Expert Answers: Eosinophilic Esophagitis (EoE) Questions and Answers

What EoE symptoms should cause you to see a doctor?

In adults and adolescents, the most common symptom is difficulty swallowing or food sticking. It is important to note that it is not normal for food to slowly sink or get stuck. Many people diagnosed with EoE do not initially pay attention to the symptoms. They may simply avoid certain foods or chew them more carefully until a serious problem arises. Don’t wait for that to happen. If your food goes down very slowly or you have difficulty swallowing, you should get tested. Other gastrointestinal (GI) symptoms, such as chest discomfort or heartburn, are also associated with EoE.

Other illnesses can cause food to slowly go down or get stuck. 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. This may be abdominal pain, vomiting, poor growth, not switching to foods of a different consistency, or avoiding certain foods. Many pediatric gastrointestinal disorders 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?

We believe that EoE typically begins with allergic inflammation. If left untreated over time, inflammation can lead to scar tissue. The esophagus can then narrow and harden, causing more symptoms and complications, such as food impaction. Contact with food can cause perforation or rupture of the esophagus, which can be a very serious problem. It doesn’t happen often, but it should be considered. Children with severe forms of this disorder may become malnourished.

Quality of life is also affected. Anything that affects your diet affects social events, family gatherings, work events and travel, and can cause significant anxiety. Symptoms, impact on quality of life, and possible complications are good reasons to get tested.

How is EoE diagnosed?

The diagnostic procedure consists of an endoscopy to examine the esophagus. There is no blood test or other method to diagnose EoE.

Endoscopy is a procedure that uses sedation. A lighted camera is inserted through the mouth, down the esophagus, and into the stomach. We try to detect typical signs of EoE. The esophagus may appear inflamed. It may be covered with white spots, a sign of inflammation. There may be scar tissue that is annular or narrowed. The biopsy is sent to a pathologist who tests for allergic cells, or eosinophils. Once there are enough eosinophils and the possibility of other factors causing them has been ruled out, EoE can be officially diagnosed.

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

EoE is a chronic disease that requires long-term management. When people are diagnosed but do not receive treatment, many serious complications can develop over time. It is important to see a medical professional and receive timely treatment.

The severity of this disorder varies. Medical staff provides customized treatment according to each individual’s situation. For example, someone who goes to the emergency room with an impaction will need much more follow-up than someone with mild symptoms. Ongoing treatment varies from person to person, but it is very important to seek treatment to avoid recurrences and worsening problems.

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

Some people will receive follow-up services primarily from their GI doctor. Some people will primarily follow up with an allergist. Some people will be followed up by both types of doctors in a comprehensive manner. Children may need lactation therapists and other providers from a variety of specialties. We often work with nutritionists and nutritionists.

How is EoE controlled?

There are two main categories of treatment: food restrictions and medications.

We believe that EoE is a disorder triggered by specific foods in most patients. Unlike a typical food allergy, which causes an immediate reaction, this is a condition that causes inflammation when certain foods are consumed over a long period of time. Current allergy tests aren’t really accurate for EoE so it’s a bit difficult. But we know most of the most common food triggers: dairy, wheat, eggs, soy, nuts, and shellfish. Food restrictions can be used to identify food triggers and eliminate them from the diet. This is a good option, but it really varies from patient to patient.

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

Topical corticosteroids are also available. We now have budesonide (Eohilia) oral suspension, an approved drug specifically designed to attach to the esophagus. This may be effective for more than 50-60% of people.

Another option is the systemic drug dupilumab (Dupixent). It is a weekly injection that blocks some of the allergic factors that cause EoE. It is usually reserved for people who do not respond well to other treatments. Because dupilumab is approved for all of these conditions, it can be used for people being treated for asthma and eczema as well as EoE.

Why is EoE control a lifelong process?

Although the majority of people can control EoE, it is a chronic condition. If people don’t get treatment, problems tend to develop at some point. Not everyone will develop complications, but there is no reliable way to know who is at risk for complications and who is not. Therefore, it is desirable to provide personalized treatment and regular check-ups for everyone.

New treatments are also being developed. Science is advancing rapidly in this field. If you see someone in a clinic today, they may be able to suggest options that weren’t possible a few years ago. There are also several awareness groups that provide education and support to patients.

If you experience these symptoms, don’t ignore them. This is becoming a much more common disorder. Get yourself tested.