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Eosinophilic esophagitis is an allergic condition that results in inflammation of the esophagus.
The defining characteristic of this disease is the abnormal presence of eosinophils, a type of white blood cell, in the esophagus. This condition has been linked to other allergic conditions, such as asthma, eczema, and food allergies. Eosinophilic esophagitis is caused by a combination of environmental factors, such as exposure to particular foods or allergens spread through the air, and genetic influences. Both children and adults can have eosinophilic esophagitis; it is more common in male individuals. Eosinophilic esophagitis is generally not life threatening; however, patients can experience food getting stuck in the esophagus.
Symptoms of eosinophilic esophagitis include vomiting, food impaction, abdominal pain, and pain or difficulty swallowing. Children may not want to eat because of pain, may experience vomiting, and may have failure to thrive. Adults are more likely to develop painful swallowing and food impaction. Patients may notice spending more time chewing their food and taking a longer time to eat. These problems may be chronic or appear intermittently. The frequency of some symptoms varies with age. Inflammation associated with the condition can lead to structural changes in the esophagus, resulting in stricture (narrowing of the esophagus). A rare but serious symptom is esophageal perforation (tearing) due to intense vomiting.
Symptoms such as those described above raise suspicion for diagnosis of eosinophilic esophagitis, but many conditions can cause similar symptoms. Esophageal endoscopy (insertion of a tube with a light and camera into the esophagus) is a procedure in which tissue samples are taken from the esophagus to help diagnose eosinophilic esophagitis. Allergy testing is not adequate for diagnosis or for identifying aggravating foods.
Treatment focuses on reducing symptoms and the number of eosinophils in the esophagus. To determine the effectiveness of treatment, endoscopy may need to be done repeatedly to look inside the esophagus. A proton pump inhibitor is often the first treatment used to relieve the symptoms of eosinophilic esophagitis and gastric acid reflux. A physician may also recommend swallowing the same type of corticosteroids that are usually inhaled. In severe cases, a brief course of systemic corticosteroids may be prescribed. Treatment options are expected to increase as medications being researched become available. Many of these medicines target allergic and inflammatory pathways. These potential new therapies should be discussed with a physician. In cases of esophageal stricture, expansion of the esophagus with endoscopic dilation may be needed.
Eliminating certain foods from the diet can be an effective treatment for eosinophilic esophagitis. Some of these include cow’s milk, wheat, egg, soy, nuts, and seafood. There are many strategies for selecting foods for elimination, including gradually increasing the number of food types restricted from the diet over time. This strategy could be helpful in reducing excessive dietary limitations while improving patient adherence to less restrictive diets. Your physician can help you decide which strategy is best for you.
American Academy of Allergy, Asthma, & Immunologywww.aaaai.org/conditions-and-treatments/related-conditions/eosinophilic-esophagitis
Conflict of Interest Disclosures: None reported.
Source: Spergel J, Aceves SS. Allergic components of eosinophilic esophagitis. J Allergy Clin Immunol. 2018;142(1):1-8. doi: 10.1016/j.jaci.2018.05.001
Peiris CD, Tarbox JA. Eosinophilic Esophagitis. JAMA. 2019;321(14):1418. doi:10.1001/jama.2019.1992
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