By Brenda Keller, APRN-CNP, Certified Nurse Practitioner
Gastroenterology Associates of Northwest Ohio
Eosinophilic esophagitis, or “EoE” for short, is a condition that affects the esophagus, the tube that carries food from the mouth to the stomach. In cases of EoE, the esophagus has cells called eosinophils.
Eosinophils are not normally found in the esophagus. They are cells associated with allergies. The exact cause of EoE is unknown but thought to be related to food allergies.
There is a strong association of EoE with allergic conditions such as food allergies, environmental allergies, asthma and atopic dermatitis (eczema). EoE occurs in adults and children. It sometimes runs in families.
Symptoms can vary, depending on a person’s age. In adults and teens, symptoms usually include trouble swallowing. This is the most common symptom. The patient has difficulty with solid foods and may feel like food gets “stuck” in the throat or chest.
Chest and abdominal pain can also occur as well as a “burning” sensation in the chest. In children, there may be problems with nausea and vomiting, abdominal pain or a reluctance to eat solid foods.
The test most often performed to diagnose EoE is an esophagogastroduodenoscopy (EGD). The test is an upper endoscopy performed by a gastroenterologist. With the test, a tube with a light and camera on the end are placed in the mouth and into the esophagus.
The lining of the esophagus is evaluated, and a small sample of tissue is removed so the cells can be viewed under a microscope by a pathologist to determine whether the patient has EoE. Esophageal biopsies from patients with EoE show an increased number of eosinophils.
Treatment for EoE usually involves changes in diet and medication. Your healthcare provider may suggest that you avoid foods that are commonly known to cause EoE.
The empiric elimination diet also called the “six-food elimination diet (SFED)” empirically eliminates foods that most commonly cause immediate hypersensitivity to a population, such as people in the United States. This diet eliminates foods that account for the majority of IgE-medicated food reactions (milk, egg, soy, wheat, peanuts/tree nuts and fish/shellfish).
After an elimination period that may vary from 6-12 weeks, each food is gradually re-introduced. If a patient becomes symptomatic with a food re-introduction, that food is removed from the diet again.
Medication management can also be used to treat EoE. Proton pump inhibitors (PPIs) are first-line treatment if dietary changes are unacceptable or fail. The patient is treated initially with an 8-week course of a PPI.
Topical glucocorticoids (“steroids”) can also be an effective treatment for EoE. Most adult patients are treated with swallowed budesonide and fluticasone. Fluticasone is administered using a metered-dose inhaler without a spacer. The medication is sprayed into the patient’s mouth and then swallowed.
The patient is advised that EoE is a chronic condition. Untreated, the patient may remain symptomatic or have episodic symptoms with a high likelihood of recurrence of symptoms after treatment is discontinued. The long-term prognosis of EoE is unclear, but EoE does not appear to shorten lifespan significantly.
The American Partnership for Eosinophilic Disorders and Campaign Urging Research for Eosinophilic Disease (CURED) are advocacy groups for patients with eosinophilic gastrointestinal diseases.
