What causes EoE?
The exact cause of EoE is not fully understood, but it is closely related to allergic reactions and many people with it have other allergic type problems. It may be triggered by particular foods including dairy, eggs, wheat, soy, nuts, and seafood. In some cases, airborne allergens like pollen can also play a role.
Eosinophils are commonly found throughout the gastrointestinal tract due to its constant exposure to foods, environmental allergens, toxins, and pathogens. However, the oesophagus in healthy individuals is an exception, as it typically does not contain eosinophils. In cases of EoE, eosinophils abnormally infiltrate the oesophagus, leading to tissue damage and ongoing inflammation. EoE is defined by the presence of 15 or more eosinophils per high power field during microscopic laboratory examination in one or more oesophageal biopsy samples, together with the absence of pathological gastroesophageal reflux disease (GERD). This absence is confirmed either by normal pH monitoring results or a lack of response to effective acid-suppression therapy.
Symptoms to watch for
Symptoms of EoE vary greatly between people and can be quite non-specific.
Symptoms might include any of the following:
- Difficulty swallowing (dysphagia)
- Food getting stuck in the oesophagus after swallowing
- Chest pain that is not heart-related
- Persistent heartburn
- Upper abdominal pain
- A sensation of food coming back up into the mouth (regurgitation)
- Coughing and choking when eating
Diagnosis
Diagnosing EoE involves the following steps:
- A discussion of symptoms and medical history.
- If EoE is suspected, our gastroenterologist may recommend performing an endoscopy. During the endoscopy, small samples of tissue (biopsies) are taken to be examined for eosinophils.
Treatment options
Treatment for EoE aims to reduce the number of eosinophils in the oesophagus which usually leads to resolution of symptom.
The approach can vary based on the severity of the condition and the patient’s response to initial treatments.
Common strategies include one or more of the following:
- Dietary management, which involves eliminating foods that trigger symptoms.
- Medications such as proton pump inhibitors (PPIs) to reduce acid production
- Topical steroids to decrease inflammation.
- In some cases, an oesophageal dilation might be performed by a specialist to widen the oesophagus if it has become too narrow.
Managing EoE long-term
For some people, living with EoE means regular monitoring and adapting treatment as necessary. Others find that after an initial course of treatment, they remain well and do not need regular appointments with a doctor.
Conclusion
Eosinophilic esophagitis is a manageable condition with the right treatment and dietary strategies.
If you suspect you or a loved one might have EoE, it is important to consult with a healthcare provider for proper evaluation and to discuss the best management plan tailored to your needs.
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