Proven information about eosinophilic esophagitis (EoE)

What is eosinophilic esophagitis (EoE)?

EoE is a chronic (long-term) immune disorder 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 in the mucosa of this duct. This buildup causes chronic inflammation (swelling) of the esophagus, which can lead to EoE symptoms.

What Causes EoE?

The immune system of people with EoE floods the esophagus with white blood cells in response to triggers, such as certain foods and environmental allergens that contact the lining of the esophagus. 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, immune reactions to food are the main cause of EoE.

Foods that can cause EoE include:

• dairy products
• Peanuts and dried fruits
• wheat
• fish and seafood
• egg
• bean

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

What are the symptoms of EoE?

EoE varies depending on age. Infants may not want to eat, may vomit or vomit more often, may develop abdominal pain, may have trouble sleeping, and may not develop properly.

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

• difficulty swallowing
• Food stuck in throat after swallowing (impactuation)
• acidity
• chest pain
• colic
• Food rising to the stomach after swallowing (reflux)

These symptoms may occur intermittently, occasionally, or continuously. Even if you don’t have symptoms, you may develop EoE because EoE is a chronic disease that lasts a lifetime.

Mr. Lee: Our family’s world was turned upside down when our son was diagnosed with EoE >>

Who is affected by EoE?

EoE can affect people of all ages, but certain risk factors may make you more likely to develop the disorder. You are more likely to receive an EoE if:

• food allergy
• Environmental allergies (pollen, dust, animal hair, etc.)
• Asma
• Rhinitis (seasonal 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 difficult to diagnose because its symptoms are similar to other medical 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 refer you to a gastroenterologist (GI doctor), a doctor who diagnoses, treats, and manages digestive disorders. Your doctor will evaluate 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 look for allergens, abnormally high amounts of eosinophils, and other signs of an allergic reaction. Keep in mind that individual blood tests cannot definitively diagnose EoE or identify dietary triggers.

• Esophageal sponge: A small sponge attached to a thread is used to take a sample from the esophagus without performing an endoscopy.

How is EoE handled?

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

The treatment that is best for you will depend on your specific medical situation. Some treatment options for EoE include:

• dietary changes For example, reducing consumption of certain foods that can cause EoE.

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

• corticosteroids, It is a useful drug for reducing inflammation. EoE is treated using liquid corticosteroids that are swallowed to bring them into direct contact with the lining of the esophagus to reduce inflammation.

• Biopharmaceuticals (monoclonal antibodies), A treatment that specifically targets specific cells or proteins associated with inflammation to reduce inflammation and make swallowing easier.

• 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. Dilatation is usually 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 or lifestyle changes. Symptoms alone do not determine whether treatment is effective, so repeat endoscopy and biopsies will be needed to evaluate treatment and the activity or progression of the disease. Together, you and your health care provider can determine a plan for treating EoE on an ongoing basis.