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Eosinophilic Esophagitis

Disease Summary:

Eosinophilic esophagitis ( EoE) has been referred to as allergic esophagitis.  Eosinophils are a type of white blood cell typically associated with allergies.  This disease occurs when these eosinophils are deposited in the lining of the esophagus.  This leads to inflammation and can result in stiffening or narrowing of the esophagus, which can cause an individual to have trouble swallowing.  This can occur in children and adults.  It is more common in males.  Reflux of stomach acid into the esophagus can also cause eosinophils in the lining of the esophagus.  However in EoE, eosinophils remain in the lining of the esophagus after the acid reflux has been treated with medication.


The most common symptoms in adults are difficulty swallowing solid foods and presenting with a food impaction, where food is lodged in the esophagus and does not pass into the stomach.  When a food impaction occurs, an upper endoscopy is often needed to treat this problem.  Most adults with EoE are between the ages of 20 and 40, but it can occur in older individuals.  A history of allergic conditions such as allergic rhinitis, asthma, eczema, or food allergy are common in adults with EoE.  The cause of EoE in adults has not been clearly identified.


The only way to diagnose EoE is by performing an upper endoscopy and taking tiny pieces of tissue (biopsy) from the lining of the esophagus.  This tissue sample is examined under a microscope by a pathologist to look for changes of eosinophilic esophagitis, including the number of eosinophils.  There may be findings at endoscopy including narrowing or a stricture that can be seen with EoE.  The esophagus may also appear normal.  There is an overlap between EoE and gastroesophageal reflux with both diseases causing eosinophil deposition in the lining of the esophagus.  Therefore, more than one upper endoscopy may be required to confirm the presence of eosinophils while on acid suppression medication.


Most individuals are initially treated with acid blocking medications to rule out gastroesophageal reflux.  If eosinophils persists on biopsy, then oral steroid formulations are given to coat the lining of the esophagus that may improve symptoms. This tends to be well tolerated.  Dietary treatment may also be tried and consists of a six-food elimination diet usually for six weeks.  After six weeks, foods are reintroduced one at a time to identify the trigger food.  The six-food elimination diet contains no milk, soy, egg, wheat, nuts, or seafood.

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