Eosinophilic Esophagitis- Immune Driven Esophageal Dysfunction

What is Eosinophilic Esophagitis?

The esophagus is the tube that carries food from the throat to the stomach. In some patients, difficulty swallowing can lead to incidents of food impaction in the throat due to a condition known as Eosinophilic Esophagitis. Eosinophilic Esophagitis (EoE) is a chronic, immune related esophageal disease characterized by esophageal dysfunction and inflammation related to food intake. Symptoms include stomach pain, nausea, vomiting, difficulty swallowing, and food impaction. In children, symptoms can also include difficulty feeding, poor weight gain, decreased appetite, and general failure to thrive. In the past, it was thought that these symptoms were merely a manifestation of gastroesophageal reflux disease (GERD), which occurs when stomach acid or bile flows into the esophagus and irritates the lining. In the mid 1990’s, the differentiation between the two diseases was made when patient’s tried acid suppression methods and anti-reflux surgery for GERD with no relief in symptoms. Now, between 1 and 5 out of 10,000 people in the US and Europe have been diagnosed with EoE.

Diagnosing Eosinophilic Esophagitis

EoE is diagnosed by endoscopy and biopsy of the esophagus. An endoscopy utilizes a small camera to look at the lining of the esophagus and stomach. White plaques and damage to the mucosa of the esophagus are visible with endoscopy. An increased number of eosinophils are also visible in the lining of the esophagus under microscopic analysis. Greater than 15 eosinophils under high power field are considered symptomatic of EoE. Eosinophils are disease-fighting white blood cells that help kill bacteria and microorganisms. They also help to control allergic reaction and disease. While they normally function to protect the body, in excess they can cause abnormal symptoms such as EoE.

Eosinophilic Esophagitis and Allergies

EoE often occurs in patients that have environmental and food hypersensitivity, asthma, or eczema. Traditional food allergies will occur in response to specific immunoglobulin E (IgE) antibodies that float in the blood stream. When a patient ingests a trigger food, the immune system overreacts to the allergen with production of the IgE antibodies, causing immediate itching, rash, or hives. While EoE can be linked to certain foods, it is predominantly a non-IgE mediated allergy, meaning that other parts of the immune system are responsible for the reaction. For this reason, skin and blood testing usually does not adequately identify a patient’s food triggers as well as their history.

Managing Eosinophilic Esophagitis

Treatment of EoE includes alleviation of symptoms, control of inflammation, and restoration of esophageal function. Together, gastroenterologists, allergists, and nutritionists come up with treatment plans tailored to a patient’s specific needs. Some treatment options are an elimination diet to certain triggering foods to address the underlying allergic mechanism of the disease, dilation of the esophagus to stretch narrow areas, and use of glucocorticoids to reduce inflammation of cells lining the esophagus. Symptoms of EoE, such as food impaction, are often underestimated. If food impaction ever occurs, patients should seek immediate medical attention. Patients will try techniques such as eating slowly, chewing carefully and cutting food into small pieces to avoid symptoms. EoE can interfere with your social life and cause a fear of eating in public as food impactions often occur while eating with distraction or conversation. There is now a greater awareness of this disease and more tailored treatment plans for patients.

Weihong Zheng, M.D.