Facts about Eosinophilic Esophagitis (EoE)

What is eosinophilic esophagitis? (EoE)?

EoE is a chronic (long-term) immune disease that affects the esophagus, the tube that connects the mouth to the stomach. EoE occurs when a type of white blood cell called eosinophils accumulates on the lining of these tubes. This buildup can cause chronic inflammation (swelling) in the esophagus, leading to EoE symptoms.

What Causes EoE?

The immune system of people with EoE floods the esophagus with white blood cells that reach the lining of the esophagus in response to triggers such as certain foods and environmental allergens. This abnormal response of the immune system is called type 2 inflammation.

Allergens such as pollen, mold, dust, and animal fur can cause EoE. However, the main cause of EoE is an immune response to food.

Foods that can cause EoE include:

• dairy products
• peanuts and nuts
• wheat
• Seafood/Shellfish
• egg
• soy sauce

Note: Not everyone with EoE reacts to the same foods, and testing cannot predict with certainty which foods may be triggers.

What are the symptoms of EoE?

EoE looks different at different ages. Babies and young children may not want to eat, vomit or vomit more often, have abdominal pain, have disturbed sleep, and may not grow properly.

In older children and adults, the main symptoms of EoE include:

• Having difficulty swallowing
• When food gets stuck in the throat after swallowing (impactuation)
• water brash
• chest pain
• colic
• Food comes back up after swallowing (reflux)

These symptoms may come and go, appear once in a while, or appear continuously. Even if you don’t have symptoms, you still have EoE because EoE is a chronic disease that lasts a lifetime.

Read: My family’s world was turned upside down when my son was diagnosed with EoE >>

Who is affected by EoE?

EoE can affect anyone at any age, but certain risk factors may make you more likely to develop the disease. EoE is more likely to occur if:

• food allergy
• Environmental allergies (pollen, dust, animal hair, etc.)
• asthma
• Hay fever (allergic rhinitis)
• Eczema or other skin conditions that cause itchy, inflamed patches
• Family history of EoE or other allergic disorders

How is EoE diagnosed?

EoE can be tricky to diagnose because the symptoms are similar to those caused by other health problems that affect the esophagus, such as gastroesophageal reflux disease (GERD) or food allergies.

If your health care provider (HCP) thinks you may have EoE, he or she will send you to a gastroenterologist (GI doctor), a doctor who diagnoses, treats, and manages digestive disorders. They will look at your symptoms and do some tests, including:

• Upper endoscopy and biopsy: A long, thin tube equipped with a light and a camera (endoscope) is used to view the lining of the esophagus and samples are taken to be viewed under a microscope. Endoscopy and biopsy are required to diagnose EoE.

• Blood tests: Blood tests are done to identify allergens that have a higher than usual eosinophil count or other signs of an allergic reaction. Blood tests alone cannot definitively diagnose EoE or food triggers.

• Esophageal sponge: Using a small sponge attached to a string, esophageal tissue can be collected without an endoscopy.

How do you handle EoE?

EoE is a chronic, life-long condition with no cure, but it is treatable. Gastroenterologists treat and manage EoE. An allergist may also be part of your treatment team. Although it cannot diagnose or treat EoE itself, it can help manage conditions that coexist with EoE, such as food allergies.

The treatment that is best for you will depend on your unique health condition. Some treatment options for EoE include:

• diet change Like cutting out certain foods that can cause EoE.

• proton pump inhibitors (PPIs); This is a medication that lowers the amount of acid produced in the stomach.

• steroid, This medicine helps reduce inflammation. EoE is treated using liquid steroids that are swallowed to come into direct contact with the lining of the esophagus to reduce swelling.

• Biological agents (monoclonal antibodies); A treatment that targets specific cells or proteins associated with inflammation to reduce inflammation and improve swallowing ability.

• esophageal dilatation, This is a procedure that uses an endoscope to widen the esophagus to make swallowing easier, but it does not treat the underlying inflammation. Extensions are typically used in conjunction with medication or dietary changes.

You should frequently reevaluate your treatment options with your health care provider because treatments may change over time as your reactions and/or lifestyle changes. Symptoms alone cannot determine whether a person will respond to treatment, so repeat endoscopy and biopsies are necessary to measure response to treatment and disease activity or progression. Together, you and your HCP can create a plan for the ongoing treatment of EoE.