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EOSINOPHILIC ESOPHAGITIS

Eosinophilic esophagitis (EE) is a relatively newly recognized disease that has been increasingly diagnosed in both adults and children since 2000.  It is characterized by a large number of white blood cells called eosinophils that cause inflammation in the esophagus (the tube that connects the mouth and stomach).

This inflammation prevents the esophagus from functioning normally and leads to symptoms. EE commonly occurs in people with other allergic diseases such as allergic rhinitis (hayfever), asthma and/or eczema.


Symptoms

Reflux that does not respond to usual therapy: 

  • Dysphagia (difficulty swallowing)
  • Food impactions (food gets stuck in esophagus)
  • Nausea and vomiting
  • Failure to thrive (poor growth, malnutrition or weight loss)
  • Abdominal or chest pain
  • Feeding refusal/intolerance or poor appetite
  • Difficulty sleeping

Diagnosis
The only way to definitively diagnose EE is through endoscopy with biopsies, usually done by a gastroenterologist.  The endoscopy is often performed after treatment with reflux medications have failed to relieve symptoms.  During the endoscopy, the gastroenterologist looks at the esophagus, stomach and duodenum (the first part of the small bowel) through an endoscope (small tube inserted through the mouth) and takes multiple biopsies (small tissue samples) which a pathologist reviews under the microscope.  A high number of eosinophils (>15 per high power field under the microsope) suggests a diagnosis of EE.
 
Once EE is confirmed, allergy testing is recommended as many patients with EE have underlying food and possibly environmental allergies that are contributing to the abnormal inflammation seen in the esophagus.  The most common type of allergy testing is skin prick testing, but patch testing to certain foods can be useful as well. In patch testing, a small amount of the foods is placed on the skin (usually the back) and covered with tape for 48-72 hours. At that point, the site is assessed for evidence of redness and inflammation indicating food allergy.

Treatment
At present the two main treatments recommended are dietary management and topical corticosteroids.
 
Dietary Therapy
 
Elimination Diets – All “positive” foods on allergy testing are removed from the diet.  Often this is the only treatment needed.
Six-food Elimination Diet – Patients eliminate the top 6 most allergenic foods (dairy, eggs, wheat, soy, peanuts/other nuts, fish/shellfish).
Elemental Diets – All sources of protein are eliminated from the diet except for an amino acid (building blocks of protein) formula.  These diets are mostly used in young children with EE.

Food Trials – This involves adding back one ingredient at a time to one’s diet to determine specific foods causing a reaction.  They begin after symptoms resolve and eosinophils have cleared. 
   
Medications - Medications most commonly include steroids to control inflammation and suppress eosinophils.  They can be taken orally (a form of prednisone) or topically (swallowed asthma inhaled steroid such as fluticasone or budesonide).

How We Can Help
The diagnosis and treatment of eosinophilic esophagitis requires a multidisciplinary team approach involving gastroenterologists, allergists, nutritionists.   As part of the nation’s largest allergy practice, Allergy Partners’ physicians provide the expertise needed to accurately diagnose underlying allergic triggers to EE. With this information, a personalized and comprehensive treatment plan aimed at alleviating symptoms of EE can be formulated.

More Information:
Check out these links to other resources:

American Partnership for Eosinophilic Disorders