Understanding Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus that is caused by an allergic reaction to certain foods or aeroallergens. In this condition, there is an increased number of white blood cells called eosinophils that accumulate in the esophagus. While EoE was once considered a rare disease, it is now recognized as a major cause of esophageal disease worldwide. This article aims to provide a comprehensive overview of EoE including its causes, symptoms, diagnosis and treatment.

What causes EoE?

EoE is considered a type of food allergy where the immune system reacts abnormally to normally harmless foods. The exact causes of food sensitivities in EoE are still being studied, however several factors are believed to play a role:

Genetics: Studies have found that genetic variants in genes related to immunity are linked to higher risk of developing EoE. This suggests that genetics may influence a person’s predisposition to develop food allergies.

Barrier dysfunction: The esophageal lining acts as a barrier to protect the body from potential allergens in food. Defects in this barrier may allow food particles to come into direct contact with cells of the immune system, triggering an inappropriate allergic response.

Environmental triggers: Exposure to certain airborne allergens or aeroallergens like pollen, dust mites or mold can exacerbate eosinophilic inflammation in the esophagus in sensitized individuals.

Diet: EoE often involves a non-IgE mediated food allergy response to specific dietary proteins. Top food triggers include eggs, milk, wheat, soy and nuts. However, dietary causes can vary greatly between patients.

Symptoms of EoE

The most common symptoms of EoE include:

– Dysphagia: Difficulty or pain while swallowing due to narrowing of the esophagus. This is often experienced with both solid foods and liquids.

– Food impaction: Feeling of being stuck mid-swallow when swallowing certain foods. Typically feels like sticking or catching in the mid-chest or throat area.

– Heartburn: A burning sensation or pain in the lower chest area, often worse after eating.

– Chest pain: May mimic the pain of a heart attack, usually comes after swallowing.

– Vomiting: Of undigested food, often with difficulty swallowing.

– Weight loss: Due to avoiding foods difficult to swallow or from food impaction episodes.

Diagnosing EoE

Diagnosing EoE requires ruling out other conditions and confirming eosinophilic infiltration through diagnostic tests. The gold standard is an upper endoscopy with biopsies:

– During endoscopy, doctors examine for physical changes in the esophagus like rings, strictures or plaques.

– Biopsies taken from multiple sites are checked under a microscope for >15 eosinophils per high power field, confirming EoE.

– Additional tests like barium swallow x-rays may help identify structural abnormalities in severe cases.

– Blood tests, allergy tests or pH monitoring can exclude other conditions like GERD before diagnosing EoE.

Managing EoE through diet and medication

Currently there is no cure for EoE, but it can be effectively managed through a multidisciplinary approach involving diet therapy and medication:

Elimination diets: The goal is to identify and eliminate food triggers through various diet approaches overseen by a dietician or nutritionist. Common diets include the 6-food elimination diet.

Swallowed topical steroids: Topical steroids like fluticasone help reduce esophageal inflammation and are the most effective medications for EoE when taken daily as prescribed.

Other medications: In cases where steroids provide inadequate relief, additional options include acid suppressants, leukotriene receptor antagonists and biologics.

Dilatation: This endoscopic procedure helps widen a strictured esophagus through stretching. However, it does not cure or prevent EoE from recurring.

With proper management, patients can gain long-term control over their symptoms and prevent EoE from causing further scarring or strictures in the esophagus. Large supportive multicenter clinical trials are also underway to improve EoE treatments.

Living well with EoE

While EoE is a challenging condition to live with, many patients are able to get their symptoms under control and live symptom-free lives by following their long-term management plan. Some tips for coping include:

– Strictly adhering to the elimination diet as prescribed and tracking food introducections.

– Having an action plan in place for symptom flare-ups and working closely with doctors.

– Joining a patient support community for advice and encouragement.

– Eating smaller, frequent meals to lessen pressure on the esophagus.

– Making lifestyle modifications to reduce stress and allergens.

– Speaking to employers, friends or family about EoE to understand accommodations.

– Pursuing holistic remedies like acupuncture or behavioral therapy if desired.

With ongoing care, awareness of triggers and modifications, patients with EoE can minimize discomforts from the disease and thrive. Although incurable, it need not dominate their daily lives. Continuing research also promises improved therapies.

This article aimed to comprehensively cover eosinophilic esophagitis from causes and symptoms to diagnosis, management options and living well with the condition. With growing recognition, more individuals are empowered to seek timely care and partners like dietitians that enable them to stay healthy long-term. Further elucidating EoE holds promise to enhance treatment outcomes worldwide.

Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it