Eosinophilic esophagitis (EE or EoE) is an increasingly recognized disease that can develop in adults and children. It is characterized by an abundance of white blood cells called eosinophils in the esophagus (the tube that connects the mouth and stomach) that leads to inflammation and, over time, narrowing of the esophagus.
People who have other allergy conditions such allergic rhinitis (hay fever), asthma, or eczema are at greater risk of developing EE, and allergies can be an underlying cause of EE. The symptoms of this inflammation result from the esophagus’s inability to function regularly. If left untreated, inflammation can worsen and result in esophageal blockage, scarring, and constriction.
Reflux is a common symptom of eosinophilic esophagitis. If your reflux does not respond to standard therapy like medication, you may have EE. Common symptoms include:
- Dysphagia (difficulty swallowing)
- Food impactions (food gets stuck in the 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
An endoscopy performed by a trained gastroenterologist is the most reliable method for diagnosing EE. The gastroenterologist uses an endoscope, a tiny tube put through the mouth, to examine the esophagus, stomach, and part of the small bowel. Biopsies (tissue samples) are collected during this process to confirm diagnosis.
These tissue samples are examined under a microscope by a pathologist. An EE diagnosis is suggested by a high density of eosinophils. Once EE is identified, allergy testing is typically advised, since many people with this condition also have underlying food and/or environmental sensitivities that may be contributing to esophageal inflammation. Skin-prick tests and patch tests can help diagnose allergens that may be amplifying symptoms. These tests are examined for signs of redness and inflammation, which could indicate an allergy.
Four Steps to Relief
Planning Your First Visit
Schedule an appointment at your local office and fill out our pre-registration and medical history forms to help minimize any wait time when you arrive.
Your First Visit
Your initial visit will last between two and three hours and consist of an initial consultation, evaluation, and comprehensive exam. We’ll create a treatment plan tailored to your unique needs.
Diagnostics and Testing
We may complete one or more tests to better understand the cause of your symptoms. Common tests include skin testing, pulmonary testing, and blood testing.
Following the evaluation and testing, we’ll provide a comprehensive diagnosis and implement a personalized treatment plan that will deliver relief.
Dietary management, acid reducing medications and topical corticosteroids are among the treatment options for eosinophilic esophagitis. Newer medications, called biologics, are now an option as well. Your allergist may recommend additional lifestyle adjustments, such as:
- Elimination diets - Your allergist may recommend any food tests that come up as positive to be removed from your diet.
- Six-food elimination diets - Depending on the severity of the allergic reaction, your allergist may recommend eliminating the top six foods that cause allergic reactions: fish/shellfish, dairy, eggs, wheat, nuts, and soy.
- Elemental diets - These types of diets are typically recommended for young children with EE. These diets omit all protein sources from the diet in favor of a protein-building amino acid formula.
- Food trials - To identify which foods specifically cause reactions, food may be eliminated and added back into diets on a trial basis.
- Medications - Steroids are the most often used medications to decrease eosinophils and reduce inflammation. They can be applied topically or taken orally depending on symptoms. Newer biologics are now available as well.
The Allergy Partners Difference
At Allergy Partners, we use a multidisciplinary team to diagnose and treat eosinophilic esophagitis. Our board-certified allergists have the knowledge necessary to correctly identify the underlying allergic causes of EE and the appropriate treatments for relief.