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What is eosinophilic esophagitis?

Eosinophilic esophagitis is a recognized chronic allergic/immune condition. A person with eosinophilic esophagitis will have inflammation of the esophagus. In eosinophilic esophagitis, a large number of white blood cells called eosinophils are found in the tissue of the esophagus.

 


What Are The Symptoms Of Eosinophilic Esophagitis?

Eosinophilic esophagitis is considered a chronic condition and cannot be outgrown. Symptoms of eosinophilic esophagitis vary with age. Infants and toddlers may refuse their food or are not growing properly. Children often have recurring abdominal pain, trouble swallowing or vomiting. Teenagers and adults may have difficulty swallowing. The esophagus can narrow to the point that food gets stuck or has difficulty going down. Food getting stuck in the esophagus is called a food impaction and is a medical emergency.

 


How Is Eosinophilic Esophagitis Diagnosed?

Currently, the only way to diagnose eosinophilic esophagitis is with an endoscopy and biopsy of the esophagus. An endoscopy is a medical procedure that allows your physician to see what is happening in your esophagus. During a biopsy, tissue samples will be collected and analyzed. Other diseases can result in eosinophils in the esophagus, such as acid reflux or other inflammatory conditions. Sometimes additional steps may be needed to confirm that you have eosinophilic esophagitis.

 


How Is Eosinophilic Esophagitis Treated?

Treatments in eosinophilic esophagitis include diet-based treatments, medications, and sometimes endoscopic dilations.

  • Targeted elimination diet - If you are diagnosed with specific food allergies after prick skin and patch testing, your physician may remove specific foods from your diet. For some patients, this helps control their eosinophilic esophagitis.
  • Empiric elimination diets – Often time there are common triggers (allergens) in eosinophilic esophagitis. Eliminating major food allergens from the diet also another treatment of eosinophilic esophagitis. The foods excluded usually included dairy, eggs, wheat, soy, peanut, tree nuts and fish/shellfish. These diets have been shown to be helpful in treating eosinophilic esophagitis. Since these diets can be challenging to follow, a dietician/nutritionist is often helpful in guiding the diet changes. Foods can be added back one at a time with follow-up endoscopies to be sure that eosinophilic esophagitis remains in control.
  • Elemental Diets – All sources of protein are removed from the diet. The patient receives their nutrition from an amino acid formula as well as simple sugars and oils; all other food is removed from their diet. A feeding tube may be needed since most patients do not like the taste of this formula. This approach is usually for children with multiple food allergies who have not responded to other forms of treatment.
  • Medical Therapy – There are currently no medications approved by the FDA to treat eosinophilic esophagitis, however, medications have been showed to reduce the number of eosinophils in the esophagus and improve symptoms. Corticosteroids control inflammation and have been the most helpful in treating eosinophilic esophagitis. Swallowing small doses of corticosteroids is the most common treatment; different forms of swallowed corticosteroids are available. Other medications are being investigated for treatment and may play a role in the future.
  • Dilation – Inflammation over years in the esophagus may lead to narrowing. While diet and medications often times can improve the inflammation and the narrowing, occasionally patients may benefit from an endoscopic treatment called a dilation where the doctor stretches out the esophagus with either a balloon or a series of flexible rods.

We provide a comprehensive workup for suspected eosinophilic esophagitis and provide management for patients diagnosed with this condition.