Expert Answers: Questions and Answers about Eosinophilic Esophagitis (EoE)

What symptoms of EoE should cause me to see a doctor?

In adults and adolescents, the most common symptom is difficulty swallowing or food sticking. It is important to note that food slowly going down or getting stuck is actually abnormal. Many people who are ultimately diagnosed with EoE do not initially pay attention to these symptoms. You may also want to avoid certain foods or chew them more carefully until serious problems arise. Don’t wait for that to happen. You should be checked for problems swallowing or swallowing food. Other gastrointestinal (GI) symptoms, such as chest discomfort or heartburn, are also associated with EoE.

Other illnesses may cause food to slowly sink or stick. If these symptoms occur along with asthma, eczema, or food allergies, they are more likely to be a sign of EoE.

Children with EoE have completely different symptoms. They may have abdominal pain, vomiting, poor growth, inability to move to a different consistency, or avoidance of food. Many pediatric gastrointestinal diseases can cause these symptoms. However, it can also be a sign of EoE, especially if the child has eczema, asthma, or food allergies.

Why is it so important to get a diagnosis if you have EoE?

EoE is generally thought to begin with allergic inflammation. If left untreated over time, the inflammation may progress to scar tissue. The esophagus can then narrow and become stiff, causing more symptoms and complications, such as food impaction. If food gets stuck, it can lead to perforation or rupture of the esophagus, which is a very serious problem. Although it doesn’t happen often, this is the complication that worries us. Severely affected children may become malnourished.

It also affects quality of life. Anything that affects eating affects social events, family gatherings, work events and travel, and can cause significant anxiety. Symptoms, impact on quality of life, and potential complications are good reasons to get tested.

How is EoE diagnosed?

The diagnostic process boils down to endoscopy to view the esophagus. There is no blood test or other method to diagnose EoE.

Endoscopy is a procedure that uses sedation. The lighted camera goes into the mouth and travels down the esophagus and stomach. We look for classic signs of EOE. The esophagus may appear swollen. It may be coated with white spots that are inflamed. There may be scar tissue, such as a ring or stricture. The biopsy is sent to a pathologist who tests for allergic cells, which are eosinophils. If you have enough eosinophils and can eliminate other factors that may cause them, you can officially diagnose EoE.

Why is it important to receive ongoing treatment if you have EoE?

EoE is a chronic condition that must be managed over time. If diagnosed but not treated, many people ultimately develop more serious complications. It is important to have a team and be consistent in your care.

The condition has varying degrees of severity. The team tailors its approach to each individual’s situation. For example, someone who goes to the emergency room with an impaction is followed much more closely than someone with mild symptoms. Ongoing care varies from person to person, but it is very important to get it right to prevent recurrences and problems getting worse.

What type of health care provider should be part of your care team if you have EoE?

Some people will be followed primarily by a GI doctor. Some people primarily follow an allergist. Some people may follow both in a multidisciplinary approach. Children may need nutritional therapists and other interdisciplinary providers. We often work with nutritionists or nutritionists.

How do I manage EoE?

There are two main categories of treatment: elimination diet and medication.

We believe that EoE is a food-induced condition in most patients. Unlike a typical food allergy that causes an immediate reaction, this is a disease that causes inflammation when a specific food is consumed for a long period of time. Current allergy tests are a bit tricky as they are not really accurate for EoE. However, we do know the most common food triggers: dairy, wheat, eggs, soy, nuts, and seafood. Elimination diets can be used to identify food triggers and eliminate them from the diet. It’s a good option, but it really depends on the individual patient.

Antacids, such as omeprazole (Prilosec) or lanzoprazole (Prevacid), are often the first medications we try. About 30 to 40 percent of people may respond to these simple medications.

Then there are topical steroids. We now have budesonide oral suspension (Eohilia), an approved drug specifically designed to stick to the esophagus. It may be effective for 50-60% of people, if not more.

Another drug we use is dupilumab (Dupixent), a systemic treatment. It is a weekly injection that blocks some of the allergic triggers that cause EoE. It is usually reserved for people who have not responded to other treatments. dupilumab may also be used in people being treated for EoE, as well as asthma and eczema. Because dupilumab is approved for all of these.

Why is EoE management a lifelong process?

The majority of people can control EoE, but it is chronic. If people do not receive treatment, they tend to develop problems in the future. Not everyone will develop complications, but there is no reliable way to know who is at risk for complications and who is not. That’s why we want to provide everyone with individualized treatment and regular follow-up.

New treatments are also being developed. The field is moving quickly. If you see someone in the clinic today, they may offer different options than they did a few years ago. There are also many patient advocacy groups that can help with education and patient support.

If you experience these symptoms, don’t ignore them. This is becoming a much more common condition. Please check out.