It is a long-term condition, but with proper care, you can eat comfortably and maintain a good quality of life.

Lifestyle tips

• Work with a dietitian to find a safe, balanced diet
• Read food labels carefully to avoid hidden allergens
• Eat slowly and in a relaxed setting
• Always carry emergency contact information if you are at risk of food impaction

Diet and exercise

There are no special exercise restrictions. A well-balanced diet is important. You may need to eliminate certain foods (like milk or wheat) for a while and then slowly reintroduce them under medical guidance. Regular exercise can help overall health.

Mental health and emotional wellbeing

Living with a chronic swallowing problem can cause anxiety, especially about eating out or choking. It is normal to feel frustrated or stressed. Talking to a counsellor or joining a support group can help.

Prevention

There is no known way to prevent eosinophilic oesophagitis because it is related to your immune system and allergies. However, avoiding your specific food triggers can prevent flare-ups and complications.

Vaccines

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Screening programmes

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Complications

If left untreated

• Narrowing of the food pipe (strictures), making swallowing harder
• Food getting stuck more often (food impaction), which may need emergency removal
• Rarely, a tear or hole in the food pipe (perforation) from severe swelling or food impaction

Long-term outlook

With the right treatment, most people with eosinophilic oesophagitis can control their symptoms and prevent long-term damage. It is a chronic condition, but many people lead normal, active lives. Close follow-up with your doctor is important to adjust treatment as needed.

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