What is Eosinophilic Esophagitis?

Blues Perspectives

| 3 min read

Eosinophilic esophagitis is an allergic condition in the esophagus, causing inflammation, sores, damage, and pain and discomfort. It is an immune condition, responding to real or perceived immune threats in the esophagus, according to Johns Hopkins Medicine. It can be triggered by foods, allergens, or air conditions. It results in a thick lining of white blood cells along the esophagus which can lead to irritation and sometimes debilitating symptoms, according to the Mayo Clinic.
The condition was only recognized as recently as the 1990s, according to the Mayo Clinic, and diagnosis and treatment for the condition is not as routine as many other gastrointestinal conditions, leading to more common delays or errors in diagnosis, according to a 2021 study in Digestive and Liver Disease. It is rare, with no more than 1.2 out of 10,000 worldwide thought to have eosinophilic esophagitis as of 2023.

Symptoms of eosinophilic esophagitis

The most common symptoms can make eating and day-to-day life uncomfortable and difficult. Symptoms vary but often will include:
  • trouble eating or swallowing or dysphagia
  • chest pain
  • heartburn or acid reflux that may not respond to medications for other conditions such as GERD
  • gas or abdominal pain
  • vomiting
  • stunted growth or poor weight gain in children
Narrowing of the esophagus can cause impaction, or food getting stuck in the esophagus.
Some of these symptoms are common to other gastrointestinal conditions and eosinophilic esophagitis may be initially misdiagnosed as acid reflux or GERD.

How is eosinophilic esophagitis diagnosed?

There are several tests used to diagnose eosinophilic esophagitis. The most used include upper endoscopy with biopsies, blood tests, and esophageal sponge testing, according to the Mayo Clinic and the Cleveland Clinic.

Upper endoscopy and biopsies or tissue samples

An upper endoscopy allows a physician to view the esophagus with a camera placed down the esophagus. This can greatly aid in diagnosis by allowing the doctors to see and record symptoms such as:
  • inflammation and swelling
  • scar tissue, rings, or grooves
  • narrowing of the esophagus
  • white spots or discoloration
Upper endoscopy also allows an opportunity for tissue samples or biopsies of the esophagus to be taken for further testing if needed.
Noting the existence and severity of these symptoms can help your care team diagnose eosinophilic esophagitis, but more tests may be needed.

Esophageal sponge test

In this test, a pill attached to a string is swallowed that when dissolved, releases a sponge. According to the Mayo Clinic, as this sponge is pulled out through the esophagus, it provides samples of tissue and substances in the esophagus for testing to help determine if an eosinophilic esophagitis diagnosis is accurate.

Blood tests

These can include blood tests for allergies that can help to determine the triggers or causes for an immune response such as eosinophilic esophagitis.

Eosinophilic esophagitis treatments

Some common treatments for eosinophilic esophagitis include dietary modifications, medications like steroids, proton pump inhibitors, and monoclonal antibodies, and dilation of the esophagus for severe narrowing.
Dietary modifications may be needed to avoid trigger foods or hard-to-digest foods while symptoms are prevalent or severe, or longer. Common foods that trigger eosinophilic esophagitis include cow’s milk, eggs, soy, and wheat.
Steroids can help to calm the immune response caused by eosinophilic esophagitis. These are usually topical and prescribed as a drinkable liquid that coats the esophagus without entering into the bloodstream, according to the Mayo Clinic.
Injectable immune agents, biologics and antibodies are an increasingly common treatment for immune conditions, including eosinophilic esophagitis, for adults and children over the age of 12. Injectable medications for eosinophilic esophagitis target and disrupt the functions of specific proteins involved in the immune response associated with eosinophilic esophagitis and related symptoms.
Image credit: Getty Images

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