Eosinophilic esophagitis (EoE) is a chronic disorder of the digestive system in which a large amount of a particular type of white blood cell called eosinophils are present in the esophagus. Eosinophils are an important part of the immune system and play a role in immune regulation and fighting certain diseases. However, eosinophils are not typically found in the esophagus.
A person with EoE will have inflammation of the esophagus. The buildup of eosinophils, which is a reaction to foods, allergens or acid reflux, can inflame or injure the esophageal tissue. Damaged esophageal tissue can lead to various digestive illnesses.
Symptoms
The symptoms of EoE will vary with age. Most adults with EoE will present with one or a combination of the following:
- Difficulty Swallowing
- Food gets lodged in throat after swallowing
- Heartburn like chest pain
- Regurgitation (backflow of undigested food)
- Upper belly pain
When to see a doctor for EoE Symptoms?
Typically patients will see a gastroenterologist when experiencing EoE symptoms or due to a referral from their primary care physician or the ER. The most common symptoms Dr. Malik sees are:
- Trouble swallowing
- Reflux
- Chest pains
- Asthma can be associated with EoE
The frequent occurrence of these symptoms is generally the best indicator that they need to be evaluated by a medical professional.
NOTE: You should seek immediate medical attention when experiencing chest pain.
Diagnosis
Your doctor will begin by having a conversation to thoroughly understand your symptoms and a physical examination. After the initial assessment is completed, it is common to order an upper endoscopy (EGD), which will allow your gastroenterologist to examine the esophagus and evaluate any tissue damage. The biopsy taken during the EGD will be used to count eosinophils present in esophagus and determine any tissue injury. Also, a barium swallow can be used to further evaluate the esophagus when a patient complains of dysphagia .
Treatment
If you are diagnosed with EoE, you will require ongoing treatment, since this is a relapsing condition. The goal of treatment is to eliminate the eosinophils from the esophagus and to reduce symptoms. Treatment will involve one or more of the following:
6 Food Elimination Diet
Trigger foods must be determined and removed from one’s diet in order for symptoms to dissipate. Dr. Malik likes to use the 6 Food Elimination diet with his patients, which allows them to still eat solid food and avoid extensive allergy tests.
The diet works by removing the top 6 food allergens: milk, soy, eggs, wheat, peanuts/tree nuts, and seafood. A study showed a 74% success rate when using the 6 Food Elimination diet for EoE symptom management. If this diet is unsuccessful, other allergen trigger foods will be considered for removal.
Medications
Medications can be used to reduce the number of eosinophils in the esophagus and improve symptoms.
- Topical Steroids - The medication coats the lining of the esophagus, with very little if any getting absorbed and circulated to the rest of the body. Topical steroids can help decrease the number of white blood cells in the esophagus.
- Proton Pump Inhibitors (PPI) – Used for patients with acid reflux to control the amount of acid in the esophagus.
- Dupilumab - this is an interleukin-4 receptor alpha antagonist. It is an injectable medication typically self injected with a prefilled pen once a week. Dr Malik can help you decide if this is the right medication for you
Dilation
If you experience severe narrowing of your esophagus (called strictures), your doctor may recommend dilation to help make swallowing easier. Dilation is performed with an endoscope using balloons or tapered tubes. The widening allows food to pass more easily through the esophagus.